Help with results please!

So I've had a private thyroid test done through Thriva and just received the results.

I would appreciate if someone could interperet it for me.

Thank you

[Hidden]

I've just noticed I put the wrong ranges for the antibodies.

TgAB 871.3 (0-115)

TPOAb 593.1 (0-34)

[SeasideSusie Remembering in reply to Hidden]

geworgie3008

You have put the wrong ranges for almost everything, not just the antibodies.

I think you have made the mistake of putting their "optimal" ranges - the darker green bar, whereas the reference range is the whole of the green bar from light green on the left hand side for the lower limit, through the dark green optimal part, then the light green part on the right hand side which is the upper limit.

For example, the FT4 range is 12-22 not 12-17 as you have put.

And your Ferritin range is very likely to be 13-150.

Perhaps check your results again and edit your post to put the full reference range, you could even add a picture/screen shot of your Thriva results. You can edit your post by clicking on MORE below your opening post, choose EDIT, make changes, even UPLOAD A PICTURE, then click SUBMIT.

We can't make accurate suggestions when reference ranges are incorrect.

However, you have put the correct range for Active B12 and I can tell you that anything below 70 suggests testing for B12 deficiency according to Viapath at St Thomas' Hospital:

viapath.co.uk/our-tests/act...

Reference range:>70. *Between 25-70 referred for MMA

Check for signs of B12 deficiency here:

b12deficiency.info/signs-an...

If you have any then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.

Also, Vit D is low at 70nmol/L and the Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L.

[Hidden in reply to SeasideSusie]

Sorry! I was in such a rush. Got all flustered at the antibody results. I'll post a picture now.

[SlowDragon Administrator]

Make an appointment to see GP and take these results into GP

You have high TSH, low Ft4 and Ft3 and high thyroid antibodies. This confirms hypothyroidism caused by autoimmune thyroid disease (also called Hashimoto’s)

Technically, because Ft4 and Ft3 are still within ranges your results are classed as “sub clinical “

But guidelines are clear with results like yours and symptoms you should be prescribed Levothyroxine

See flow chart top of page 2

gp-update.co.uk/Latest-Upda...

Vitamin D is slightly low. But probably not low enough for GP

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamin D

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

Ferritin is very low

Ask GP for full iron panel test for anaemia

B12 and folate are also low. Ask GP to test via NHS test

Ask for coeliac blood test too

[Hidden in reply to SlowDragon]

Thank you so much.

While I have suspected Hashi's for some time it was a bit overwhelming to have it confirmed.

Why would B12 and Folate need to be tested via NHS test?

I will make an appointment today and ask for all those test.

I really appreciate your time to reply to me.

[SlowDragon Administrator in reply to Hidden]

Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

[SlowDragon Administrator in reply to Hidden]

GP won’t understand an active B12 test (not routinely available on NHS)

You need further testing to rule out pernicious anaemia before starting on B12 / B complex

It’s more likely B vitamins are low due to being hypothyroid

ncbi.nlm.nih.gov/pubmed/186...

There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,

[SeasideSusie Remembering]

geworgie3008

Vit D: 70nmol/L

As mentioned, this is recommended to be 100-150nmol/L.

To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 3,500iu D3 daily.

Retest in 3 months.

Once you have reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

afibbers.org/magnesium.html

**

Ferritin: 16 (13-150)

This is very low, ferritin is recommended to be half way through range. Low ferritin can suggest iron deficiency/anaemia. You should ask your GP to do an iron panel (which would show if you have iron deficiency) and a full blood count (which will show if you have anaemia).

Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.

**

Active B12 already addressed in previous reply.

**

Folate: 18 (8.83-60.8)

Folate should be at least half way through range (35+ with that range) so yours is low. This will need addressing once you've sorted any further testing that may be carried out for your B12. Do not start taking a B Complex to address low folate level before further testing of B12, as mentioned. B12 injections/supplements should be started first, then followed by B Complex.

**

TSH: 8.4 (0.27-4.2)

FT4: 14.3 (12-22)

FT3: 4.3 (3.1-6.8)

TgAB 871.3 (0-115)

TPOAb 593.1 (0-34)

Your TSH is well over range although your FT4 and FT3 are within range. Normally a GP will wait until TSH reaches 10 before diagnosing primary hypothyroidism. As you have said in a previous post, you have been diagnosed with subclinical hypothyroidism because your TSH is raised but not over 10.

Your raised antibodies suggest that you are positive for autoimmune thyroid disease aka Hashimoto's which is where the thyroid is attacked and gradually destroyed.

Fluctuations in symptoms and test results are common with Hashi's.

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.

Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies and this is probably the reason for your poor levels.

**

Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.

**

Over range, but below 10, TSH plus raised antibodies should get you a prescription for Levothyroxine. Please send for the following article and show it to your GP, requesting a prescription for 50mcg Levo now, retest in 6 weeks:

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors) in answer to Question 2:

Question 2 asks:

I often see patients who have an elevated TSH but normal T4. How should I be managing them?

Answer:

The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat thyroid function tests in 2 or 3 months in case the abnormality represents a resolving thyroiditis.

But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune thyroid disease - the patient should be considered to have the mildest form of hypothyroidism.

In the absence of symptoms, some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow up.

Treatment should be started with levothyroxine in a dose sufficient to restored serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

print it and highlight question 2 to show your doctor.

[Hidden in reply to SeasideSusie]

Thank you, Seaside

Lots to take in an process. I've been looking into my nutrition for awhile now so I'll be making some changes anyway. Gluten free is intimidating but I guess it'll be easy once I'm in the swing of it!

I really appreciate your feedback. Thank you.

[SlowDragon Administrator in reply to Hidden]

Gluten free diet can seem daunting at first, but you get use to it

It does need to be absolutely strictly gluten free to be effective

Make sure to get coeliac blood test BEFORE going gluten free

[Hidden]

Thank you both SO much for your help.

I had a phone appointment this morning with my GP who has prescribed 25mgs(?) of levo.

Bloods will be taken again in 8 weeks to check TSH but she will also do a full blood count and iron panel and re-do coelics test (which was neg in 2013) at the same time.

So overall a success!

[Marz in reply to Hidden]

50mcg is the usual starting dose unless you are elderly. Starting too low can make things worse !

[Hidden in reply to Marz]

I know, but it's all she would prescribe. So at the moment I'll go with it and see what my results are in a few week's time.