Hi, I am new here. My teenager daughter has been completely exhausted., sleeping a lot, extremely moody. She has been anaemic before and previously had an iron infusion, she assumed she was anaemic again, so we went to Dr. to have her bloods done. It came back normal according to the Dr. but when I saw the report, it doesn't look normal to me. Do you think this looks like subclinical hypothyroidism.
TSH 4.73 (range 0.43 - 4.20) (prev test Oct 2018, 2.39)
FT4 10.6 (range 10.1 - 17.9)
FT3 6.1 (2.8 - 6.3)
Iron 8.8 (7.00 - 26)
Ferritine 30 (10 - 400)
Vitamin B12 191 (150 - 650) (prev test Oct 2018, 312)
She started taking the birth control pill for extremely heavy periods and we assumed the weight gain is from that.
We have a strong family history of thyroid disease, my sister, mom and I have Graves, and most of my female cousins have hypothyroid.
Thank you for your input.
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Ft4 extremely low ...only just within bottom of range
Ft3 ok - as high TSH is forcing thyroid to flog on
Iron and ferritin are both low
B12 - EXTREMELY low - needs full testing for Pernicious Anaemia before starting at least daily B12 supplements and daily vitamin B complex....but may need B12 injections
Folate and vitamin D need test
She needs both TPO and TG thyroid antibodies tested for autoimmune thyroid disease also called Hashimoto’s
For full Thyroid evaluation 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 have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin d and folate levels and thyroid antibodies
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 .
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
Thank you SO much for the quick and informative reply. The idea is that they will do antibodies test a few weeks after she has the next iron perfussion, which I insisted on, although the Dr. told me she didn't need a perfussion. I will arrange the antibodies test and the other tests you suggest, earlier now rather than , wait for the iron infusion. I have started checking out pernicious anaemia also and a lot of her symptoms are consistent with that also. .
Here are the results of her blood count, everything is in range but on lower end of the range.
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,
I have both i.e. pernicious anaemia and hypothyroidism and I have also developed alopecia areata. So if we have one autoimmune condition we can develop others. I was lucky in that P.A. was diagnosed many years before I had any symptoms by an excellent doctor who was puzzled about a blood test and I told him my mother had P.A. I then got a 'nuclear test' (I don't think they do that now) which confirmed P.A, long before I became hypothyroid which I'd never heard of either.
Iron 8.8 (7.00 - 26) 9.5% of the way through the range
Ferritine 30 (10 - 400) 5% of the way through the range
Haemoglobin 124 (range 120 - 160)
Haemoglobin - If this was below range your daughter would be officially anaemic. She isn't there yet, but she is very close. Improving her iron and ferritin should improve her haemoglobin and therefore get her further away from being anaemic.
Her iron and ferritin levels are terrible, but since they are both in range many doctors will ignore them, just like yours did.
Optimal levels for iron and iron-related results are given in this link :
It is possible to buy iron supplements without a prescription - there are quite a lot of different kinds. The important thing with any iron supplement is how much pure iron it contains.
The kind of iron a doctor would prescribe is described on this link :
You could print out the picture and take it to a pharmacist and ask for a box, or just show them the picture on a phone. The last time I bought it it cost about £6 - £7 for the box. Since it is usually prescribed it is up to the pharmacist whether they sell it without a prescription. If they refuse to sell it just go to a different pharmacy and ask again. I've always bought mine at a Tesco Pharmacy or Lloyds Pharmacy. I was refused once at a Boots Pharmacy - I just went elsewhere.
Dosing for ferrous fumarate 210mg is discussed on this link :
If your daughter starts thyroid hormone medication then she must leave a gap of four hours between taking iron and taking thyroid tablets. But since she isn't currently taking thyroid meds she should just take an iron tablet twice or three times a day with food. I would suggest sticking to twice a day to begin with because iron tablets are hard to tolerate. It would also help if she took a vitamin C supplement with every iron pill because vitamin C helps the body to absorb iron.
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If your daughter starts taking iron pills then it is vital that she has her iron levels tested every couple of months to be sure that her levels don't go above optimal. Iron and ferritin (iron stores) are poisonous in overdose.
An iron deficiency test which can be done with just a finger-prick sample is this one :
I can't thank you enough for giving me the information I need to discuss in an informed way with the Dr. Both the GP and gynaecologist said her results are normal, but the reality is she is symptomatic of something ! She is going into her final year of secondary school, so really needs to be on top form for the upcoming stress of studying for her exams. . We don't live in the UK, but I am going to take her to an endocrinologist and insist on the other tests suggested here. ,We have an iron perfussion booked for the end of August, she has had two before and they have really helped her. I will keep you updated . Thank you again
Definitely just outside the limits and should start on a little thyroxine. My daughter was diagnosed at 16, and there is a history of Graves too (myself, aunt and brother). Doctor said we’d test for anaemia first and I insisted on thyroid function as I knew the signs. Hope your daughter gets treatment!
T3 is high because it's pooling due to low ferritin. If you can fix the iron situation things may settle down. Ferritin is the bus that transports T3 in the blood. I went through this and felt terrible till my iron levels improved.
T3 is the active thyroid hormone which controls the metabolism and every cell in the body.
Her free T3 is almost at the top of the normal range which is good so she is not hypothyroid.
She could however still have a thyroid problem. One possibility is Impaired Sensitivity to Thyroid Hormone, also known as thyroid hormone resistance. With it you need very high T3 levels to overcome the resistance.
Two pointers to thyroid hormone resistance:
1. It is genetic so other family members with thyroid, autoimmune, heart disease, cancer would be indicative.
2. A low basal temperature (taken in morning before getting out of bed) or low heart rate.
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