What do I ask my GP when they call later ?

[Discodiva1]

Struggling with low energy, hair loss, low mood and disturbed sleep pattern. I started 100mcg of Levothyroxine in April when I discovered a TSH of 55.5 and T4 of 4.7. I asked for repeat bloods including T4 and I have TSH but no T4 :-(. My results are:

TSH 0.83

B12 537 ng/L

Folate 11.9ug/L

Hb 10.6

Haematocrit 0.327

I would add that I did feel a lot better on Levo for first 3 months and then brand changed packaging and became Northstar still Accord so not sure if anything actually changed with meds.

I need to speak to my GP later and I am frustrated they did not redo my T4 level. What else can I do to improve my symptoms and help can I ask GP for (they failed to diagnose me since I had my son I have been presenting at practice with all the symptoms and was written off as tired depressed overweight mum with bowel problems )

Thanks for your help

Thankyou

[Barrister]

It would help to have the ranges but even without them, I am see that you are anaemic, your Hb is low.

Clemmie

[Discodiva1 in reply to Barrister]

Thanks Clemmie I just spoke to them. I am going to get some iron prescribed even though I don’t tolerate it well.

[SeasideSusie Remembering]

Welcome to the forum Discodiva1

When posting test results, we always need the reference ranges please as these vary from lab to lab. It's not so essential with TSH because the ranges are all very similar.

Your current TSH level of 0.83 is good. However, testing TSH alone is not an indication of thyroid status. It's fine for diagnosing thyroid conditions but once on thyroid hormone replacement it's not particulalrly useful as it's not a thyroid hormone, it's a pituitary hormone which sends a signal to the thyroid. The thyroid hormones are FT4 and FT3 so even though you have a decent TSH level, it's essential to see FT4 and very important to see FT3.

It's possible that you may have a good level of FT4 but if your FT3 remains low this will cause symptoms. Unfortunately, very few doctors are aware of the importance of testing FT4 and FT3.

Did you have a test 6 weeks after starting Levo? That is the normal protocol and an increase in dose if necessary. Or did you have to ask for this recent test?

Normal protocol is to retest 6 weeks after starting Levo, increase dose if necessary, retest 6-8 weeks later. Retesting is necessary 6-8 weeks after any dose change, also after any brand change.

Northstar 50mcg and 100mcg tablets are Accord and as far as we are aware there has been no change to the forumula. Northstar 25mcg are made by Teva.

I think what you should do when you speak to your GP is point out all the symptoms you are still experiencing, say that even though your TSH is at a good level this is a pituitary hormone rather than a thyroid hormone, would he please test the thyroid hormones - FT4 and FT3 - because if these are low then they will be causing the symptoms.

B12 537 ng/L (ng/L and pg/ml are the same)

This is a bit low but your GP wont think so because it will be within range. 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."

If you wish to improve your level you will need to buy a supplement yourself.

Folate 11.9ug/L

Impossible to comment without a range, they vary so much.

You could supplement with a good quality, bioavailable B Complex which will help both B12 and folate. Consider Thorne Basic B or Igennus Super B.

Hb 10.6

Haematocrit 0.327

Again, impossible to comment without the ranges. Was this all that was done or did you have the Full Blood Count?

Were Vit D and Ferrritin tested? These are very important too.

[Discodiva1 in reply to SeasideSusie]

Thankyou Seaside Susie

That’s really helpful

I will put ranges next time I post. I spoke to my GP about FT4 level missing from results and he said if TSH is normal then they don’t proceed to check T4.

I have decided to get a full thyroid and vitamin check via Thriva as I actually was diagnosed this way not via my GP.

I will definitely get a B12 supplement as I agree I could optimise that.

Does having a poor iron status mean that thyroxine I have is not working as well ?

Thanks again Disco

[SeasideSusie Remembering in reply to Discodiva1]

Discodiva1

I will definitely get a B12 supplement as I agree I could optimise that.

It's not a stand alone B12 supplement that you need, it's a B Complex which contains all 8 B vitamins, including B12. They need to be kept in balance. If your B12 level was low enough to need a B12 supplement, you'd still need a B Complex to keep the B vits in balance. I mentioned two brands in my previous reply.

Does having a poor iron status mean that thyroxine I have is not working as well ?

From nahypothyroidism.org/deiodi...

Iron deficiency

Iron deficiency is shown to significantly reduce T4 to T3 conversion, increase reverse T3 levels, and block the thermogenic (metabolism boosting) properties of thyroid hormone (238-242). Thus, iron deficiency, as indicated by an iron saturation below 25 or a ferritin below 70, will result in diminished intracellular T3 levels. Additionally, T4 should not be considered adequate thyroid replacement if iron deficiency is present.

To know if you have iron deficiency you would need an iron panel to include Serum Iron, Ferritin, Transferrin Saturation and Total Iron Binding Capacity.