Help with blood results

[jsy_girl]

Hi all just had updated blood test results and wanted to check interpretation before I speak to GP on Monday.

Previous post here: healthunlocked.com/thyroidu...

9 sept:

Full blood count

Haemoglobin concentration 123 g/L [115.0 - 165.0]

Total white blood count 6.6 10*9/L [4.0 - 11.0]

Platelet count - observation 253 10*9/L [150.0 - 400.0]

Haematocrit 0.36 L [0.37 - 0.46]

Below low reference limit

Red blood cell count 3.98 10*12/L [3.8 - 5.8]

RDW 13.9 % [11.0 - 14.8]

Mean cell volume 91.2 fL [80.0 - 100.0]

Mean cell haemoglobin level 31.0 pg [27.0 - 32.0]

Mean platelet volume 11.1 fL

Neutrophil count 3.41 10*9/L [1.7 - 7.5]

Lymphocyte count 2.05 10*9/L [1.0 - 4.5]

Monocyte count - observation 0.47 10*9/L [0.2 - 0.8]

Eosinophil count - observation 0.59 10*9/L [0.0 - 0.4]

Above high reference limit

Basophil count 0.09 10*9/L [0.0 - 0.1]

Serum ferritin level 23 ng/mL [15.0 - 300.0]

Ferritin >15 and <100ng/mL. With low Hb and MCV,

a normal ferritin in the presence of inflammatory

changes does not exclude iron deficiency.

Thyroid function test

Serum TSH level 4.98 mu/L [0.3 - 5.0]

Serum free T4 level 13.2 pmol/L [7.9 - 16.0]

Thyroid function test

Serum free triiodothyronine level 4.9 pmol/L [3.8 - 6.0]

So I’m thinking ferritin testing is odd. Medichecks ferritin seemed to suggest my levels were pretty good but NHS test is low again (although slightly better....I’ve been eating a lot of liver pate)... anyone else experienced this?

Haematocrit levels low and eosinophil high (which it was before)... I’ll ask Doctor about this as what’s the point of there being a range if it doesn’t mean anything.

TSH has come down and fT3 has gone up but only a tiny amount. Think I need another dose increase. FT4 looks more normal than it did last time. In terms of conversion though it doesn’t look too bad to me?

TIA

[fuchsia-pink]

Serum TSH level 4.98 mu/L [0.3 - 5.0]

This is still too high. Once you are on levo the aim is for TSH to reduce to less than 2, probably less than 1

Serum free T4 level 13.2 pmol/L [7.9 - 16.0]

This is 65% through range which is ok - although I like my level higher

Serum free triiodothyronine level 4.9 pmol/L [3.8 - 6.0]

This is 50% through range which again isn't high enough for me ...

... so I agree a dose increase makes sense. Good luck x

[jsy_girl in reply to fuchsia-pink]

Yes I thought definitely TSH could be lower (much lower) but I was surprised by T4 and t3 being not too bad in the grand scheme of things. Hopefully another dose increase and I can really get things moving.

I have been supplementing b vitamins and vitamin d so maybe this has been helping despite my ferritin being low.

[SlowDragon Administrator]

Aim is to bring a TSH under 2.5

gp-update.co.uk/SM4/Mutable...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

Median TSH graph of healthy population

healthunlocked.com/thyroidu...

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine 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...

[jsy_girl in reply to SlowDragon]

Thanks SlowDragon - I wondered about citing this dosage at the doctor again and now i've titrated up from 50 to 100 wondered instead of skipping to 125, going straight to the dosage according to my weight, which would currently be 132. Do they do a tablet around that amount, would that be 137.5?

I think your link to detail on NHS guidance is to get it under 2.0 would be useful as my GP seems sympathetic but was quoting 3.0. The link however doesn't seem to work for me. Would you mind resending it or directing me to how I can find it with the right search terms on google or something? thanks a lot