Results please help: Hi All Please could you... - Thyroid UK

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Results please help

Quyejoyce1 profile image
12 Replies

Hi All

Please could you help and advise on the attached results?

My case is very complicated as I have congenital heart structural disease so I have had arrhythmia issues too. I recently had my pulmonary valve replaced but my heart remains enlarged and the arrhythmia despite a maze procedure I’ve now had an ICD fitted.

Yet still getting palpitations. I was previously diagnosed with sub clinical hypothyroidism but tests stopped due to the above heart needs.

Hopefully, this will give me the final answers

What do the results below mean? Thank you

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Quyejoyce1
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SlowDragon profile image
SlowDragonAdministrator

Previous post from year ago showed similar hypothyroid results

And low vitamin levels as direct result

TSH 6.09 (0.27-4.2)

T4 16.3 (12-22)

Serum folate 2.8 (3.9-26.8)

Serum ferritin 18 (30-400)

B12 255 (191-663)

As this was 2nd abnormal thyroid result you should have been started on 50mcg levothyroxine a year ago

No vitamin D test done?

Obviously likely to have low folate, ferritin and B12 again unless supplementing

Are you getting regular B12 injections

Being hypothyroid causes low vitamin levels

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

See GP and get started on levothyroxine

Get all four vitamins retested

Standard starter dose of levothyroxine is 50mcg

Bloods should be retested 6-8 weeks after each dose increase

Dose is increased slowly upwards in 25mcg steps over several months until typically on at least 100mcg levothyroxine per day

See flow chart on here

gp-update.co.uk/Latest-Upda...

Enlarged heart can be due to being hypothyroid

mayoclinic.org/diseases-con...

Quyejoyce1 profile image
Quyejoyce1 in reply to SlowDragon

Thank you SlowDragon, yes they didn’t do the antibodies last year and insisted my surgery to replace my pulmonary valve and arrhythmia was undertaken first. So they wouldn’t start medication until after then. I always have low ferritin and folate. Vit D and B12 have been low previously.

Super glad to finally be making progress even if it means I have gone full circle over the last 18 months or so.

SlowDragon profile image
SlowDragonAdministrator in reply to Quyejoyce1

As this is now 3rd high TSH result and high thyroid antibodies, you should be starting on levothyroxine

They may want to start cautiously on 25mcg

How old are you?

I always have low ferritin and folate. Vit D and B12 have been low previously.

Vitamins are likely low BECAUSE you are hypothyroid

How low are they currently and what vitamin supplements are you taking

When hypothyroid we frequently need to supplement Vitamins virtually continuously to maintain optimal vitamin levels

Hypothyroidism results in low stomach acid and as result poor nutrient absorption

Quyejoyce1 profile image
Quyejoyce1

Hi SnapDragon

I’m 45. I need a full set of vitamin tests as I’ve had an iron transfusion since the last set was taken. My haemoglobin was severely low after a blood transfusion during my operation.

I’m not currently taking any supplements. I was taking folic acid and iron but advised to stop after the iron transfusion in November.

SlowDragon profile image
SlowDragonAdministrator in reply to Quyejoyce1

Ask GP to test vitamin D, folate and ferritin levels

Are you still getting B12 injections?

All Patients with autoimmune thyroid disease should have vitamin D tested annually (but rarely do)

pubmed.ncbi.nlm.nih.gov/286...

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.

pubmed.ncbi.nlm.nih.gov/273...

Vitamin D insufficiency was associated with AITD and HT, especially overt hypothyroidism. Low serum vitamin D levels were independently associated with high serum TSH levels.

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

The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.

Quyejoyce1 profile image
Quyejoyce1 in reply to SlowDragon

Doctor is refusing to treat my thyroid without advice from an endocrinologist. It’s so frustrating as I’ve been going in circles for over a year now

Quyejoyce1 profile image
Quyejoyce1

Will do

No they only gave me a short course of B12 with no loading dose.

Thanks for the info as well regarding Vit D. My GP is typically good if I ask for specifics.

SlowDragon profile image
SlowDragonAdministrator in reply to Quyejoyce1

Roughly where in the U.K. are you

Email Thyroid UK for list of recommend thyroid specialist endocrinologists.

..NHS and Privatetukadmin@thyroiduk.org

The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is under 2

When adequately treated, TSH will often be well under one. Most important results are ALWAYS Ft3 followed by Ft4.

When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)

Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

Quyejoyce1 profile image
Quyejoyce1 in reply to SlowDragon

I’m in East London. I was previously under Barts. But they discharged me due to the heart issues. I’ve just asked the royal Brompton who I’m under for my CHD if I can get advice from their endo as it makes sense to do it all at one place with all the specialists consulting with each other.

Problem I have now is consultants are too scared to touch me with all my heart issues as well.

SlowDragon profile image
SlowDragonAdministrator in reply to Quyejoyce1

The heart need Ft3 to work

Heart specialists are often quite keen on getting thyroid levels optimal

Marz has details of heart research and books on heart and low Ft3

heart.bmj.com/content/84/4/...

Over replacement with thyroxine?

There is some concern that administering thyroxine in a dose which suppresses serum TSH may provoke significant cardiovascular problems, including abnormal ventricular diastolic relaxation, a reduced exercise capacity, an increase in mean basal heart rate, and atrial premature contractions.12 Apart from an increase in left ventricular mass index within the normal range, these observations have not been verified.13 Moreover, there is no evidence, despite the findings of the Framingham study, that a suppressed serum TSH concentration in a patient taking thyroxine in whom serum T3 is unequivocally normal is a risk factor for atrial fibrillation.

Atrial fibrillation can occur with low Ft3 or low Ft4

pubmed.ncbi.nlm.nih.gov/175...

60 patients (22.4%) had low FT3 levels (<2 pg/ml) and 24 patients (9%) had low FT4 levels (<0.9 ng/dl).

Quyejoyce1 profile image
Quyejoyce1 in reply to SlowDragon

Thank you.

The GP come back to me after seeking advice from the local hospital endo department and is refusing to do anything. Other than retest in 6 months. No consideration for Hashimotos etc.

I fortunately got my heart hospital to agree to a referral to their endo specialist. Meanwhile I feel worse every day...

SlowDragon profile image
SlowDragonAdministrator in reply to Quyejoyce1

Essential to improve vitamin levels significantly ASAP

by self supplementing

Email Thyroid UK for list of recommend thyroid specialist endocrinologists

...NHS and Privatetukadmin@thyroiduk.org

You’ll need to see one privately

Getting full thyroid and vitamins tested via Medichecks or Blue horizon done just before any consultation

Come back with new post once you get vitamin results

Aiming to improve vitamin D to at least around 80nmol and around 100nmol maybe better

Serum B12 at least over 500

Active B12 at least over 70

Folate and ferritin at least half way through range

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