Had my thyroid checked in Cyprus. Fed up with 'out of range' results being ignored by my GP

[A1Amber]

As many people feel I am sure I was reluctant to speak to my GP about my blood results and descriptions of how I felt. I recently visited Cyprus and after more 'woozy' feelings booked in for blood tests. The Dr wasn't an endocrinologist but organised my tests. The TSH T3 T4 looked fine. The Dr looked at my Anti TPO and Anti TG and decided on an ECG. He diagnosed tachycardia and suggested this be a result of the thyroid. I also had an ultrasound on my thyroid and was told it was destroyed due to chronic thyroiditis. I have this information now am now on betablockers and the 'woozy ' has stopped. I take 200mg thyroxine and have done for the last 2 years but don't really know what all this means going forward. Any suggestions welcomed.

[humanbean]

If you could post your results and reference ranges we could give you some feedback. If you got any nutrient testing done then posting those results would be helpful as well.

Regarding the beta blockers and the tachycardia, beta blockers are actually not something to take permanently if it can be avoided. And if you've been on them for more than a few days you would need to wean yourself off them slowly. But you shouldn't do this unless you can find and fix the cause of the tachycardia.

Read the Patient Information Leaflet for references to beta blockers and thyroid disease.

Having low iron and/or ferritin (iron stores) can cause tachycardia. So, fixing that might remove the need for beta blockers in the first place.

Low B12 can also affect the heart, and for the body to make use of B12 properly it needs a good level of folate.

Some prescribed drugs may affect your heart too.

[A1Amber in reply to humanbean]

Thank you. I will list my blood results. Would you mind looking over them please?

[humanbean in reply to A1Amber]

Okay. Other people will be able to comment too.

[A1Amber in reply to humanbean]

Ferritin 80.08 ng/ml range 10 - 329

Vitamin D 14.9 ng/ml desirable level >30

Folate 3.34 ng/ml 4.6 - 18.7

Vitamin B12 473.5 pg/ml 197 - 221

TSH 0.30 mIU/L 0.27 - 4.2

Free T4 17.34 pmol/L 12 - 22

Free T3 4.18 pmol/L 3.4 - 6 8

Thyroperoxidase >600.0 IU/ml <34

Thyroglobulin 3302 IU/L <115

[humanbean]

I forgot to say...

There are various kinds of tachycardia. If you've been told what kind of tachycardia you have it would help you to research the condition.

en.wikipedia.org/wiki/Tachy...

[shaws Administrator]

When you're having your thyroid hormones checked, do you allow a gap of 24 hours of between last dose and test and have the earliest blood draw? Have your vitamins/minerals also been checked?

[SlowDragon Administrator]

So for For full Thyroid evaluation you 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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Were vitamins tested

Please add actual results and ranges

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)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Which beta blocker are you prescribed?

[A1Amber in reply to SlowDragon]

Yes. Followed all your recommendations.

[SlowDragon Administrator in reply to A1Amber]

Which beta blocker are you prescribed?

Have you had coeliac blood test done yet?

[SlowDragon Administrator]

Do you always get same brand of levothyroxine?

If yes, which brand

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

Low vitamin levels affect Thyroid hormone working

This can lead to high Ft4 and low Ft3......can cause palpitations

Low iron/ferritin or magnesium can cause irregular heart rate too

Poor gut function of Hashimoto’s 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)

Are you currently on strictly gluten free diet?

If not .....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.

[humanbean]

Ferritin 80.08 ng/ml range 10 - 329 --- 22% of the way through the range

Vitamin D 14.9 ng/ml desirable level >30 --- Deficient

Folate 3.34 ng/ml 4.6 - 18.7 --- Deficient

Vitamin B12 473.5 pg/ml 197 - 221 --- The reference range looks wrong, please check

TSH 0.30 mIU/L 0.27 - 4.2

Free T4 17.34 pmol/L 12 - 22 --- 53% of the way through the range

Free T3 4.18 pmol/L 3.4 - 6 8 --- 23% of the way through the range

Thyroperoxidase >600.0 IU/ml <34 --- Shows you have Hashimoto's Thyroiditis

Thyroglobulin 3302 IU/L <115 --- Shows you have Hashimoto's Thyroiditis

Your Free T3 is far too low for most people with thyroid disease to do well and feel well. Your Free T4 is barely over mid-range. Many people prefer their Free T4 to be higher. But the biggest problem is your Free T3. It probably needs to be a minimum of halfway through the range or higher. There are a substantial number of hypothyroid people who feel at their best with their Free T3 and Free T4 well over mid-range and possibly up to 70% or 80% of the way through the range. The balance of T4 and T3 is individual to the person, so it isn't possible to say what will eventually work for you - we all have to do our own experimenting.

The thyroid produces T3 itself, but yours has been destroyed by Hashi's so it probably produces absolutely nothing. The other source of T3 in the body is by conversion from T4 to T3, which occurs in various organs throughout the body, particularly the liver and kidneys.

One of the most important factors in converting well is having good levels of nutrients. And yours are all very poor indeed.

Vitamin D - You can calculate your own dose of vitamin D supplement using this link :

grassrootshealth.net/projec...

You will need a loading dose to start with since your level is so low. Vitamin D3 (NOT D2) is available from all sorts of sites selling supplements, including Amazon, Ebay and lots of other places. The best kind of D3 supplement is in a small capsule which just contains vitamin D3 and olive oil. If you can't find that then D3 and sunflower or vegetable oil in a capsule will be okay - you'll only be taking a drop or two of the oil in the capsule per day anyway. Take vitamin D3 with your fattiest meal of the day since it is a fat-soluble vitamin.

You also need to take vitamin K2 and magnesium to get the best from the vitamin D3. If you search the forum you'll find lots of replies about K2 and magnesium. SeasideSusie's replies are particularly helpful.

Folate - You will need to supplement. Doctors usually prescribe folic acid in cases like yours, but the better supplement is methylfolate. Folic acid was developed in a lab in 1943. No human had ever taken it before then, they had got their folate from food. For more info on methylfolate and folic acid this link is very good :

chriskresser.com/folate-vs-...

You will need 1000 mcg per day, which you will find on supplement sites.

Vitamin B12 - You will need to raise your level to a minimum of 500, but preferably up to 1000. The best type of supplement is methylcobalamin. You will need to start on a dose of 1000mcg per day. A useful link on the subject :

stichtingb12tekort.nl/engli...

For all the above, once you have got your levels to optimal you can either reduce the number of days a week you take a supplement or you can buy a lower dose of supplement. Some people buy one bottle (covering two months) of a supplement just for a couple of months then reduce to a lower dose after the first bottle. Preferably people will test to be sure of what they are doing.

I'll post this and write about ferritin in a new post, rather than possibly lose everything I've written.

[A1Amber in reply to humanbean]

Thank you very much. I've never had such a comprehensive view of my vitamin levels. I have been prescribed some vitamins but just finishing off at work. May I contact you and give you the details of these?

[humanbean in reply to A1Amber]

Yes, but just reply to this post, then others can comment as well if they want to.

[humanbean]

Ferritin 80.08 ng/ml range 10 - 329 --- 22% of the way through the range

Ferritin is a measure of your iron stores - one molecule of ferritin contains up to 4,500 atoms of iron.

For the body to make use of iron it needs to be released from ferritin into the bloodstream where it gets carried to wherever it is needed. Iron moves back and forth from "free" or serum iron to ferritin and back again day and night all the time.

It is possible to have the following situations arise (ignoring the optimal situations) :

Low iron with low ferritin

Low iron with high ferritin

High iron with low ferritin

High iron with high ferritin

Each of the above situations can mean different things. As a result it is not a good idea for someone to take iron supplements when they have low ferritin without knowing what their serum iron level is. Alternatively it is not a good idea to supplement iron when iron is low if you don't also know the ferritin. Please read this link plus all the replies :

healthunlocked.com/thyroidu...

If you can get an iron panel done first (with a fingerprick test) it would be helpful. Incidentally, a doctor would say your ferritin was absolutely fine. But you would feel much better with optimal ferritin and iron.

medichecks.com/iron-tests/i...

healthunlocked.com/thyroidu...

The above discount code is old, but as far as I know it is still active. Medichecks also has other discounts, usually on a Thursday. It is worth registering with them so you get notification of their special offers via email.

Optimal ferritin is roughly mid-range or slightly higher. So for the range you've been given you would probably feel best with a result of around 170 - 200.

For other iron-related measures see this link :

rt3-adrenals.org/Iron_test_...

If you get an iron panel done you should post the results in a new post and ask for feedback, then we can advise on the kinds of iron supplements available and what dose you might need. I wrote a reply to another member on the subject of iron supplements :

healthunlocked.com/thyroidu...

[A1Amber in reply to humanbean]

I do have my Iron result.

67 ug/dl 49 - 51

The blood tests I had show 38 results. Very comprehensive should I know what to do with them!

[A1Amber in reply to A1Amber]

I mean 151.

[humanbean in reply to A1Amber]

Ferritin 80.08 ng/ml range 10 - 329 --- 22% of the way through the range

Iron 67 ug/dl 49 - 151 - Approx 18% of the way through the range

Do you have results for any of the following :

Transferrin or transferrin saturation

TIBC (Total Iron Binding Capacity).

Haemoglobin

If you do could you post them, please.

[A1Amber in reply to humanbean]

Sorry for delay in replying.

Haemoglobin 13.5 g/dl Reference values F 12 - 16

The Dr in Cyprus prescribed Betabloc ZOK 1 x 25mg daily Vit D3 1 x 5,000iu daily

Folic Acid 1 x 5mg daily

I used Ask the Dr to tell my GP what I have been prescribed. He told me he is not interested in Antibodies just the normal thyroid results. He asked that I drop in all my paperwork from Cyprus and he will get back to me.

[humanbean in reply to A1Amber]

Folic Acid 1 x 5mg daily

The problem with folic acid (which is synthetic) is that it has to be converted to folate in the body. And there are lots of people who can't do this conversion very well. So they end up with lots of folic acid that their body can't do much with. This is why it is better to supplement with methylfolate or the other compounds suggested in this link :

chriskresser.com/folate-vs-...

You would need a dose of 1000mcg per day.

Haemoglobin 13.5 g/dl Reference values F 12 - 16

This is not bad at all. It is fairly well into the range and indicates that you are not currently anaemic.

Ferritin 80.08 ng/ml range 10 - 329 --- 22% of the way through the range

Iron 67 ug/dl 49 - 151 - Approx 18% of the way through the range

Both your ferritin and your iron are too low.

Ideally your ferritin would be raised to mid-range or a bit higher, say 170 - 200 with the range you've given.

Ideally your iron would be raised to 55 - 70% of the way through the range i.e. around 105 - 120, according to this link :

rt3-adrenals.org/Iron_test_...

You will need to supplement to raise your iron and ferritin. I wrote about iron supplementing, how to go about it and what options are available, in this reply to someone else - please follow all the links :

healthunlocked.com/thyroidu...

Good luck.

[Thenightowl]

Yes folate far too low. For your body to use the b12 that you have, it needs to be much higher, aim for top quarter of range. B12 and folate work together.

When my folate was low I started to become quite mentally unstable, this totally resolved after just a few weeks of methylfolate. I'm at last on injections for my b12 deficiency, my levels plummeted after I raised my folate... And I've had repeated low b12 tests since I was a teenager which were not treated with injections as per the NICE guidelines. Please note, any b12 supplements or energy drinks may skew test results for over 4 months (maybe a lot longer), something to bear in mind if you start to get deficiency symptoms in the future. The Facebook 'b12 wake up' has excellent information if needed.

Best of luck.