I’ve been under active for 13 years and I’m on levothyroxine 150mg. I had a battle when I first saw my GP as I was only upper end of the normal range and briefly went over, but eventually they started me on medication and I’ve been mainly stable ever since with my TSH coming down to around 1.5-2.0.
Lately I’ve been extremely tired again and suffering with such awful lethargy so I requested my GP look into it. He said he was running full bloods, checking vitamins and also liver function etc.
I called the GP to get my results and was told “All came back Normal”- so I requested a print out of the report. Looking at my results very interesting is the fact my TSH is back up to nearly its highest number “within range” which previously had me very symptomatic despite being classed as “normal” for the first time in 13yrs(it’s 4.47)! Also my Serum Ferritin level is the lowest it could be to be (20) to be classed as within “normal” range- so does this indicate very low iron and therefore could be contributing to my tiredness?
I’m not sure what I’m looking at with regards to things like B12 and serum folate. Do these look acceptable to you? Obviously it’s saying they’re within range BUT we all know that doesn’t mean it’s optimal 🤷♀️.
I’m going to make an appointment to discuss with the GP but before I do I’d appreciate any guidance on this from anyone that has more knowledge that me!
Thankyou so much in advance!
Written by
KenchT
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Do you always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after?
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test missing vitamins and full iron panel test for anaemia
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
One big change for me personally was having my gallbladder removed this January but I’m not sure of the impact of this on my thyroid. My medication is unchanged in dose or brand. Yes I always take it on an empty stomach.
I’m Surprised he didn’t test for Vit D since I’ve been complaining of extreme tiredness.
Your TSH is very nearly at the top of the range, far too high. The aim of a Hypo patient on Levo, 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. You need an immediate increase of 25mcg, retest in 6-8 weeks, repeat until your levels are where they need to be for you to feel well.
To support your request for an increase in dose, use the following information:
Thyroxine Replacement Therapy in Primary Hypothyroidism
TSH Level .................. This Indicates
0.2 - 2.0 miu/L .......... Sufficient Replacement
> 2.0 miu/L ............ Likely under Replacement
Also Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
As for your ferritin being at the very bottom limit of the range, you should ask your GP to do an iron panel to see if you have iron deficiency. Your full blood count doesn't suggest anaemia so I expect this could well be iron deficiency.
Symptoms of low ferritin include:
◾Weakness
◾Fatigue
◾Difficulty concentrating
◾Poor work productivity
◾Cold hands and feet
◾Poor short-term memory
◾Difficulty remembering names
◾Dizziness
◾Pounding in the ears
◾Shortness of breath
◾Brittle nails
◾Headaches
◾Restless legs
B12 is on the low side (GP wont agree). According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Thanks so much for this comprehensive advice! This platform wouldn’t let me upload more than one picture so I couldn’t put all my results on but my folate level is:-
7.8ng/mL with the accepted range stated as (3.1-20.5)
Folate is recommended to be at least half way through range (12+ with that range) so yours is a bit low
A good quality, bioavailable B Complex should improve your B12 and Folate levels. Consider Thorne Basic B or Igennus Super B.
Always leave off B Complex for 7 days before any blood tests. This is because B Complex contains biotin and if biotin is also used in the testing procedure (which most labs do) then this will give false results.
I had my gallbladder removed this January and someone mentioned to me earlier today this may have impacted my bodies ability to absorb vitamins so I’m wondering if I need to do some research as to what I can do to improve my vitamin levels
That makes sense, if the gall bladder produces the enzymes responsible for the digestion of fats then having it removed would slow the digestion and absorption of those vitamins.
(Sorry, I can't just be told, I need to understand the reasoning behind things.)
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