I would be really grateful for some help interpreting my Blue Horizon thyroid test results. I'm wondering how significant it is that my anti-TPO result is high, while the rest of the results seem perfectly normal. (Took test at 8am, after 12 hour fast with no iron or other vitamin supplements for a few days before.) A bit of context:
I have a family history of Hashimoto's hypothyroidism (mother, sister, maternal aunt) as well as other autoimmune diseases (PCOS, rheumatoid arthritis, chron's, severe vit D deficiency) in immediate family. I had some investigations done by my GP in August 2020 due to a host of long term symptoms which had been growing steadily worse over the years. That included a full blood count, liver function tests, B12, ferritin, folate, and TSH. The main results were:
Ferritin: below range 12 ng/ml [15.0 - 350.0]
Full blood count: most investigations out of range, including low lymphocytes
Liver function: all normal except Serum alanine aminotransferase -7 IU/L [10.0 - 40.0]
GP prescribed iron supplements to treat the anaemia, which was back within normal range by February 2021 and said nothing about the rest of the results. I didn't think twice about the TSH because I trusted the lab results which put it 'in range'. Since then, I've sadly experienced two very early miscarriages, before 5 weeks, and while knowing that they can be common, decided to check back over my lab results from last year just incase there was something preventable going on. It was then that I found that for people with diagnosed hypothyroidism, a TSH as high as mine was considered over the safe limit.
Paid for the Blue Horizon test straight away rather than battle with the GP to get a full set of tests, and these are the results. Relieved that my TSH is actually better than it was last year (unsure why this would be?), as well as T3 and T4 looking ok. I'm not sure what the high anti-TPO in the presence of normal T3 and T4 could mean though. Does it always mean there's some kind of autoimmune issue going on?
I take ferritin, B12, folate and vitamin D supplements, though paused them a few days before the test.
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Aurell
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Your ferritin level is very poor. What level did it reach with GP's treatment? What is your maintenance dose, it doesn't look as though it's enough? Ferritin is recommended to be half way through range with some experts saying the optimal ferritin level for thyroid function is between 90-110 ng/ml.
Testing magnesium is unreliable, testing what's in the blood isn't really giving an accurate picture of our magnesium status. A red cell magnesium test is the better indicator of magnesium status, not the standard serum magnesium test done here.
You haven't said what time you did the test so interpreting the cortisol result isn't really possible.
TSH is OK but your FT4 has barely scraped into range.
Your raised TPO antibodies do suggest Hashimoto's but at the moment you don't have a high TSH which would give you a diagnosis of Hashi's if it was over range.
Vit D is way too low, the Vit D Society and Grassroots Health both suggest a level of 100-150nmol/L. What dose of Vit D are you taking and do you also take D3's important cofactors - magnesium and Vit K20-MK7?
Your B12 is just about OK, it translates to 589pg/ml and according to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Do you take a good quality, bioavailable B Complex to balance all the B vitamins or just folate? Your folate is a decent level, if you only take folate I'd swap to a B Complex such as Thorne Basic B or Igennus Super B.
Ferritin came up to 56 ng/ml with treatment. I had been on 210mg 3 times a day to get to that, and since been on 210mg once a day but there was a month's gap while getting the prescription sorted which can't have helped.
I did the test at 8am, in a fasted state with no supplements for a few days prior. Does that put my cortisol in a reasonable place?
If my TPO antibodies are elevated and T4 on the low side, but with normal T3, could it be that my thyroid function is starting to decline but my body is perfectly 'good' at converting T4 to T3? I've also just realised that pregnancy usually decreases TSH, and I have been pregnant two months in a row since my first TSH test, losing the second pregnancy 10 days ago. Wondering if this could be why my TSH has gone down from 3.24 to its current 1.19.
Really interesting what you've said about vitamin levels, I didn't think much of them as they were listed as in range.
When I started ferritin supplements, I also started taking a 1000 micrograms B12 with 400 micrograms folic acid, as well as 4000IU vitamin D3 but when I had my February blood test with GP my B12 had shot above range to 987 ng/l [200.0 - 960.0] so I stopped both of those and have since only been taking a combined folic acid 400 micrograms and vitamin D 10 microgram supplement as NHS recommended for pregnancy.
High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Clearly your vitamin levels are generally dire without significant supplements
Low vitamin levels tend to lower TSH
Low vitamin levels affect Thyroid hormone working
Poor gut function with Hashimoto’s 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.
Improving low vitamin levels to optimal levels by supplementing
Vitamin D at least around 80nmol and around 100nmol maybe better
Folate and ferritin at least half way through range
For pregnancy TSH should ALWAYS be under 2 and Ft4 in top third of range
Your results confirms Hashimoto’s and very low Ft4 suggests you are hypothyroid and need prescription for levothyroxine, especially before considering pregnancy
GP likely only looking at low TSH and you may struggle to get any medic to treat
Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private
tukadmin@thyroiduk.org
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
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