Help with Thyroid labs please: Hello, I’ve been... - Thyroid UK

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Help with Thyroid labs please

Snooperkitty21 profile image
15 Replies

Hello, I’ve been feeling awful for 3 years and am trying to figure out why. I’ve recently gotten test results back regarding thyroid and would love some input. I’m not on thyroid meds.

Symptoms are brains fog (worst one!), tiredness, severe short term memory loss, sensitive to light and dim places, sound sensitive, hair loss, Terry’s nails, (kidney and liver tests are good) low mood, no motivation, hot feet and hands. Before this I was working ft and keeping busy and now I can barely function.

I’ve had a lot of tests done. I’ll most the relevant results:

B12 - 175 pmol (now on injections for a year)

Folate >45 nmol (>8)

Ferritin is 29 (was 11 a year ago, I’m on 300 mg elemental iron per day now)

Reverse T3 is 15 (8-25 ng)

I am a type 2 diabetic on insulin but have been for 15 years and my A1C is 6%, so it’s good.

Thank you for any help!

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15 Replies
SlowDragon profile image
SlowDragonAdministrator

Are you on metaformin? Metaformin lowers B12

Have you had vitamin D tested

Obviously ferritin is far too low

Are you vegetarian or vegan?

Request ultrasound scan of thyroid

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Snooperkitty21 profile image
Snooperkitty21 in reply toSlowDragon

I’m not on Metformin, I’m on insulin and Victoza.Vitamin D is low at 63 nmol (75-250). It was 74 nmol last August. I’ve been supplementing for a year 5,000 iu sublingual but I’ve recently switched to a recommended soft gel brand. I’m taking cofactors too.

I’m not vegetarian or vegan.

Thank you for those links! That is possible.

I don’t know if I have a thyroid problem or hashimotos or maybe my thyroid is low because my iron/vit D are low?

Snooperkitty21 profile image
Snooperkitty21

I’m trying to find out if I have a thyroid issue or if it’s my low iron cause my thyroid numbers to be off.My gp offered a trial of levo (the T4 medication) but that was without seeing these results and I don’t know if that’s be a good idea.

With low iron, would someone also take thyroid medication to help their thyroid until their iron levels go up?

Snooperkitty21 profile image
Snooperkitty21 in reply toSnooperkitty21

SlowDragon can you please comment on your opinion to the above (possible thyroid issue itself or low iron causing this)? Not sure if thyroid meds would help my symptoms until my iron is up and then come off of them?

I got another iron panel result and it’s still low.

Iron panel results
SlowDragon profile image
SlowDragonAdministrator in reply toSnooperkitty21

SeasideSusie or humanbean hopefully may pop along re low iron

Obviously ferritin needs significant work

What age approx are you?

Pre or post menopause

Heavy periods are often classic sign of being hypothyroid and will lead to low iron and ferritin ask for full iron panel testing for Anaemia

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first

Post discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Why low ferritin needs improving

healthunlocked.com/thyroidu...

Helpful post about iron supplements and testing

healthunlocked.com/thyroidu...

Snooperkitty21 profile image
Snooperkitty21 in reply toSlowDragon

Thank you for your reply! I am 40 and not in menopause. I get regular monthly periods but they’re very heavy with clots and last 4 days.My iron is very low and I’ve been on iron pills for a year without much improvement. I have been denied infusions by 2 drs.

My gp offer a levo trial without the thyroid panel results so I don’t think he knows a lot about the numbers.

Iron panel May 2021
SlowDragon profile image
SlowDragonAdministrator in reply toSnooperkitty21

Heavy periods are extremely common hypothyroid symptom

Obviously makes keeping iron levels up very hard

SlowDragon profile image
SlowDragonAdministrator in reply toSnooperkitty21

You replied to yourself here....so I wasn’t alerted

Personally yes, I would consider trying levothyroxine trial

Snooperkitty21 profile image
Snooperkitty21 in reply toSlowDragon

Ok I will try it as I’m desperate to feel better. I feel awful and lightheaded with brain fog 24/7.I’m going to basically tell my doctor what dose I want. What dose should I asked for to start? He’s probably open to my ideas about it.

If it doesn’t work can I come off of it (after trying an increase)?

SlowDragon profile image
SlowDragonAdministrator in reply toSnooperkitty21

Yes...with levothyroxine you need to start or change dose slowly

It takes 6-8 weeks for each dose change (or brand change) in levothyroxine to have effect

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

Snooperkitty21 profile image
Snooperkitty21 in reply toSlowDragon

Thank you for that info. I believe I read 50 mcg/day is the starting dose? I ask here because you are extremely knowledgeable and sometimes my dr won’t prescribe optimal doses of things (example, the B12 I’m taking)

SlowDragon profile image
SlowDragonAdministrator in reply toSnooperkitty21

Yes standard starter dose levothyroxine is 50mcg

Best to start on either Mercury Pharma or Accord brand of levothyroxine unless you are lactose intolerant.

Teva brand is lactose free, but many people find Teva difficult to tolerate

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

Snooperkitty21 profile image
Snooperkitty21 in reply toSlowDragon

I have bloodwork today to test a few other things before a Levo trial. Ferritin again

Vitamin A

DHEA

Aldosterone

AM Cortisol

I think my adrenals are not functioning well and want to get these results to see if I need to increase cortisol before thyroid meds.

If all is well, I’m meeting with my dr soon to start the levo and maybe T3 too since my RT3 is 15 (8-25) but I’ll pop back in here to discuss 🙂 thank you for your help!

SlowDragon profile image
SlowDragonAdministrator in reply toSnooperkitty21

RT3 is well within range ….and pretty irrelevant test unless on very high dose Levothyroxine (eg over 200-250mcg Levothyroxine)

Essential to test TPOand TG antibodies

Plus vitamin D, folate, ferritin and B12

SlowDragon profile image
SlowDragonAdministrator in reply toSnooperkitty21

Standard starter dose Levothyroxine is 50mcg

Retest 6-8 weeks after any dose change or brand change in Levothyroxine

As Type one diabetic

Getting coeliac blood test too before trying absolutely strictly gluten free diet

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