Thyroid results

[janet65]

Brief though they are can anyone please tell me if these explain my tiredness? Thank you.

[SeasideSusie Remembering]

janet65

What thyroid meds are you on?

For a full thyroid picture it's essential to include FT3 along with TSH and FT4.

Are your nutrient levels optimal? Have you tested

Vit D

B12

Folate

Ferritin

Low ferritin can cause fatigue.

[janet65 in reply to SeasideSusie]

I take 75 mg levothyroxine a day and and being treated for anemia 200mg x 3 a day. Although my latest test shows my haemoglobin has climbed to 135 now. The serum ferritin is 47 ugL 13 - 150. GP didn't do any other tests!

[SeasideSusie Remembering in reply to janet65]

janet65

Ferritin is still too low, it's recommended to be half way through range so you're looking at 82 with that range. Try eating liver regularly, no more than 200g per week due to it's high Vit A content. This is what raised my ferritin level.

It would be a good idea to get the others done, privately if necessary, as optimal nutrient levels are important for us Hypos.

I see in your reply to Jazz you mention that you took your Levo before the test and said

They don't seem to do fasting tests these days.

I don't understand that. Just don't have breakfast before your early morning test (best time for a thyroid test), don't discuss it with them, it's not their business.

As Jazz says, your FT4 is high because you took your Levo, the test is measuring what is in your blood after your dose of Levo. To get a measure of your normal circulating amount of hormone you take your last dose of Levo 24 hours before the test. Again, not up for discussion with phlebotomist or doctor.

[Jazzw]

Everything SeasideSusie said plus...

...if you’re on any levothyroxine, did you take it on the day of your test?

[janet65 in reply to Jazzw]

Yes I did. They don't seem to do fasting tests these days. I'm just thinking that the T4 being 21 is on the high side?

[Jazzw in reply to janet65]

It’s at the top of the range but if you took it just before the test, it would look artificially high because of peaking in your blood stream.

I suspect you’re undermedicated but it’s hard to say without an FT3 result.

[janet65 in reply to Jazzw]

Oh my, I was awful when they once gave me 100mg to take!! Maybe I need a chat with the GP?

[Jazzw in reply to janet65]

How long ago was that? Things do change over time. And what happened—what was awful? It’s worth knowing that when low in iron (which you were) some people struggle to tolerate higher doses of levothyroxine.

[janet65 in reply to Jazzw]

It was Sept 2018, I can't remember how long I took that dose but just didn't feel myself so asked for a test and put myself back down to 75mg and within 2 days felt much better. As soon as the results were back they phoned me to take the lower dose.

Last Oct I saw the GP and said I wasn't feeling myself, didn't think it was thyroid though. She did many blood tests but I was told they all came back normal. I asked for a copy and on looking back I can see my haemoglobin level had dropped considerably from my normal level. This year I change surgeries because I moved towns and at that time the Royal Brompton asked me to get a blood test. It was then that they saw I was really anemic and started investigating. The found colon cancer. So I had a successful operation but am still being treated for the lack of iron. Although I think according to the latest results I'm back in range for me.

[SlowDragon Administrator]

Just testing TSH and Ft4 is completely inadequate

Your high Ft4 is false high as you took,levothyroxine before blood test

All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

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

Do you have Hashimoto’s

What vitamin supplements are you currently taking

When were vitamin levels last tested?

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)

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

Ferritin is still too low

[SlowDragon Administrator]

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first and regularly retest when on iron supplements

Thyroid disease is as much about optimising vitamins as thyroid hormones

[SlowDragon Administrator]

Even if we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

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

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

If vitamins are low conversion of levothyroxine (Ft4) to active hormone (ft3) will be poor

We need good levels of vitamin D, folate, B12 and ferritin for good conversion

When adequately treated TSH is frequently well under one ....most important result is always Ft3