Hi,
Should the Ferritin and iron tests be taken fasting? I did mine after dinner and got unsaturated Iron towards the bottom of the range: 37.5 (range 24.2-70.1). Is that something I should worry about?
I was have hypothyroidism and treated with 50mg of levothyroxine per day and my new blood tests uncovered abnormal antibodies despite the treatment:
anti TG is 4.71 (range 0-4.11), Anti TPO 8.7 (range 0-5.61), free T3 at 2.6 (range 2.9-4.9). free T4: 14.3 (range 9-19)
Thanks
Lilly12255
Should the Ferritin and iron tests be taken fasting?
Yes.
From labtestsonline.org.uk/tests...
Ferritin Test
Test Preparation Needed?
You may be instructed to fast for 12 hours before the test; in this case, only water is permitted.
and from nhs.uk/common-health-questi...
Common fasting blood tests
an iron blood test (used to diagnose conditions such as iron deficiency anaemia) – you fast for 12 hours before the test
I did mine after dinner and got unsaturated Iron towards the bottom of the range: 37.5 (range 24.2-70.1). Is that something I should worry about?
Do you mean Unsaturated iron-binding capacity (UIBC)? If so low in range indicates that you may have too much iron in your blood which may be due to iron overload syndrome (hereditary haemochromatosis). High in range signifies iron deficiency. However, if you had eaten a meal high in iron rich foods (eg red meat, liver, etc) this will affect your iron level. However, if you've had an iron panel you look at the whole picture, not just one element but unfortunately as it's not a fasting test your results aren't reliable.
I was have hypothyroidism and treated with 50mg of levothyroxine per day and my new blood tests uncovered abnormal antibodies despite the treatment:
anti TG is 4.71 (range 0-4.11), Anti TPO 8.7 (range 0-5.61), free T3 at 2.6 (range 2.9-4.9). free T4: 14.3 (range 9-19)
Your raised TPO antibodies suggest autoimmune thyroid disease (aka Hashimoto's). This is the most common cause of hypothyroidism where the immune system attacks and gradually destroys the thyroid, leading to hypothyroidism. Taking Levothyroxine isn't going to affect the level of antibodies, Levo is a thyroid hormone replacement so is replacing the thyroid hormone your body isn't making itself. There is no actual treatment for the antibodies, they're not the problem.
However, your free T3 is below range and this is a problem. The aim of a treated Hypo patient generally is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well. Although your FT4 is mid-way through range, It's low T3 that causes symptoms.
Thanks a lot for your answer. Yes it's the UIBC being low. I cook in iron pans, so there is a risk it could be dinner related. This autoimmunity is quite worrying: is there no way to stop my antibodies to destroy my thyroid? What would be the best way to sort my T3 level?
Lilly12255
This autoimmunity is quite worrying: is there no way to stop my antibodies to destroy my thyroid?
The antibodies don't destroy your thyroid. Read again what I said:
This is the most common cause of hypothyroidism where the immune system attacks and gradually destroys the thyroid, leading to hypothyroidism.
So the antibodies are not the problem.
When the immune system attacks the thyroid, the dying cells release a lot of thyroid hormone into the blood and this can cause TSH to become suppressed and Free T4 and Free T3 to be very high or over range. These are called 'Hashi's flares' or 'swings'. You may get symptoms of being overmedicated (hyper type symptoms) to go along with these results that look as though you are overmedicated. The hyper swings are temporary, and eventually things go back to normal. Test results settle back down and hypo symptoms may return. Thyroid meds can be adjusted slightly at these times if necessary, but will need readjusting when hypo symptoms return.
Unless a GP knows about Hashi's and these hyper type swings, then they panic and reduce or stop your thyroid meds.
As mentioned, Hashi's isn't treated, it's the resulting hypothyroidism that's treated.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Gluten/thyroid connection: chriskresser.com/the-gluten...
stopthethyroidmadness.com/h...
stopthethyroidmadness.com/h...
hypothyroidmom.com/hashimot...
thyroiduk.org.uk/tuk/about_...
Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.
What would be the best way to sort my T3 level?
First of all, we need optimal nutrient levels for good conversion of T4 to T3.
Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies. It's essential to test Vit D, B12, Folate and Ferritin and address any problems.
I would do a full iron panel under fasting conditions as well as the Vit D, B12 and Folate.
You are welcome to post these results, including reference ranges (plus units of measurement for Vit D and B12), for comment and suggestions for supplementing where necessary.
Once all nutrient levels are optimal, we need to see results for TSH, FT4 and FT3 all tested from the same blood draw, this will tell us how well you convert T4 to T3. Once we know that we will know if you need to address a low FT3 problem or not.
Lilly12255
Just had another thought.
free T3 at 2.6 (range 2.9-4.9). free T4: 14.3 (range 9-19)
What would be the best way to sort my T3 level?
What's your TSH level? Your FT4 is 53% through range which is too low for someone on Levo.
How long have you been on 50mcg?
Was that your starting dose, or did you start on 25mcg?
Normal starter dose is 50mcg with usually an increase of 25mcg after 6 weeks. With your FT4 only mid-range, and your FT3 below range, then you should have an increase in your dose.
Also, I see from your profile that you are having IVF. For a successful conception and pregnancy I presume you know that your TSH needs to be below 2.5? Is your specialist aiming for this?
Thanks Susie, I started Levo in Nov last year at 25mg (at that time, my TSH was 5.6 mIU/L). After 6 weeks, my TSH improved to 2.8 (though this test is not reliable as taken after lunch). GP casually classified my file as no action.
My IVF doctor said I need TSH below 2.5. So I complained to GP in March and got a 25mg increase to 50mg.
So I had been under 3 months of 50mg before taking the blood test that detected that my TSH deteriorated further to 2.88 miU/L,
free T3 at 2.6 pmol/L (range 2.9-4.9).
free T4: 14.3 pmol/L (range 9-19).
anti TG is 4.71 iU/mL (range 0-4.11),
Anti TPO 8.7 iU/mL (range 0-5.61),
The same blood test measured:
Folate at 18.8 ng/mL (range 3.1-20),
Vitamin B12>128 pmol/L (range 35-196)
Iron: 19.3 umol/L (range 9-30.4)
Ferritin 102 ng/mL (range 22-275).
The test (incl UIBC) I sent earlier was not taken fasting, i.e. not reliable I hear.
Lilly12255
So I had been under 3 months of 50mg before taking the blood test that detected that my TSH deteriorated further to 2.88 miU/L,
free T3 at 2.6 pmol/L (range 2.9-4.9).
free T4: 14.3 pmol/L (range 9-19).
So the fact that you're having IVF, and presumabl your GP knows that the fertility doctor wants your TSH below 2.5, should have alerted your GP to increase your Levo to 75mcg on the basis of these results.
Even if you weren't having IVF, your GP isn't following protocol for increasing your Levo.
NICE Clinical Knowledge Summary - hypothyroidism:
cks.nice.org.uk/hypothyroid...
Initiation and titration
The NICE clinical guideline recommends:
* Consider starting LT4 at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms) for adults under 65 years of age with primary hypothyroidism and no history of cardiovascular disease.
* Consider starting LT4 at a dosage of 25–50 micrograms per day with titration for adults aged 65 years and over, and adults with a history of cardiovascular disease.
The British National Formulary (BNF) recommends:
* For adults aged 18–49 years — initially 50–100 micrograms once daily; adjusted in steps of 25–50 micrograms every 3–4 weeks, adjusted according to response; maintenance 100–200 micrograms once daily.
* For adults aged 50 years and over, with cardiovascular disease, or severe hypothyroidism — initially 25 micrograms once daily; adjusted in steps of 25 micrograms every 4 weeks, adjusted according to response; maintenance 50–200 micrograms once daily.
Were you started on a dosage by weight as suggested by NICE? Unlikely at 25mcg.
BNF recommends higher starter dose.
British Thyroid Foundation btf-thyroid.org/pregnancy-a...
If you have an underactive thyroid (hypothyroidism)
* If you are planning a pregnancy you should speak to your GP to arrange thyroid blood tests and ideally aim for a Thyroid Stimulating Hormone (TSH) level of less than 2.5mU/l at the time of conception
* It is recommended that your TSH should be less than 2.5mU/l in the first trimester of pregnancy and less than 3.0mU/l after that
* As soon as you know you are pregnant it is usually recommended that your levothyroxine is increased immediately by 25-50mcg daily. You should then contact your GP and arrange to have a thyroid blood test
Maybe use some of this information to get an increase in your dose. Your FT3 is a particular worry as it's low T3 that causes symptoms, you need this to be balanced as near as possible to your FT4.
Vitamin B12>128 pmol/L (range 35-196)
Is this an NHS test or a private test? For Total B12 or Active B12?
I tested privately as my GP only wants to test THS and T4. Based on weight, I should be taking 100mg of levo using the 1.6x multiple. My GP was aware of the need to fall to 2.5 but negligently wrote "no action" on my results and did not change my prescription. I have asked them today and they admitted the information they had should have got them to increase my dose. Myself, I was unaware of the 2.5 threshold at the time, only found out in Feb, and immediately complained to GP, following which I got 50mg instead of 25mg.
Today I complained again and they said they are only increasing to 75mg by fear of me becoming hyperthyroidism. It is still to low based on NICE but they don't want to hear anything.
Lilly12255
What about your fertility specialist though? Can s/he have some input and emphasise how important it is for your TSH to be below 2.5?
Can you find another doctor, with your FT3 that low you are bound to have symptoms anyway, low T3 causes symptoms, it's the active hormone which every cell in our bodies need.
What about your B12 - was that Total B12 or Active B12 test? If it's Total B12 test it's very low, if it's Active B12 it's fine.
I could get the fertility doc to prescribe me the levo but it would be better if the GP would sort it as I pay for the fertility treatment privately. GP agrees with the 2.5 just was negligent about my treatment and now very slow to increase my dose (by 25mg only). The vitamin B was the active one.
On Thryoid UK website, I discovered that the GP should have referred me to an endocrinologist back in october 2019: "NICE state that all women who have overt hypothyroidism or subclinical hypothyroidism and who are planning a pregnancy or who are pregnant should have a referral to an endocrinology specialist.4 Your doctor should discuss initiation of treatment and dosage with an endocrinologist whilst waiting for the referral." thyroiduk.org/having-a-baby...
I called the GP today about it but they are unwilling to refer me as they can treat my hypothyroidism themselves. Is there any other official website that I can use to request a referral?
Lilly12255
I think all you can do is present your GP with as many references to hypothyroidism and pregnancy as possible.
ThyroidUK have some links towards the bottom of that page you linked to so you could look through those and either send links to your GP or print off the information.
I gave you the British Thyroid Foundation information and link above and you can Google "Pregnancy and hypothyroidism" and see what else you can find.
You could always change your doctor and find one who actually cares enough.
Low Ferritin and raised Iron 
Ferritin levels & iron supplements 
Low Ferritin & Iron with Hypothyroid
Iron/ferritin - journal articles
