Having been under the GPs radar for the last 18months due to possible thyroid/peri menopause issues I have just had another blood test (been having severe pain in legs, exhaustion, weight gain) and the results came through online yesterday. I have a telephone appointment with GP next Wednesday but wondered if anyone can give me any information on my results in the meantime. These are the items that are flagged as requiring action or borderline that I assume the GP wants to discuss. I’m
You need at least 50 mcg of levo prescribing - your TSH is now well over range, and over the "magic" 10 at which even really dozy GPs wake up! And free T4 is on the floor. You must feel dreadful. Ferritin is too low. Did they test folate, vit D and B12? - these are the other nutrient tests recommended by Thyroid UK.
Once you get your levo, take it just with water, 2 hours after or 1 hour before any other food or drink (doesn't matter if that's first thing, last thing or you split the dose). Book another blood test for 6 -8 weeks later - ALWAYS as early as you can, and always fasting. Leave 24 hours from your previous dose of levo (take the next dose afterwards). See if they will also test free T3.
The aim once you're on levo is for TSH to come down to less than 2 (prob less than 1) and for free T4 and free T3 to be in the top third (or higher) of their lab ranges. Post your next results when you get them and the lovely people here will help you to understand them.
Thank you for taking the time to reply, these were the b12 and folate results
SERUM B12 AND FOLATE
Serum vitamin B12 level 157 ng/L [180.0 - 915.0]
Below low reference limit
Serum folate level 14.1 ug/L [3.1 - 19.9]
SERUM FOLATE COMMENT
Yes I do feel terrible, so tired and my bones hurt so much especially at night I am taking ibruprofen constantly just to get some sleep! My hair is terrible and I look like an old lady suddenly (I’m 52) I’ve put on lots of weight despite doing keto and running 3 times a week.
fuchsia-pink has confirmed that your results show overt hypothyroidism with a TSH level over 10 and FT4 that has barely scraped into range. If your GP offers 25mcg then politely challenge this. New guidelines state:
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.
1.3.7 Consider starting levothyroxine at a dosage of 25 to 50 micrograms per day with titration for adults aged 65 and over and adults with a history of cardiovascular disease.
Tests for follow-up and monitoring of primary hypothyroidism
1.4.1 Aim to maintain TSH levels within the reference range when treating primary hypothyroidism with levothyroxine. If symptoms persist, consider adjusting the dose of levothyroxine further to achieve optimal wellbeing, but avoid using doses that cause TSH suppression or thyrotoxicosis.
1.4.2 Be aware that the TSH level can take up to 6 months to return to the reference range for people who had a very high TSH level before starting treatment with levothyroxine or a prolonged period of untreated hypothyroidism. Take this into account when adjusting the dose of levothyroxine.
Adults
1.4.3 For adults who are taking levothyroxine for primary hypothyroidism, consider measuring TSH every 3 months until the level has stabilised (2 similar measurements within the reference range 3 months apart), and then once a year.
1.4.4 Consider measuring FT4 as well as TSH for adults who continue to have symptoms of hypothyroidism after starting levothyroxine.
This starter dose approach - dose by weight - may or may not suit you, it doesn't suit everyone. Before these new guidelines came into being, the protocol was to start on 50mcg (unless a child, elderly or with a heart condition then it would be 25mcg) and retest every 6 weeks increasing 25mcg each time until symptoms abate and you feel well. This may be a better approach for you. Whichever, don't let your GP start you on 25mcg, it just prolongs the agony.
Serum C reactive protein level 11.4 mg/L [0.0 - 5.0]
This is an inflammation marker (although non-specific) so yours is well over range. If your hypothyroidism is caused by autoimmune disease then this causes inflammation so could possibly be the cause. To know if you have autoimmune thyroid disease (known to patients as Hashimoto's) then you'd need thyroid antibodies checking - Thyroid Peroxidase (TPO) and Thyroglobulin (Tg) so you could ask your GP to test these. It wont make any difference to your treatment, Hashi's isn't treated, it's the resulting hypothyroidism that is treated, but it would be good to know if this is the cause because there are things you could try that may help.
Hashi's causes gut/absorption problems and can lead to low nutrient levels, and a couple of yours are dire, so this is another reason to check for Hashi's.
Serum ferritin level 25 ug/L [11.0 - 307.0]
This is way too low, although GP will say it's fine because it's within range. However, it's only 4.73% through range and you should discuss this with your GP. Point out that someone with your level at 4.73% through range will feel very different from someone whose level is 50% or 75%, etc, through range.
Low ferritin can suggest iron deficiency or iron deficiency anaemia. An iron panel would show iron deficiency and a full blood count would show anaemia, so if these haven't been done then ask for them.
Serum vitamin B12 level 157 ng/L [180.0 - 915.0]
This is below range so suggests B12 deficiency. Your GP should have noted this and be investigating further. Ask to be tested for Pernicious Anaemia, this is another autoimmune disease and if you do have Hashi's then it's quite possible you have PA, one autoimmune disease can often mean there are others.
Do not take any B12 supplement or folate or B Complex until further testing for B12 deficiency/PA.
Check these links which list signs of B12 deficiency:
If you have any then list them to discuss with your GP and insist on further testing.
Yes I do feel terrible, so tired and my bones hurt so much
This may be due to low Vit D level. As your ferritin and B12 levels are dire, it's quite likely that your Vit D level is too. Ask your GP to test. If you are refused then do a blood spot fingerprick test with this NHS lab that offers it to the public for £29:
Please come back with your result, regardless of what it is, for further help.
P.S. I would ease off on the running for now. Your thyroid results are so dire that your FT3 level will most likely be very low. Hard exercise depletes T3. T3 is the active hormone that every cell in our bodies need. It would be best to just do gentle exercise at the moment, eg walking, yoga, etc.
You need to be prescribed levothyroxine which you take, fasting, with one full glass of water and wait an hour before eating as food would interfere with the uptake of levo.
Most members take their dose when they get up and wait an hour before eating but others may prefer a bedtime dose but our stomach has to be empty.
All blood tests for thyroid hormones have to be at the earliest - before taking levothyroxine (TSH is highest then) and it is a fasting test (you can drink water) and wait an hour before eating.
A raised TPOab test is an indication that you are likely to go on to eventually become clinically hypothyroid ( with over range TSH and under range fT4 )and need replacement hormone (Levothyroxine) This raised result from last year is partly why they have been keeping an eye on your thyroid results.
They are just used to confirm the cause of hypothyroidism as being Autoimmune hypothyroid (the most common reason in UK), rather than something else.
There is no treatment as such for the antibodies themselves.
Just a little update, my gp has referred me to a rheumatologist as I have a raised factor there. Also I have started on a course of b12 tablets which may be replaced by injections if they don’t work. More
Blood tests booked. Also have been started on a dose of thyroxin. Still feel crap and the pains in my legs are getting worse but I knowing is going to be a bit of a long slog to get sorted.
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