I previously had hyperthyroidism and a hemi thyroidectomy to remove a 6cm toxic nodule in late 2018. Since then I have been increasingly unwell. So I've paid for finger prick blood tests with thriva. And my results are interesting.
My ferritin is borderline at 17.5 ug/l (13-150)
My iron is also pretty low 9.93 umol (5.8-35)
My transferrin saturation is low 16.14% (20 -50)
My active b12 is borderline low at 46.6 pmol (37.5-188)
My folate is low at 7.59 nmol (8.8-60)
And interestingly my tsh is only 0.6 (0.27-4.2). Last check in late 2019 was 1.04 and it was 1.4 the check before that.
My t4 is within range at 19 (12-22) but on the upper end of what I would expect.
Last time I ended up hyperthyroid, it was the same, this slow dropping of tsh, and this slow rise of t3 and t4. Resulting in t3 toxicosis and technically normally t4 for a little while until that rose too. And I spent two years on anti thyroid meds trying to stabilise it. But I was tested for graves and they said it was not likely graves as I had no antibodies, it was this toxic nodule which they removed. I'm not sure if all my other deficiencies are affecting the thyroid or the other way around. Is that possible? Or if it will continue to drop, but if it does then I assume it must be graves? Because another toxic nodule is surely pretty unlikely? I did have a 2mm echo poor nodule on the other side when they first scanned the thyroid. But I can't feel anything on my remaining thyroid.
I've been struggling to eat due to extreme stomach pain, which isn't helping my deficiencies. And the GPs are refusing to see anyone here, because of covid. Hence paying for the blood tests. I also have a heap of other neurological type symptoms, and undifferentiated connective tissue disease. I would guess my tsh will drop below the lower levels by summer this year, based on how it is dropping.
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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 is another option that contain folate, but is large capsule
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
With such low B12 result taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
It is common for people who've been hyperthyroid to have a low TSH, and for that to be permanent, or at least long-lasting, perhaps for years, after treatment.
I've never been hyperthyroid, I've only ever been diagnosed with subclinical hypothyroidism. But you might find this thread of interest :
Some optimal levels are based on patient experience.
Ferritin : 50% of the way through the range or a bit higher i.e. 82 - 120 or 82 - 130.
Iron : 55% - 70% of the way through the range i.e. 21.9 - 26.2 Higher end of that range for men.
Transferrin Saturation : 35% - 45% ; Higher end of that range for men.
Active B12 : Recommended to be a minimum of 70, but optimal for many is over 100.
Folate : Top half of the range i.e. approx 35 - 60.
Your vitamin and mineral results are very poor and there is a possibility you are anaemic. You would need to get a Full Blood Count done to test that theory. But you have sufficient information already to show that you need to supplement, and possibly for quite a long time. It depends on how well you absorb supplements.
Your levels are really low, so it might be worth asking for advice on the Pernicious Anaemia (PA) Forum about what you should do. If they say there is no chance of you having PA then come back and we can suggest supplements and doses to you. But if you do need testing for PA then don't supplement until testing is over. You'll find the PA forum here :
I've been struggling to eat due to extreme stomach pain
Given your thyroid history and your low levels of nutrients you need testing for coeliac disease. It is probably worth asking for a Helicobacter Pylori test too.
If you drink a lot of alcohol and/or smoke that could exacerbate stomach pain. Low stomach acid causes gut pain too.
If you have coeliac disease then you would need to eat a completely gluten-free diet for life. But if you go gluten-free before coeliac testing you are likely to get a negative result.
For the coeliac testing to give an accurate result you have to be eating gluten when it is done, and for 6 weeks before the test. (It's referred to as a gluten challenge and involves eating a lot of gluten).
Apparently about 5% of people with thyroid disease also have coeliac disease. But 80% or more people with thyroid disease suffer from gluten intolerance rather than coeliac disease and benefit from giving up gluten anyway. (Some people get no benefit - there are no guarantees.)
Thanks to the replies. Unfortunately I cannot take any tablet supplements. They make my stomach issues much worse. I've been getting away with using vitamin d with k spray, and vit c, plus I take fish oils. Every other attempt to take a vitamin supplement has caused me issues. I've bought a b complex spray, with folate (not folic acid) so fingers crossed that will be OK. The vitamin b12 is active b12, not total b12, the ranges are different.
I did also have my vit d tested which is 73.8, almost in optimal range, it used to be very low. The spray helped at least.
My cholesterol is 4.71 but my hdl is only 1.14 and my total cholesterol/hdl ratio is abnormal at 4.12:1
I tested negative for h pylori and for coeliac disease but gluten does make me me worse so I have been limiting or avoiding it. My tsh has been normal since late 2018 when I had my surgery. It has just been slowly dropping. Before my surgery, for 2 years or so it was zero. So the fact its dropping makes me think something is up, but the fact i have all these vitamin deficiencies makes me wonder if something else is going on and that's just messing up everything else.
I can't really take iron supplements. I've been taking liquid iron water (spatone) for years but the iron deficiencies seem to be ongoing regardless. I cannot stomach iron tablets at all. I know many of my issues come from not being able to eat. I've lost a ton of weight because I cannot eat. Luckily I had the weight to lose. Probably not enough spare weight for another year though.
Thanks for all the links, I will read through them. My GP tells me they referred me for my stomach issues back in 2019, so tough luck, i'll have to wait. But I will try to get a full blood count, they currently won't see anyone. If I can supplement enough I may see some improvement in my very poor health.
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Suppressed TSH AND LOW T4
Query about suppressed TSH
Is Suppressed TSH dangerous?
TSH is now 'suppressed' at 0.08
