Thyroid test results. Can anyone help? - Thyroid UK

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Thyroid test results. Can anyone help?

Josiah150767 profile image
20 Replies

Hi All,

Just received my results which I had done privately.

Ferritin 267ug/L ( range 13-150)

CRP HS 2.66 mg/L (<5 )

Vit B12 121 pm01/L ( 37.5-187.5)

Vit D 61 pm01.L ( 37.5-187.5)

TSH 0.2m1u/L ( 0.27-4.2)

Free T3 4.37pm01/L (3.1-6.8 )

Free Thyroxine 16.1pmo1/L ( 12-22 )

Thyroglobulin Antibodies 13.4 Kiu/L (0-115 )

Thyroid Peroxidase Antibodies 9.94 Kiu/L ( 0-34 )

I have been advised that I have iron overload. I did have my thyroid checked by gp approx 3 mths ago and ferritin levels were normal. Also advised to go down to 50 mcg levothroxine due to tsh level being so low, but I had low tsh when I was taking 50mcg. I would be grateful if anyone could explain results. Thanks

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SlowDragon profile image
SlowDragonAdministrator

Post from 2 months ago gave these results

Tsh 0.05 range (0.2-5.5)

T4 17.4 ( 10-24.5)

ferritin 120ng/l (10-300)

Vit B12 265ng/l (180-1000)

folate 7.5ng/ml (>4).

So unlikely to have iron overload

What vitamin supplements are you currently taking

Josiah150767 profile image
Josiah150767 in reply toSlowDragon

Hi

I’m not taking any other vitamins at the moment as I wanted to get tested privately first

SlowDragon profile image
SlowDragonAdministrator in reply toJosiah150767

Only add one supplement at a time or make one change at a time (eg going GF)

Quite a noticeable difference between Serum B12 and active B12

Folate could be better

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

This can help keep all B vitamins in balance and will help maintain good B12 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...

SlowDragon profile image
SlowDragonAdministrator

Ft4 is only 41% through range

Ft3 only 34% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

More likely to need 25mcg dose increase in levothyroxine

Josiah150767 profile image
Josiah150767 in reply toSlowDragon

It’s persuading my gp to do that as he wants me to go down to 50mcg.

SlowDragon profile image
SlowDragonAdministrator in reply toJosiah150767

Extremely unlikely GP will do anything other than insist dose is reduced

Email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists

You are almost certainly going to need to see a specialist

tukadmin@thyroiduk.org

Probably looking at some degree of central hypothyroidism, pretty common with autoimmune thyroid disease, but rarely diagnosed

TSH is especially unreliable with autoimmune disease

guidelines on dose levothyroxine by weight

Even if we 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...

Jazzw profile image
Jazzw

Who said you have iron overload? Doesn’t look like it.

Don’t reduce your Levo dosage. If anything, according to your FT3 results you’re a bit undermedicated (TSH is not a reliable gauge once you start thyroid hormone replacement).

Josiah150767 profile image
Josiah150767 in reply toJazzw

Hi

It was the advice I got from the dr on medicheks

SlowDragon profile image
SlowDragonAdministrator in reply toJosiah150767

Dr on Medichecks is just a standard nhs Doctor who just looks at TSH

On levothyroxine, especially with Hashimoto’s TSH is irrelevant. Most important results are Ft3, followed by Ft4

You area to have negative thyroid antibodies. Have these been tested on nhs previously, were they ever high

Have you ever had Ultrasound scan of thyroid?

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Obviously with lupus it’s virtually guaranteed that thyroid is also autoimmune

Vitamin D is too low

1000iu is frequently not high enough dose for someone with autoimmune disease

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need to be on higher maintenance dose than 1000iu to keep it there. 2000-3000iu as maintenance dose not uncommon

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Calculator for working out dose you may need to bring to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

With your Vit D, are you also taking it's important cofactors - magnesium and Vit K2-MK7?

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

Josiah150767 profile image
Josiah150767 in reply toSlowDragon

Hi

I’m not sure if my antibodies have been high or were tested, and I have never had a scan. I’m have an app with a new rheumatologist in the next few days and was going to discuss this and I will mention about Vit D. I feel overwhelmed with it all at the moment as not feeling too well due to allergic reaction to hydroxychloriquine, but on a positive note I have made a start to sorting out my thyroid thanks to all the advice on this forum as I feel drs don’t take me seriously.

SlowDragon profile image
SlowDragonAdministrator in reply toJosiah150767

Ask for scan of thyroid at next rheumatologist appointment.

Josiah150767 profile image
Josiah150767 in reply toSlowDragon

Yes I will do and thanks for advice, it has helped a lot

fuchsia-pink profile image
fuchsia-pink

You don't say how you feel ... I'm guessing not great.

As SlowDragon says. your free T4 and free T3 are too low - most of us like these in the top third of range - and these are MUCH more important results than TSH, as the "frees" are you actual thyroid hormones, rather than just a message from the pituitary. I agree with her that an extra 25 mcg sounds sensible.

Your vit D is low - particularly after the excellent summer we've had - so you may want to boost that x

Josiah150767 profile image
Josiah150767 in reply tofuchsia-pink

Hi

I don’t feel well at the moment, more due to my lupus. I had a bad flare and my hydroxychloriquine was put up to 400mg. I had an allergic reaction, had to go to hospital.i was put on high dose of Vit D by rheumatologist, 4yrs ago and now take 1000 a day which is prescribed. But before this all happened, I knew something wasn’t right with my thyroid.

fuchsia-pink profile image
fuchsia-pink in reply toJosiah150767

Hope you can get a dose increase - ie your doc isn't over-obsessed with TSH. It may help to refer to how low in range your frees are ... but it's rubbish that it can take so long to get the right meds and feel well. But SlowDragon has given you lots of excellent advice :)

Good luck x

Josiah150767 profile image
Josiah150767 in reply tofuchsia-pink

Hi yes I hope so and lots of great advice from everyone, thankyou

SlowDragon profile image
SlowDragonAdministrator

As you have autoimmune disease are you on strictly gluten free diet?

lupusnewstoday.com/2016/10/...

Obviously a very high percentage of Hashimoto’s patients find strictly gluten free diet helps or is essential

Currently research is looking at all autoimmune disease possibly being linked to leaky gut

Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

healthcheckshop.co.uk/store...?

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Josiah150767 profile image
Josiah150767 in reply toSlowDragon

Hi

Yes I’m on an autoimmune paleo diet. It has helped quite significantly. I came off it to eat gluten to be tested for coeliac as my daughter is and started to feel unwell. I blame it starting my flare up. My test came back negative, but I’d only been gluten for about 3 wks.

SlowDragon profile image
SlowDragonAdministrator in reply toJosiah150767

How long have you been on auto paleo and gluten free before this?

If a long time, this might explain why Thyroid antibodies aren’t raised.

3 weeks is unlikely to be long enough back on gluten .....but vast majority of Hashimoto’s patients are gluten intolerant not coeliac.

Josiah150767 profile image
Josiah150767 in reply toSlowDragon

Hi

I had been on paleo for 4 to 5 wks and didn’t eat a lot of gluten before that as as I was aware that gluten was the problem

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