Comprehensive thyroid blood tests - ADVICE - Thyroid UK

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Comprehensive thyroid blood tests - ADVICE

ert1542 profile image
18 Replies

Hello,

I'm due to have some blood tests this Friday and I would like some advice on what to get, aside from the generic thyroid blood test. The nurses at my GP practice will do whatever test I ask for so please let me know your recommendations. I am hypothyroid and currently take 100mcg levothyroxine but I feel my medication is not high enough as I've been struggling with elevated prolactin 1000+ (no tumour detected). More recently I have put on a little weight, feeling rather low and fatigued, telltale signs my thyroid isn't happy. I have tested positive for the thyroid antibodies and I'm very worried my thyroid issues are going to cause me some real problems re: fertility as I'm only 27.

Thanks in advance!

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ert1542
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18 Replies
SlowDragon profile image
SlowDragonAdministrator

High prolactin is relatively common with autoimmune thyroid disease (Hashimoto’s)

frontiersin.org/articles/10...

For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also EXTREMELY important to regularly test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common with Hashimoto’s

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)

What vitamin supplements are you currently taking?

Do you always get same brand of levothyroxine?

ert1542 profile image
ert1542 in reply toSlowDragon

Thank you for your reply and the advice, it really is much appreciated! I have always struggled with my ferritin so I'll definitely get the others checked too.

I try and take vitamin D regularly but I could be more strict with it but other than that I don't really take anything.

I always stick with Teva thyroxine as I'm lactose intolerant and struggle to get any other lactose free brands.

SlowDragon profile image
SlowDragonAdministrator in reply toert1542

So lactose intolerance frequently means patients may need higher dose levothyroxine

Lactose intolerance is very common with Hashimoto's

ncbi.nlm.nih.gov/pubmed/240...

Lactose intolerance was diagnosed in 75.9 % of the patients with HT

read.qxmd.com/read/24796930...

These findings show that lactose intolerance significantly increased the need for oral T4 in hypothyroid patients.

Teva and Aristo are the only lactose free tablets in U.K.

healthunlocked.com/thyroidu...

lactose free levothyroxine liquid is also available and endocrinologist could prescribe. Some people find it Can give better absorption

Come back with new post once you get results

ert1542 profile image
ert1542 in reply toSlowDragon

So insightful, thank you for sharing!

vocalEK profile image
vocalEK in reply toSlowDragon

When you said "For full Thyroid evaluation you need TSH, FT4 and FT tested. " I think you meant FT3 rather than FT.

SlowDragon profile image
SlowDragonAdministrator in reply tovocalEK

Well spotted...yes

ert1542 profile image
ert1542 in reply toSlowDragon

Added my results to the post - would be good to get your thoughts!

SlowDragon profile image
SlowDragonAdministrator in reply toert1542

Ferritin - range suggests your male ...is that correct?

Ferritin far too low anyway.

What’s your diet like

Vegetarian or vegan ?

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

List of iron rich foods

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.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

ert1542 profile image
ert1542 in reply toSlowDragon

27 year old...female!

I have always really struggled to get my iron above 60 - even when I'm taking supplements, it is the one thing I struggle with.

Eat a balanced diet, could be better but it's certainly not full of junk food. I do not eat any gluten or dairy but other than that it's pretty good!

I'll take a look at the links, thank you!

SlowDragon profile image
SlowDragonAdministrator in reply toert1542

Vitamins likely low because you are under medicated

If gluten intolerant then poor gut function

Ft4 Is only 38% through range

Ft3 very low at 13.3% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

So you are not on high enough dose and are very poor converter

Looking for both Ft4 and Ft4 roughly similar % through range...typically 50-60% minimum

What vitamin supplements are you currently taking

Getting all four vitamins optimal should help improve conversion

B12 is too low

Folate ok, not brilliant

No vitamin D result

SlowDragon profile image
SlowDragonAdministrator in reply toert1542

As you are lactose intolerant see you are on Teva

There’s now two other lactose free brands available

Aristo and glen...something (will just look it up)

Probably need to be seeing a recommended thyroid specialist endocrinologist

Email Dionne at Thyroid UK for list

Low B12

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

With current B12 result taking a B12 supplement and a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

cytoplan.co.uk/vitamins/vit...

Vitamin D needs testing twice yearly when supplementing

vitamindtest.org.uk

SlowDragon profile image
SlowDragonAdministrator in reply toert1542

Glenmark is the other new lactose free levothyroxine

healthunlocked.com/thyroidu...

Sammie48 profile image
Sammie48

All i would recommend is do your blood tests while fasting , no medications and drink just water. Good luck

fuchsia-pink profile image
fuchsia-pink

Great if you can get all the testing SlowDragon recommends. Please make sure you get the full results (and lab ranges) from your blood tests - don't be fobbed off with "it's all normal" or "in range" - you are aiming for optimal. Last time I had bloods taken (early in the pandemic) I had to put my request for the results in writing - and dropped it off with the receptionist after seeing the phlebotomist - so you might want to go equipped with a note x

ert1542 profile image
ert1542

Thank you so much for all your replies

My GP surgery is totally useless where my hypothyroid is concerned as my results are usually in the "normal range" the just ignore the problems. However, I am due to see a private endocrinologist who is very good and was the person who originally diagnosed my hypothyroidism and prescribed the thyroxine.

I am going to request the following blood tests:

Full blood count

Ferritin

Folate

B12

Vitamin D

TSH

T3

FT4

FT3

I already have the antibodies so I am assuming I don't need to check the levels again, or do I need to get those looked at again? I cannot remember the name for that test.

Are there any others I should get while I'm there?

Thank you!

SlowDragon profile image
SlowDragonAdministrator in reply toert1542

No not necessary to retest antibodies

Louiss profile image
Louiss

I would ask for a full blood count particularly B12 and D3 along with your thyroid test. I recently thought my thyroid was responsible for me to being barely able to function I was so fatigued, it was B12 extremely low 150, having boosters every other day for two weeks then back on 12 weekly doses and I'm starting to feel better. Good luck hope your sorted soon.

elwins profile image
elwins

After having blood tests done make sure you get a copy of the results for your own files, I always keep a copy. Best of luck.

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