Hello, this is my first post and I'd really appreciate some help with my blood test results. I apologise in advance for the long post!
I’ve had hypothyroidism symptoms for as long as I can remember. Reluctantly my GP agreed for me to try 25mg Levothyroxine about 6 years ago (I think to shut me up!) and I’ve taken the same dose ever since. My symptoms have drastically worsened over the last year with new ones seeming to appear every day (over 50 of the 100 on the hypothyroidism list), the most concerning being brain fog/concentration/memory loss, weight gain (2 stone in 18 months despite poor appetite), eyesight, low pulse, constipation, feeling cold and generally feeling rubbish.
I’ve had tests for coeliac disease, internal bleeding (endoscopy, colonoscopy and capsule camera), ovarian and bowel cancer, Cushing’s disease and all are fine apart from having diverticular disease.
GP has refused to test my T3 and T4 as my TSH was 2.76 (range 0.27-4.2). I’ve been offered anti-depressants for depression and HRT for menopause (despite not having typical symptoms). I already take supplements containing every essential vitamin and mineral but have now increased my Vit D and Iron. Not sure if it’s relevant but I had a small stroke in 2012 and a hysterectomy in 2014.
Here are my results…
TSH - 2.78 (0.27 - 4.2)
T3 - 4.1 (3.1 – 6.8)
T4 - 12.3 (12 – 22)
Thyroglobulin - <10 (0 – 115)
Thyroid Peroxidase - <9 (0 – 34)
Ferritin - 33 (13 – 150)
Folate - 3.3 (2.9 – 14.5)
Vit B12 - 79 (25.1 – 165)
Vit D - 44 (50 – 200)
CRP - 0.5 (0 - 5)
FSH - 175.7 (post menopause - >30)
Thank you in anticipation,
Written by
Beany101
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Quite clearly your results show that you are undermedicated with FT3 27% through range and FT4 a mere 3% through it's range. The aim of a treated Hypo patient on Levo only, generally, is for TSh to be 1 or below with FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well.
Use the following information to support your request for an increase in dose, which should be 25mcg now and retest in 6-8 weeks, further increases may be necessary:
Fine tuning of the dose could be necessary in some patients
* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
*
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional magazine for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
**
Your antibodies are nice and low and don't suggest that your hypothyroidism is autoimmune.
**
What supplements do you currently take?
Ferritin - 33 (13 – 150)
This is too low and low ferritin can suggest iron deficiency or anaemia. Ferritin is recommended to be half way through range (about 82 with that range) and some experts say that the optimal ferritin level for thyroid function is between 90-110 ng/ml.
I would ask your GP for an iron panel to see if you have iron deficiency and a full blood count to see if you have anaemia. Don't consider taking an iron supplement yourself unless these tests are done because 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 is too low, folate is recommended to be at least half way through range so around 9+ with that range. It's not quite low enough to confirm folate deficiency but definitely needs improving, see cks.nice.org.uk/anaemia-b12...
Folate level
◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.
◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.
Vit B12 - 79 (25.1 – 165)
Active B12 below 70 suggests testing for B12 deficiency so you are over that limit, a good level for Active B12 would be 100+.
If that was my result I'd be taking a good quality B complex which will help raise B12 and will also raise folate. Recommended here are Thorne Basic B or Igennus Super B, both contain the bioavailable forms of ingredients.
When taking B Complex this should be left off for 7 days before any blood test as it can give false results when the testing equipment also uses Biotin (which most labs do).
Vit D - 44 (50 – 200)
This is too low. The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L.
To reach the recommended level from your current level, you could supplement with 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.
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.
My suggestion for D3 is Doctor's Best D3 softgels, a good quality, clean supplement that contains no excipients, just D3 and extra virgin olive oil for absorption.
For Vit K2-MK7 I like Vitabay and Vegavero brands.
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.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Thank you so much for your reply and all the advice. I’ve been taking the various supplements below daily for over 3 years but looking at your info these don’t appear to be strong enough. I’ve been taking extra Vit D 75ug and Iron 10mg (Spatone) for the last week but will stop these until I’ve spoken to the GP.
Vit A 500ug
B1 74.55mg
B2 110mg
B3 44mg
B5 3.6mg
B6 1.7mg
B12 3.2ug
C 48mg
D 5ug
E 10mg
Folic 140ug
Potassium 1000mg
Calcium 650mg
Phosphorous 600mg
Magnesium 720mg
Iron 10mg
Zinc 12mg
Copper 0.74mg
Manganese 1.2mg
Selenium 37ug
Iodine 90ug
Chromium 25ug
Psyllium 100mg
I spoke to a different GP a few weeks ago who agreed to test my T3 and T4 and also my pituitary function saying, even if they came back normal, she would be willing to increase my dose to a level that alleviates my symptoms (“although we would need to make sure I didn’t get too skinny”). When I received the results they hadn’t tested my T3 or T4 and she called to say that it isn’t in her remit to authorise these tests, my TSH is normal so everything’s okay, but I'm free to speak to a different GP to get a second opinion!
I waited another two weeks for a call back from my normal GP (who is a practice partner) and I quoted the info in Dr Toft’s article but she wasn’t having any of it. Apparently I have “health anxiety”. I also mentioned it’s been suggested that people who have suffered a stroke have their pituitary gland checked annually… she wasn’t aware of this. I told her I'd arranged for private blood tests to be done and she asked if I would finally believe them if they came back okay.
I’ve asked for my GP to phone me back but I think I’ll have a fight on my hands to get any more tests done or an increase in Levothyroxine, especially as my T3 and T4 are technically in range. It’s even more difficult as I’m finding it so hard to focus/function at the moment.
I’ll ask her to arrange an iron panel but, again, I suspect she’ll be reluctant as she’s happy with my Ferritin level (“it’s within range and much higher than before my hysterectomy”). Every time I suggest I’m anaemic she tells me I’m not as my blood cells are the right size! She has said some people just don't absorb Iron very well.
20% of Hashimoto’s patients never have high thyroid antibodies
Request Ultrasound scan of thyroid
Multivitamins are never recommended on here ..far too little of what you do need plus iodine not recommended with Hashimoto’s
Vitamin levels are low BECAUSE you are under medicated
The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is ALWAYS under 2
When adequately treated, TSH will often be well below 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
Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private
Thank you. Well, I'm still awaiting a call back from my usual GP but in the meantime I thought I might be able to arrange an Iron panel and FBC from the 'on call' doctor.
Just had a long call with a doctor I haven't spoken to before and she's agreed to test my FBC but not an iron panel.
She said my thyroid levels are fine and will not arrange an ultrasound. We discussed how unwell I was feeling and my most concerning symptoms. I told her about Dr Toft’s article and the other info provided and that it’s recommended TSH should always be below 2. She thinks the possible pituitary damage is a ‘red herring’. She asked if I’d like to increase my Levothyroxine dose and suggested alternating 25mcg and 50mcg each day with a retest in 8 weeks, although will only test TSH. Should I do another private test of T3 and T4 at that point?
She’s also emailed some info on Selenium and suggested I go back on HRT (which I’d stopped last week to see if it made any difference). Oh and she also advised that I'm entitled to free prescriptions!
I'm just going to look at the suggested supplements and send an email for the list of endocrinologists.
I've got mixed feelings... I'm really happy to be prescribed a higher dose and I feel this GP has actually listened to me but I suspect I'll have another battle in 8 weeks time.
Looking like you will need to see a thyroid specialist endocrinologist in order to get anywhere
Roughly where in the U.K. are you
Many endocrinologist are still doing consultations on zoom.....so distance no object
Levothyroxine doesn’t top up failing thyroid, it replaces it
guidelines on dose levothyroxine by weight can be helpful for getting dose increase
Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
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.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
Thank you very much for your reply. I've had a read of this post and it is very similar to my own results.
It seems I was started on too low a dose and I didn't have any follow up tests done. I can't understand why my GP is happy for me to stay on Levothyroxine at all if she thinks I don't have a thyroid problem. Although I wouldn't ask her this just in case she stops it completely!
I've just thought of something else... I was on Metformin for Polycystic Ovaries up until last July/August but my GP took me off as she felt I was menopausal and they wouldn't be doing anything any more. Do you know if Metformin affects thyroid function as I think my symptoms have definitely worsened in the last six months or so.
Your TSH really is too low for your low normal fT3 and fT4. Usually with an fT4 of 12.3 TSH would be higher which would push fT3 back up to mid-interval levels. The elevated TSH would prompt a diagnosis of 'subclinical hypothyroidism' (a nonsense term) and the person would probably be OK until their thyroid declined further.
I think your problem lies with your pituitary rather than your thyroid. When TSH fails to rise as much as it should it often produces TSH with reduced bioactivity also, leading to low or low normal fT3 and fT4. This could happen in stroke, a similar thing called Sheehan's syndrome can happen during childbirth. I would push hard to get your GP to refer you to an endocrinologist to investigate potential pituitary damage, it may be minor but enough to cause you lots of problems.
Thank you very much for your reply. I have come across Sheehan's syndrome whilst I was googling and wondered if my experience during my hysterectomy could have caused similar results. During the operation a gastric vein was damaged and I was bleeding internally but they didn't realise for a couple of hours... blood transfusions and 11 hours on the table!
I'll try my best to get my GP to refer me. I have had pituitary blood tests done but I'm wondering if I need a scan or MRI. I'm sure they think I'm a hypochondriac but I just want to find out why I feel so unwell.
I think I've spoken to virtually every GP at the practice! Although this morning I spoke to an 'on call' doctor (not sure if she's permanent or a locum) and she has agreed to increase my Levo to see if it improves my symptoms.
All I want to add is that if you have had a hysterectomy you will be lacking in female hormones. And not everyone gets hot flushes. I didn't. Many don't. The list of menopause symptoms is long.
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