Had a blood test done in Feb 20 for unexplained breathlessness/weakness after a bad cold. The results were (doctors ref. ranges in brackets) -
Serum TSH - 5.77 mU/L (.35-5.50)
Serum free T4 - 7.6 pmol/L (7-17)
B12 - 699 ng/L (150-900)
iron ferritin - 231 ug/L (15-300)
folate - >24.9 ug/L (>3.00)
Total Cholesterol 10.4 mmol/L
LDL 7.2
HDL 2.5
Triglycerides 1.6
The doctor said my TSH was a little high, but was more concerned about my high cholesterol, with seemingly no reason for it (don't smoke/drink, recently lost 3 stone - not obese, exercise well, no family history) and wanted me to take statins (I'm not touching them with a barge pole!). She then suggested another blood panel in a couple of months.
I went home intending to look up thyroid, and also cholesterol. One of the first things I came across on an NHS page was that low thyroid causes high cholesterol, which she didn't seem to be aware of at all.
The follow up blood test was cancelled because of covid, so I did a home thyroid panel through Blue Horizon end of April, results of which were -
TSH - 5.61 mIU/L (0.27 - 4.20)
T4 Total - 55.2 nmol/L (66 - 181)
Free T4 - 10.8 pmol/L (12.0 - 22.0)
Free T3 - 4.04 pmol/L (3.1 - 6.8)
Anti-Thyroidperoxidase abs - <9.0 kIU/L (<34)
Anti-Thyroglobulin Abs - 11 kIU/L (<115)
Cortisol (Random) 586.0 nmol/L - taken 11.30am - same time as previous test (6-10am 113-456; 4-8pm 58 - 278; Midnight <64)
"The ferritin level is high, this can be a sign of inflammation or infection but is less likely with a normal CRP (as it is here). Serum cortisol is on high side. It rises in response to stress (have suffered a lot of stress in last 10 years), but it can also rise in those taking steroids (I take symbicort?).
TSH is elevated and free T4 level is low. A normalish free T3 level if you are not taking thyroxine is likely to represent a new diagnosis of hypothyroidism".
My own doctor's ranges are obviously out of sync with these, which may create a problem. I may also have adrenal problems with the high cortisol? I am not sure about going down the artificial T4 route, as there seem to be problems with it? I would like opinions on things like iodine/selenium; ashwaghanda; diet etc. if I am subclinical?
I apologise profusely for the very long post/question, but wanted to give as much info as possible at once. I hope it is not too long?
Thanks in anticipation.
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juliekat
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lots to say here. I ll start with the easy stuff and someone else will be along to comment on other stuff.
The way to read results from different labs with different ranges is to look at the % of the result against the range of that lab. (i'll assume both tests were done under similar circs , early in day? empty stomach?)
The Dr test FreeT4 is only 6% through the range, which is very low.
A test of free T3 would tell you more.
We dont need to calculate % of TSH to see that its over range.
The private test shows
FT4 is 12% through range (is a bit higher, but still dreadful)
FT3 is 25.4%. (also dreadful)
Again TSH is over range.
i expect you feel pretty rough with those results.
Are you under 65?
section 1.5.4 of the NICE guidelines state you should be offered a trial of Levothyroxine
Re - I'm new here - advice on possible hypothyroid blood tests
General - As I said a few days ago thank you all very much for your input/advice.
Apologies for taking a while to respond, I have had a tough couple of days health wise. Very exhausted, hardly able to get out of bed, and a bit breathless (not asthma just feel like I have run a marathon).
I also posted this reply in the wrong place I think (never posted anything before!) so I am replying again.
Responses to your posts below and also further general info. I hope you haven't all forgotten me and I get no answers!
Wetsuiter -
Yes I do feel pretty rough. I have various symptoms* that are effecting my life quite badly and probably have been for maybe 5-10 years I am thinking now.
Because I am post menopausal (60) I at first (which is apparently a common error) thought it might be hormonal (yes I know thyroid is also hormonal!), and after seeing a private menopause specialist (doctor being hopeless as usual) had been trialling bioidentical hormones.
But after the 3 month period nothing has really changed, so I thought that the other possibility, as I had had a slightly low TSH earlier in the year, would be to do a private thyroid blood panel, which has brought me here.
*Symptoms -
High cholesterol
Occasional high blood pressure (white coat syndrome)
Low (no) libido
Dry gritty eyes
Skin - quite thin in places, coarse in others, easy bruising, itchiness
Memory problems
Clumsiness/lack of coordination (constantly breaking/dropping/spilling things, hurting myself
Difficulty concentrating
Brain fog
Poor stamina
Lethargy
Chronic fatigue/breathlessness (like I have run a marathon on empty)
Asthma worsened (was originally mild - no treatment needed, but now gets bad/chest infections everytime I get a cold - so covid is scary)
Bad depression often suicidal (tried almost every anti dep. over last 10 years, help a bit not much)
Irritability - extremely short tempered sometimes
Lack of motivation
Menopausal symptoms
Muscle and joint pains - shoulders very stiff and painful
Irritable bowel mixed with slow digestion
Difficulty losing weight (lost 3 stone but took over a year)
Coarse frizzy dry hair
Thick toe nails
Hair loss on body (no hair on legs/realised I haven't plucked eyebrows for about 5 years)
Cold hands and feet
Dry cough
Hoarseness/croakiness in voice when talking a long time
Difficulty swallowing sometimes (can't swallow more than one large pill at a time, or gulp down drinks without a pause - it feels as if everything gets a bit stuck or backs up)
Insomnia/difficulty getting up
Weak immune system
Frequent illnesses - get ill every winter, asthma/chest infections last for months
I realise these are often vague common symptoms which is the problem I think! Apologies for the long post again.
Hypothyroid with low fT4 and elevated TSH. This could explain high cholesterol, at least in part. Doctor needs to start you on levothyroxine, more than 25 mcg.
The doctor said my TSH was a little high, but was more concerned about my high cholesterol, with seemingly no reason for it (don't smoke/drink, recently lost 3 stone - not obese, exercise well, no family history) and wanted me to take statins
Oh, dear, she doesn't know much about thyroid, does she. What she should have said was that your TSH was over-range. It's really quite high, because you are actually hypo when your TSH gets to 3. And, with such a high TSH, your FT3 is going to be low, and that's what's causing your high cholesterol, nothing to do with smoking, drinking, obesity, exercise or family history.
Cholesterol is made in the liver, and the liver makes just the amount you need. But, when T3 is low, the body cannot process cholesterol correctly, and it builds up in the blood. Glad to hear you're not taking statins!
Also, neither she nor you should be concerned about it, because it does no harm. It doesn't cause strokes or heart attacks, that's a Big Pharma myth to scare people into taking statins.
Cortisol (Random) 586.0 nmol/L - taken 11.30am - same time as previous test (6-10am 113-456; 4-8pm 58 - 278; Midnight <64)
A random cortisol test like that, doesn't give you much information.. As cortisol varies throughout the day - highest in the morning, to get you out of bed, slowly dropping throughout the day, lowest at night so that you can sleep. Different adrenal problems will have different patterns, so you need to know what's happening throughout the day, not just at one point. Is it also high early morning? Or low? Is it high at night? etc. What you need is a 24 hour saliva cortisol test, with a DHEA test. But, the NHS doesn't do that, so it would have to be private.
I would want my B12 higher than that, at least over 550. The rest of your nutrients are good, except the ferritin which is high. You should see your doctor about that, for further investigation.
My own doctor's ranges are obviously out of sync with these, which may create a problem.
It doesn't matter about the different ranges. It's the percentage through the range that counts, as Wetsuiter said. Here is a handy calculator to calculate the percentages:
Ranges vary from lab to lab, there are no national or international ranges. It depends how their analysis machines are calibrated.
I am not sure about going down the artificial T4 route, as there seem to be problems with it?
Who told you that? Some people have problems with levo (synthetic T4, not artificial, it's structure is exactly the same as the T4 your thyroid produces). But many, many more people do very well on it - even some people on here, and we're the odd ones out, the difficult cases. Don't judge until you've tried it.
I would like opinions on things like iodine/selenium; ashwaghanda; diet etc. if I am subclinical?
You can only replace a hormone with a hormone, not a nutrient. If your thyroid can no-longer produce enough endogenous hormone to make you well, you need to take some form of exogenous thyroid hormone. Iodine is an especially bad idea. If your oven is on the blink, adding an extra egg to the mix won't bake you a cake. Iodine is just one of the ingredients of thyroid hormone, it cannot replace thyroid hormone. And, if your thyroid is on the blink, adding in more iodine won't get you more hormone. Even if you do add selenium (selenium isn't even an ingredient of thyroid hormone, but is essential for conversion of T4 to T3 and needs to be balanced with iodine).
You should never take iodine unless you have been tested and found deficient - and then only under the supervision of an experienced practitioner. It is not something to mess around with because excess iodine is anti-thyroid. And cause a lot of other problems, too, including thyroid cancer.
Ashwagandha is an adaptogen, and unpredictable. I know the idea is that it balances hormones by increasing low hormones and decreasing high ones. But, in my experience, if something sounds too good to be true, it usually is. And, it doesn't suit everyone.
As for diet, obviously a good diet is essential because the body needs optimal nutrients to be able to use thyroid hormones efficiently. But, you cannot 'cure' an ailing thyroid with food.
Your antibodies are negative in the above test. But, that does not automatically mean you don't have autoimmune thyroiditis - commonly known as Hashi's. Antibodies fluctuate, so could be high in future tests. Also, 20% of Hashi's people never have over-range/positive antibodies. So, it's difficult to prove you don't have it. You still could.
Re the cholesterol - I am of the same mind as you, and not worried about it, but unfortunately my doctor seems fixated on it. She wanted me to see a specialist in case I had a familial cholesterol problem, but the high cholesterol has only happened in the past five years or so. If it was familial I would have thought it woould have been there from youth?
She is obsessed with statins like so many doctors, but I will have no truck with them.
Re B12 - I am taking a sublingual B12 supplement (Methylcobalamin), so seems I will need to carry on with this.
Re T4 - as I replied to waveylines - I have been reading up, looking online etc. There seems to be good and bad stuff about synthetic T4 on all these sites and others, quite a few people saying it isn't working, or they're feeling worse than they were without it, even after more than a year, which worries me a bit.
Perhaps it might be the people who have trouble converting T4 to T3 who are mainly having the problems with it, or they need T3 as well? I don't know what you all think?
Would anything from the blood panel I posted suggest that I would have problems converting? How would you be able to tell if this was a problem?
Yes, because they get financial incentives for prescribing it. They get nothing from levo.
There seems to be good and bad stuff about synthetic T4 on all these sites and others
Yes, of course there is. No form of thyroid hormone replacement suits everyone. NDT made me very ill - worse than synthetic T4 - but we're all different, and we have to find what suits us. Nothing specific to be worried about. It's always best to start out with T4 because, if it suits you, it's the easiest thing to source and use.
Perhaps it might be the people who have trouble converting T4 to T3 who are mainly having the problems with it
Not necessarily. I converted perfectly, but I still couldn't get on with levo, nor NDT, I'm only well on a high dose of T3 only. But, it took me years of experimenting to find that out.
Would anything from the blood panel I posted suggest that I would have problems converting? How would you be able to tell if this was a problem?
You're far too hypo at the moment to be able to see that. But, normally, to see that, you would convert your results to percentages - handy converter here:
And compare your FT4 result with the FT3. The FT4 percentage should be a little higher than the FT3. Your FT4 is only -12%, because your FT4 is below range. Your FT3 is 25.41%. So, you're rather hypo, and the high TSH is probably driving conversion - either than, or your failing thyroid is concentrating on making more T3 than T4 in order to keep you alive - which means it isn't a fair test for conversion. It would be better to recalculate when you're TSH has come down to 1 or under to get a clearer idea of how well you convert.
My Ferritin was also high in the previous doctor's test [231 ug/L (15-300 range)] but regarded as within normal range then. It was only regarded as high in the private one [250.0 ug/L (13 - 150)], even though it was still within the doctor's previous range, so don't know how that works.
I am taking multi minerals with 14mg iron & multi vits with no iron. (Intend to revise these as reading up has enlightened me about multis)
Steroids are for asthma. (Symbicort, plus Salamol when needed) used to be generally mild but has worsened in recent years.
Vit D was not tested by the doctor in February but was in the private test -
I am not able to add anymore , greygoose has given a good reply.
You need to be on T4 and take it from there. Even your Asthma could improve with a higher T3 - have a search of research papers.
Is there Biotin in your multi ? That can have an effect on some results I have read.
There are simply thousands taking Levo without any issues - one step at a time ... On the one hand you list all your symptoms and then on the other hand you create a block by thinking T4 is not for you or that it concerns you. Surely it's worth a try.
Excellant advice given. You need to talk to your GP, on the phone at the moment due to pandemic, about these results and point out the guidelines about trialling Levothyroxine as you have two consecutive results showing all the classic indicators of a failing thyroid. Once on the correct dose of thyroid meds your chloesterol will lower . The current higher level should have been seen by your GP as yet another indicator that your thyroid is failing. And you must be feeling rotten on those levels at the mo poor you.
Id also start reading up. Look on Thyroid UK they have a list of good books. Knowledge is power!
Keep posting. There are lots of people with amazing knowledge on here......so never feel alone with it. Hope the levothyroxine works for you -it does for many so take heart.. My next door neighbour is on it - happy as larry!!
I have been reading up, looking online etc. - including -
Thyroiduk; stopthethyroidmadness.com; chriskresser.com; tpa-uk.org.uk - Thyroid Patient Advocacy UK - amongst others + thyroidbook.com - about Dr Datis Kharrazian's books Why Do I Still Have Thyroid Symptoms & Why Isn’t My Brain Working (he seems to be well respected) which I am reading.
There seems to be good and bad stuff about synthetic T4 on all these sites and others, quite a few people saying it isn't working, or they're feeling worse than they were without it, even after more than a year, which worries me a bit.
Perhaps it might be the people who have trouble converting T4 to T3 who are mainly having the problems with it, or they need T3 as well? I don't know what you all think?
Would anything from the blood panel I posted suggest that I would have problems converting? How would you be able to tell if this was a problem?
You said you were feeling unwell when you had tests. The Blue Horizons doctor said
"The ferritin level is high, this can be a sign of inflammation or infection but is less likely with a normal CRP (as it is here). Serum cortisol is on high side. It rises in response to stress”
During illness the thyroid sometimes slows down to conserve energy for recovery.
I would have blood tests again in 3 months time before taking any other medication.
I also note that your ferritin was within range on your GP test but over on the private one also you B12 was good in range with GP and over on private. Are you taking a tonic? Like Ferroglobin for instance.
Supplements especially those contains vitamin Bs can interfere with the thyroid blood test results so it’s best not to take any supplements at least 2 weeks before a test.
"Blood tests again in 3 months time before taking any other medication" - would this be okay?
With the reading up etc. I have been doing, I am tempted to go down the gluten free, possibly grain free road, plus maybe appropriate good quality supplements (not multis) for a month or so to see if this helps, until hopefully this covid thing dies down, and I can have a good chat with my GP (or perhaps a more enlightened one?) and maybe get more blood tests.
I have had a tough couple of days health wise, very exhausted at the moment (made the mistake of trying to go for a walk!) so I will post possibly tomorrow with replies to specific inquiries/comments if that is okay?
Re - I'm new here - advice on possible hypothyroid blood tests
As I said a few days ago thank you all very much for your input/advice.
Apologies for taking a while to respond, I have had a tough couple of days health wise. Very exhausted, hardly able to get out of bed, and a bit breathless (not asthma just feel like I have run a marathon).
Responses to your posts below and also further general info. I hope you haven't all forgotten me and I get no answers!
Yes I do feel pretty rough. I have various symptoms* that are effecting my life quite badly and probably have been for maybe 5-10 years I am thinking now.
Because I am post menopausal (60) I at first (which is apparently a common error) thought it might be hormonal (yes I know thyroid is also hormonal!), and after seeing a private menopause specialist (doctor being hopeless as usual) had been trialling bio identical hormones.
But after the 3 month period nothing has really changed, so I thought that the other possibility, as I had had a slightly low TSH earlier in the year, would be to do a private thyroid blood panel, which has brought me here.
*Symptoms -
High cholesterol
Occasional high blood pressure (white coat syndrome)
Low libido
Skin - quite thin in places, coarse in others, easy bruising, itchiness
Memory problems
Difficulty concentrating
Brain fog
Poor stamina
Lethargy
Chronic fatigue/breathlessness (like I have run a marathon on empty)
Asthma worsened (was originally mild - no treatment needed, but now gets bad/chest infections every time I get a cold - so covid is scary)
Bad depression often suicidal (tried almost every anti dep. over last 10 years, help a bit not much)
Irritability - extremely short tempered sometimes
Lack of motivation
Menopausal symptoms
Muscle and joint pains - shoulders very stiff and painful
Irritable bowel mixed with slow digestion
Difficulty losing weight (lost 3 stone but took over a year)
Coarse frizzy dry hair
Thick toe nails
Hair loss on body (no hair on legs/realised I haven't plucked eyebrows for about 5 years)
Cold hands and feet
Dry cough
Hoarseness/croakiness in voice when talking a long time
Difficulty swallowing sometimes (can't swallow more than one large pill at a time, or gulp down drinks without a pause - it feels as if everything gets a bit stuck or backs up)
Insomnia/difficulty getting up
Weak immune system
Frequent illnesses - get ill every winter, asthma/chest infections last for months
Marz -
My ferritin was also high in the previous doctor's test [231 ug/L (15-300 range)] but regarded as within normal range then. It was only regarded as high in the private one [250.0 ug/L (13 - 150)], even though it was still within the doctor's previous range, so don't know how that works.
I am taking multi minerals with 14mg iron & multi vits. with no iron. (Intend to revise these as reading up has enlightened me about multis)
The steroids are for asthma. (Symbicort, plus Salamol when needed) used to be generally mild but has worsened in recent years.
Vit D was not tested by the doctor in February but was in the private test -
Vitamin D (25 OH) 98 - nmol/L (50 - 175)
waveylines -
I have been reading up, looking online etc. - Thyroiduk/stopthethyroidmadness.com/chriskresser.com/tpa-uk.org.uk - Thyroid Patient Advocacy UK, amongst others, + thyroidbook.com - about Dr Datis Kharrazian's books - Why Do I Still Have Thyroid Symptoms & Why Isn’t My Brain Working (he seems to be well respected), which I am reading.
There seems to be good and bad stuff about synthetic T4 on all these sites and others, quite a few people saying it isn't working, or they're feeling worse than they were without it, even after more than a year, which worries me a bit.
Perhaps it might be the people who have trouble converting T4 to T3 who are mainly having the problems with it, I don't know what you all think?
Would anything from the blood panel I posted suggest that I would have problems converting? How would you be able to tell if this was a problem?
Blondiejayjay -
"Blood tests again in 3 months time before taking any other medication" - would this be okay?
With the reading up/research etc. I have been doing, I am tempted to go down the gluten free, possibly grain free road, plus maybe appropriate good quality supplements (not multis) for a month or so to see if this helps, until hopefully this covid thing dies down, and I can have a good chat with my GP (or perhaps a more enlightened one?) and maybe get more blood tests.
Can't afford to pay for more private ones
Again - thank you all for your input/support at the moment. Apologies for the long post again.
Id push for a trial of Levothyroxine - it does work just not for everyone. Your symptoms fit a profile of underactive and your bloods test results show that your thyroid is struggling. Start with the standard treatment first.....you can always branch out if it doesnt work for you.
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I'm new here, struggling with underactive thyroid, and blood tests.
Advice on Blood Tests + Levo dose
Blue Horizon Blood Test Results
Here are my full blood test results - i'm hypothyroid please help me interpret - 
