Hi,
I seem to have all the classic symptoms, excessive tiredness being the main one.
If this helps, last bloods done Dec/20, TSH=5.5miu/L , Free T4=13.9mol/L, B12=483 ng/L
Ferritin 32 ug/L
Subclinical Hypothyroid - looking for solution/... - Thyroid UK
Subclinical Hypothyroid - looking for solution/treatment
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colin_q
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SeasideSusieRemembering
Colin_q
Can you please add the reference ranges for your results, these vary from lab to lab so we need the ranges that came with your results. We can see that your TSH is high and very likely over range and in some countries hypothyroidism is diagnosed when TSH goes over 3, but we need to see where your FT4 lies.
B12 is recommended to be at least 550ng/L, preferably at the top of its range.
Ferritin is dire. It's recommended to be half way through range and the normal range for a male is usually around 30-400
According to cks.nice.org.uk/topics/anae...
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
You should discuss this with your GP and ask for a full blood cou t to see if you have anaemia and an iron panel to see if you have iron deficiency considering your Ferritin level is so low and lose to the limit mentioned above.
Low Ferritin has many symptoms, fatigue being one of them.
Thank you for your analysis.
There are the test results that I can find.
Serum TSH level miu/L [0.3 - 4.20] 5.5 (10/12/2020), 6.6 (24/07/2020), 6.6 (22/01/2020), 4.7 (05/06/2019)
Serum free T4 level pmol/L [12.0 - 22.0] 13.9 (10/12/2020), 13.9 (24/07/2020), 13.9 (22/01/2020), 12.7 (05/06/2019)
Combined total vit D2 + D3 lvl nmol/L [50-150] 61.3 (10/12/2020), 58.5 (30/05/2019)
Serum ferritin ug/L [30-400] 32 (10/12/2020), 14 (23/08/12), 20 (10/03/2012), 14 (27/05/2010)
Serum vitamin B12 ng/L [197-771] 483 (10/12/2020)
Serum vitamin B12 pg/ml [144-9050] 344 (13/3/2012), 351 (27/5/2010)
Serum folate ug/L [3.89-26.8] 6.4 (10/10/2020), 9.9 (13/03/2012), 9.4(27/05/2010)
Hopefully I've listed these accurately.
Vitamin D is too low, but not low enough for GP to prescribe. NHS only tests and treats deficiencies
Down to us as individuals to supplement to maintain optimal vitamin levels
GP will often only prescribe to bring vitamin D levels to 50nmol.
Some areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing vitamin D if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But, improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly via NHS
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with thyroid disease we frequently need higher dose than average
Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol
grassrootshealth.net/projec...
Government recommends everyone supplement October to April
gov.uk/government/news/phe-...
Taking too much vitamin D is not a good idea
chriskresser.com/vitamin-d-...
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
healthline.com/nutrition/vi...
2 good videos on magnesium
healthunlocked.com/thyroidu...
Vitamin D and Covid
Notice how much vitamin D many of these medics are taking
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.
SlowDragonAdministrator
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Have you had thyroid antibodies tested
Ask GP to test vitamin D and folate levels and thyroid antibodies
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
When on T3, day before test, split dose into three smaller doses roughly equal 8 hour intervals. Taking last dose T3 at roughly 8-12 hours before test
If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test
Thriva also offer just vitamin testing
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
NHS easy postal kit vitamin D test £29 via
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
List of hypothyroid symptoms
thyroiduk.org/if-you-are-un...
Thanks for the response, just before I read in-depth, at the moment I've not been prescribed any drugs for my condition, all I've had are regular blood tests as any walk-in patient would have.
TSH level miu/L [0.3 - 4.20]
5.5 (10/12/2020),
6.6 (24/07/2020),
6.6 (22/01/2020),
4.7 (05/06/2019)
Serum free T4 level pmol/L [12.0 - 22.0]
13.9 (10/12/2020),
13.9 (24/07/2020),
13.9 (22/01/2020),
12.7 (05/06/2019)
So in Aug 2020 After 2nd TSH result over 5 you could/should have been started on levothyroxine
TSH above range and very low Ft4
See flow chart on top of page 2
gp-update.co.uk/Latest-Upda...
Strongly recommend getting full thyroid testing including both thyroid antibodies
Always test as early as possible in morning before eating or drinking anything other than water. This gives highest TSH and most consistent results
Have you had thyroid antibodies tested?
About 90% of primary hypothyroidism is autoimmune thyroid disease (hashimoto’s) diagnosed by high thyroid antibodies
How ever 20% of Hashimoto's patients never have raised antibodies, if both antibodies are negative request ultrasound scan of thyroid
healthunlocked.com/thyroidu...
Paul Robson on atrophied thyroid - especially if no TPO antibodies
Suggest you start supplementing vitamin D
Getting full thyroid and vitamin testing done via private testing including thyroid antibodies
Make sure you get test done as early as possible in morning before eating or drinking anything other than water
Only do test early Monday or Tuesday morning and then post back via tracked postal service
Come back with new post once you get results
Assuming TSH is still over 5 after next test see GP and request/insist on starting on levothyroxine
List of hypothyroid symptoms
thyroiduk.org/if-you-are-un...
Ever had cholesterol tested?
High cholesterol is linked to being hypothyroid
SlowDragonAdministrator
Vitamins need retesting. It’s 6 months since last tested in Dec
Low vitamin levels are extremely common with hypothyroidism. When hypothyroid we get LOW stomach acid and this leads to poor nutrient absorption and low vitamin levels as direct result
Low vitamin levels tend to lower TSH, in effect hiding how hypothyroid you actually are.
Essential to improve low vitamin levels as first step
Ferritin
Your Ferritin has been extremely low for years, especially for a man
Are you vegetarian or vegan
Did GP do full iron panel test for anaemia after any of these results?
Were you prescribed iron supplements after any of these terrible ferritin results?
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
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...
Iron/ferritin and restless legs
healthunlocked.com/thyroidu...
Thank you so much for your very kind advice.
Vegetables are a big issue for me, most I can manage are green beans and broccoli.
Back in Aug 2012 I had "Serum iron tests" which came in at 14 ug/L (30 - 400 ug/L )
but the term "iron panel test" is unfamiliar to me. I was prescribed supplements when my ferritin level dipped below the lowest limit (30) the concern at the time was that I may be bleeding internally. Since then there has been no more concern, but it has always been at the low end.
Was also prescribed vitamin D , initially 2 doses of 20,000 weekly for 7 weeks, but almost immediately I developed ulcerative colitis and ended up having a colonoscopy and a restricted diet which lasted about a month. Now I'm prescribed 800 units/day but the prospect of getting colitis again frightens me.
Liver, pate etc would be no problem (may be not pumpkin seeds)
My total cholesterol was 5.3 mmol/L, I was prescribed Avorvastin 20mg/day which lowered it to 4.6 Aug 2020, 3.9 Jan 2020
Do not believe I've had a thyroid antibodies test per say, I can find no data on Patient Access.
Interesting you mention Gluten intolerance as I've mentioned that to the the doctor too. Also when exercising (running) struggling with lack of performance.
Your wealth of information is most helpful, I will go through them but it will take some time. From the The list of Symptoms I tick so many boxes, so I know I have to do something to dig myself out the hole.
Getting a doctor's appointment with Covid is difficult, also my confidence is low, so may be private is the way to move forward.
Thank you so much again.
I think you should insist on full iron panel test for anaemia.
Ferritin is extremely low, especially for a man. Iron levels may not be as low as ferritin
humanbean posts and replies in-depth to many of low iron/ferritin. I suggest you read these
Not eating vegetables won’t be a large effect on low iron levels
Look at increasing iron rich foods in diet….red meat ….and if you don’t like liver on its own, look at adding liver to shepherds pie, spaghetti bolognaise, curry etc
Also you absolutely must get thyroid antibodies tested ASAP
Coeliac blood test done too BEFORE considering trial on strictly gluten free diet
Anyone hypothyroid should not be given statins.
Clear NHS guidelines on this
nhs.uk/conditions/statins/c...
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
Median TSH graph showing vast majority of healthy population have TSH of 1-1.5
healthunlocked.com/thyroidu...
TSH daily variation has significance re what time day you test
healthunlocked.com/thyroidu...
Always test early morning before eating or drinking anything other than water
researchgate.net/publicatio...
“According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon.”
“Further analysis demonstrated inadequate compensation of hypothyroidism, which was defined in 45.5% of the morning samples and in 9% of the afternoon samples”
ncbi.nlm.nih.gov/pubmed/252...
TSH levels showed a statistically significant decline postprandially in comparison to fasting values. This may have clinical implications in the diagnosis and management of hypothyroidism, especially SCH.
Thank you, I will follow your recommendations and report back when I have results.
Back in Aug 2012 I had "Serum iron tests" which came in at 14 ug/L (30 - 400 ug/L )
but the term "iron panel test" is unfamiliar to me. I was prescribed supplements when my ferritin level dipped below the lowest limit (30) the concern at the time was that I may be bleeding internally. Since then there has been no more concern, but it has always been at the low end.
NHS only tests and treats deficiencies
But currently your ferritin levels are far from optimal.
SeasideSusie or humanbean may pop along and comment
Links about low iron/ferritin and ulcerative colitis
everydayhealth.com/ulcerati...
ncbi.nlm.nih.gov/pmc/articl...
With ulcerative colitis may need higher dose levothyroxine that typical
colin_q
but the term "iron panel test" is unfamiliar to me. I was prescribed supplements when my ferritin level dipped below the lowest limit (30) the concern at the time was that I may be bleeding internally. Since then there has been no more concern, but it has always been at the low end.
An iron panel consists of
Serum iron: This test measures the amount of iron in your blood.
Transferrin saturation: This test measures the percentage of transferrin that is attached to iron.
Total iron-binding capacity (TIBC): This test tells how much transferrin (a protein) is free to carry iron through your blood. If your TIBC level is high, it means more transferrin is free because you have low iron.
Serum ferritin: This test measures how much iron is stored in your body. When your iron level is low, your body will pull iron out of “storage” to use.
and possibly:
Unsaturated iron-binding capacity (UIBC): This test measures how much transferrin isn’t attached to iron.
If there was previously concern about internal bleeding, was this followed up with investigations?
As mentioned above a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency according to NICE so ou should discuss this with your GP and ask for a full blood count to see if you have anaemia and an iron panel to see if you have iron deficiency considering your Ferritin level is so low and close to the limit mentioned above (30).
Symptoms of low ferritin can include:
◾Weakness
◾Fatigue
◾Difficulty concentrating
◾Poor work productivity
◾Cold hands and feet
◾Poor short-term memory
◾Difficulty remembering names
◾Dizziness
◾Pounding in the ears
◾Shortness of breath
◾Brittle nails
◾Headaches
◾Restless legs
Article about iron deficiency anaemia:
webmd.com/a-to-z-guides/iro...
Article about iron deficiency without anaemia:
Back in Aug 2012 I had "Serum iron tests" which came in at 14 ug/L (30 - 400 ug/L )
but the term "iron panel test" is unfamiliar to me. I was prescribed supplements when my ferritin level dipped below the lowest limit (30) the concern at the time was that I may be bleeding internally. Since then there has been no more concern, but it has always been at the low end.
Were you ever given a faecal occult blood test (FOBT)? It is a test whereby you provide multiple (up to 6) tiny samples of faeces smeared on a card and they are tested to see if they have almost invisible (occult) blood in them.
FOBT tests are extremely poor tests but they are cheap and simple to carry out. Sometimes doctors only suggest supplying one sample rather than the multiple samples needed. If you had a bleeding polyp in your colon it might only bleed occasionally. Intermittent bleeding of polyps is very common, so the more samples a patient provides the more likely it is that blood will be detected if it is there to be found.
Another problem with FOBT tests is that they produce a lot of false positives and false negatives. See this thread :
healthunlocked.com/thyroidu....
Another possibility is that you could have ulcerative colitis, coeliac disease, Crohn's Disease, or possibly other Inflammatory Bowel Diseases that I know nothing about, and for such conditions to be diagnosed requires appropriate blood testing, samples/biopsies to be taken from stomach and/or colon, which are done via endoscopy and colonoscopy.
en.wikipedia.org/wiki/Infla...
Do not confuse Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). They are NOT the same condition. And to make life even harder than it already is, many doctors now diagnose IBS as a mental health problem to save money (specifically a "functional disorder" but that is just a euphemism doctors use for "mental health problem"), and having IBD is often misdiagnosed as IBS.
You might even have parasites, but doctors almost never look for those and I have no idea under what circumstances tests for parasites are carried out or how they are done.
However, one of the commonest causes (that I'm aware of - and I'm not a doctor) of low iron and/or ferritin is basically that the person concerned doesn't absorb iron very well from their diet for some reason, or their diet is low in iron, or they have low stomach acid which means they can't extract nutrients from their food very well (or a combination of all of these).
....
Back in Aug 2012 I had "Serum iron tests" which came in at 14 ug/L (30 - 400 ug/L )
The above test would be a ferritin test, not a serum iron test. You can tell by the reference range (30 - 400), which is a standard reference range for ferritin for males.
An example of an iron test is this one :
medichecks.com/products/iro...
It includes :
Serum iron
TIBC (Total Iron Binding Capacity)
Transferrin Saturation
Ferritin
CRP-hs (C-Reactive Protein - high sensitivity)
The test is a private one from Medichecks which can be done without seeing a doctor and only needs a finger-prick sample of blood. The blood can be collected at home, the sample is sent to the lab through the post, and results are supplied online via your account with Medichecks. If you decide to buy such a test, ask before buying it and ask about the best way to produce the sample and the best conditions to produce the sample in - for example, need for fasting, avoiding iron tablets, best time of day, best days of the week to post the sample to the lab to get it there as fresh as possible.
If you get such a test done you can then post the results in a new post on here and ask for feedback).
...
When doctors do treat patients for iron deficiency they often supply just enough tablets for 2 - 3 months then stop prescribing. It may have taken 5 years of complaining to get tested for iron deficiency and levels could be extremely low by the time treatment is given. Once the prescription is finished iron levels will drop again very quickly. In reality, patients may need to take a maintenance dose of iron to prevent their levels becoming low again, but doctors won't test or prescribe for this in my experience.
It takes a lot longer to treat severe low iron than two or three months. Some people absorb iron tablets well, some don't. Personally it took me 21 months to raise my ferritin to mid-range, and even then my serum iron was still very low in range. I take a maintenance dose of iron and now do a private iron panel test a couple of times a year.
The good news is that iron tablets prescribed by doctors to treat iron deficiency are available over-the-counter in Pharmacies with the permission of the Pharmacist in charge. It was only once I learned this (purely by accident) that I was able to turn my iron problems around and actually fix them, and maintain them at much healthier levels ever since (although they are still far from perfect).
Again thank you, it's quite a bit to digest.
So much terminology to get to grips with.
I did/do have ulcerative colitis, I don't recall a FOBT test, but do have a Faecal Haemoglobin result:-
Faecal Haemoglobin > 400 ug/g, 0 - 9, Abnormal, 18 Sep 2020
So not sure if this is relevant.
So according to my Patient Access Records 23 Aug 201 under the Title says "Serum Iron Tests" the results were
Serum ferritin, 14 ug/L, 30 - 400 ug/L, Abnormal, 23 Aug 2012
The title may be a misnomer (I'm an engineer not medical)
I've asked about parasites which I did have in the past (Japan, raw fish) but I'm assume after two recent colonoscopies they would have picked up on that.
An iron test seems appropriate which I will arrange taking onboard your advice. Again my symptoms match, quote "Do you have symptoms like fatigue, pale skin and dizziness? Do you get out of breath easily?" all except the pale skin.
Graph of Serum Ferritin
So with your most recent result of 32 for your ferritin, what iron tablets are you taking and at what dose?
Are you still supplementing iron or has the doctor stopped prescribing? Have you ever bought your own iron supplements? Doctors are crap at treating low iron, but it is particularly bad for you given that the cause of your low iron is known, and is unlikely to get better.
[Personally, I think I have a genetic problem with iron absorption based on the levels of anaemia found in many of my relatives, but I've never followed it up or sought confirmation. I just test and treat my own low iron now.]
The faecal haemoglobin test sounds like a fancier version of the FOBT I described. Clearly you are losing a lot more blood in your faeces than normal, and this is probably all that is required to explain your low iron.
(Everybody loses some blood/iron in their faeces every day but in healthy people with healthy digestive systems the amount lost per day is miniscule and should be more than made up for by eating a normal diet.)
So no further iron prescribed by doctor, I've just been taking regular vitamins with extra iron.
Medichecks bloodtest ordered (thank you), so will have an update soon.
When you get the results Write a new post and give it a title something like "Iron panel done - could I have some feedback please".
The conditions for getting the most accurate results that I can remember ...
1) If you take any supplements or drugs that include biotin before any test of any kind give it up for a week before the test. Reasons for this are given in these links :
healthunlocked.com/thyroidu......
healthunlocked.com/thyroidu...
2) For testing iron or anything iron-related, stop taking any supplements containing iron for a week before testing.
3) Don't eat or drink for 12 hours before producing your blood sample except for water which you can (and should) drink freely. Aim to do the sample first thing in the morning before you normally take any drugs, hormones or supplements or eat breakfast.
4) To get the best blood sample possible for finger-prick testing, read this post by SeasideSusie .
healthunlocked.com/thyroidu...
5) You need to get the sample to the lab as soon as possible after you produced it, so do the sample on the same day you post it off. You don't want it sitting in a hot post box or sorting office over the weekend and you want it to arrive when staff are at the lab to take in parcels. Don't forget to take account of public holidays.
6) Produce samples on Mondays or Tuesdays and package them up - don't forget to put all the paperwork and tubes back in the cardboard boxes it came in before putting into the envelope. For quickest delivery the best option is to take the package to the Post Office as soon as possible and ask for "Guaranteed Next Day Delivery by 1pm". (It might actually be 4pm, but they'll know which one you mean - they changed the service a few months ago.) Don't go for the earlier guaranteed delivery - it's extremely expensive, and you also want staff to be at the lab to take delivery.
royalmail.com/sending/uk/sp...
Good luck.
Graph results underline that NHS only tests and treats deficiencies
32 is not a “normal” result …..only just 2 points above abnormal ….it’s within range, just, but far from optimal
At least 80-100 for ferritin is good result
Iron Panel Test Results (Medichecks Service)
Inflammation
CRP HSX 9.5 mg/l (Range: 0 - 5)
Iron Status
Iron 26.3 umol/L (Range: 10.6 - 28.3)
TIBC 72 umol/L (Range: 41 - 77)
Transferrin Saturation 37 % (Range: 20 - 55)
Ferritin 54 ug/L (Range: 30 - 400)
The CRP is elevated so I will raise with my doctor, it may be connected with my ulcerative colitis condition.
The Ferritin level is again low (10/12/20 level = 32ug/L)
Considering taking the Advanced Thyroid Function Blood Test from Medichecks (by nurse) and then presenting these to my doctor to follow-up.
Any suggestions would be very much appreciated...
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