Can anyone advise me please. During an mri on my neck it was discovered that i had multiple cysts on my thyroid gland one in the front area that is 3cm. Subsequent ultrasound showed they were fluid filled and didn't appear to be of concern. Had bloods done at gp following this which showed tsh level was 0.26 and t3 was 6.1 and would be repeated in 3 months. After 3 attempts to speak to a gp regarding this i have now paid to get tested myself via thriva and these are the results.
active b12 83pmol/l (range 37.5-188)
ferritin 42ug/l (range 13-150)
folate 29.6nmol/l (range 8.83-60.8)
ft3 5.8pmol/l (range 3.1-6.8)
tsh 0.23miu/l (range 1-4.2) thriva said this is abnormal
tgAB 14ku/l (range 0-300)
TPOAb 87.5kiu/l (range 34-200) thriva said this is abnormal
t4 113nmol/l (range 66-181)
ft4 16.9pmol/l (range 12-22)
vitamin d 55nmol/l (range 50-175) thriva said needs improving
The report says I need to repeat in 2 months and speak to gp in the meantime but this still doesn't explain what these results mean and I'm worried sick. Any help would be so appreciated. Thank you
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Natasha5
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Could you please edit your post to include the lab ranges as they do vary from lab to lab so are needed in order to interpret. The only one that looks on the low side at a glance is your vitamin D but without lab range we can't be sure.
Thriva's results are notorious for being confusing if you are looking at the coloured bar graphs which show "optimal", "normal", etc. Ignore these and go to the downloadable pdf which lists them like this and shows the normal range:
I have based my comments on you not taking any supplements, if you do take supplements please advise.
active b12 83pmol/l (range 37.5-188)
This result isn't too bad but a level of 100+ would be better.
ferritin 42ug/l (range 13-150)
This is too low and ferritin is recommended to be half way through range. However, don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
This isn't too bad, folate is recommended to be at least half way through range so that would be 35+ with that range
vitamin d 55nmol/l (range 50-175) thriva said needs improving
This is only 5 points into the "sufficient" category. The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L.
To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 4,000-5,000iu D3 daily.
Retest after 3 months.
Once you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
tsh 0.23miu/l (range 1-4.2) thriva said this is abnormal
Range is actually 0.27-4.2 so you are a touch below range.
ft4 16.9pmol/l (range 12-22)
This is 49% through range.
ft3 5.8pmol/l (range 3.1-6.8)
This is 72.97% through range which is good.
t4 113nmol/l (range 66-181)
Total T4 is not a particularly useful test, it's FT4 that is the one that tells us what we need to know. Total T4 measures the total amount of T4 which is both bound to proteins and unbound. It's the unbound (free) T4 that is important.
tgAB 14ku/l (range 0-300)
The range for TG antibodies is <115 so yours are nice and low.
TPOAb 87.5kiu/l (range 34-200) thriva said this is abnormal
The range for TPO is <34 so your TPO antibodies are elevated and suggest autoimmune thyroid disease, known to patients as Hashimoto's. This is where the immune system attacks and gradually destroys the thyroid leading to hypothyroidism.
With Hashi's it's common for symptoms and hormone levels to fluctuate. Hashi's often starts with a "hyper" episode where TSH is low and FT4/FT3 levels are high, this is not hyperthyroidism but a "false hyper" where excess hormone is released into the blood during an immune attack and then things settle down and hormone levels drop and can become low and you can have hypo symptoms. FT4 and FT3 are the thyroid hormones, TSH is a pituitary hormone not a thyroid hormone. Generally, when TSH is high then FT4/FT3 tend to be low (hypo), and when TSH is low then FT4/FT3 tend to be high (false hyper when Hashi's is present).
To be diagnosed with Hashi's by the NHS you would need an over range TSH with raised antibodies and then an enlightened GP would diagnose and prescribe Levothyroxine. In Primary Hypothyroidism (non-Hashi's) doctors wait until TSH goes over 10 before diagnosis.
Some members have found that when Hashi's is present then adopting a gluten free diet can help although there is no guarantee. Supplementing with selenium l-selenomethionine (100-200mcg daily) can help reduce antibodies.
That's right, you'll get some good responses now. Looks like TPO antibodies are elevated although it's within the range given. Usually we see above around about 30 meaning elevated. If this is the case then you have thyroid antibodies which is indicative of Hashimotos thyroiditis.
Definitely retest at GPS in 3 months. You do need to supplement vitamin D but unlikely to get a prescription as its just within range. Vit D is said to be best around 100 - 150 nmol/L according to the vitamin D Society.
That sounds like you have a multinodular goiter which I also have and can cause symptoms. I have regular ultrasounds every few years to make sure none of the nodules have got bigger.
Thyroid cysts: These are growths that are filled with fluid or partly solid and partly filled with fluid. Inflammatory nodules: These nodules develop as a result of chronic (long-term) inflammation (swelling) of the thyroid gland. These growths may or may not cause pain.
High TPO antibodies confirms autoimmune thyroid disease also called Hashimoto’s
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
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
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
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.
Extremely common with Hashimoto’s to have low vitamin D and Very important to improve vitamin D to at least around 80nmol and around 100nmol maybe better
Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.
Thank you so much, that's so helpful. My gp has failed to ring on 3 separate occasions and has listed me as being symptom free, which I disagree with. Its such a worry when you have no idea what is going on. I can't thank you all enough for all the advice and links you've given me
I'm trying to get the gp to do a referral but he won't return my calls!! I'm going to keep pushing though as I'm concerned about them, one is 3cm in size
With Graves disease one would expect to see a suppressed or undetectable TSH with over range FT4 and FT3, none of which the OP has. Her results point to Hashi's.
If the OP wishes to pursue testing for Graves disease then she can ask her GP and this she would have to be referred to an endocrinologist, it isn't done in primary care, and routine hospital appointments on the NHS here in the UK in the present Covid climate are virtually non-existent.
Just wanted to give an update. Finally spoke to gp and after much pushing he's agreed to refer me for the cysts to be investigated further and he agreed that results indicitive of hashimotos. He said he doesn't want to start any sort of medication until he has no choice though
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Thriva for blood tests?
TEST RESULTS FROM THRIVA
Blood test results - advice please
Thriva results
