Need guidance about the bloodwork related to thyroid

[vink123]

Hi, I went for the second test (after 2 months) and here are the test results:

1) Tested on June 11 , 2021

TSH 4.33 Range 0.40 - 0 .45

T4,FREE 1.4 Range 0.8 - 1.8

Vitamin B12 277 Range 200 -1100

Folate, Serum 8.6 > 5.4

Vitamin D 11 Range 30- 100

2) Results from first test done on April 14, 2021

TSH 5.19 Range 0.40 - 0 .45

Thyroid peroxidase antibodies 1 Range < 9

Thyroglobulin 5 Range <1

During the last 2 month, I discontinued drinking tea, milk and doing some yoga, jogging/walking .

Now based on the second test my GP has prescribed OTC Vitamin D 50,000 tab weekly and Vitamin B12 1000 MG daily for 4 months and asked me to repeat the test after 4 month.

So, can you please help me interpret these tests, am I still at the risk of hypo or anything else?

Is the Dr. on right track? Or do I need to do anything else? Do I continue doing what I have been doing for last 2 months. I am vegetarian , if I don't take milk, would it worsen by vitamin D and B12 situation.

Thanks in advance.

[Saggyuk]

Hi Vink123

I'm not often on here these days but just because no one else has answered yet I figured I might as well - did you have any results for iron (ferritin/iron panel/red blood count) as I imagine you might need help in that department too if you're vegetarian with low B12 so the others will likely also ask you this. If you haven't had these done you may want to ensure that they're checked

Your Vit D is dire but the dose the doc has prescribed should be adequate. Maybe should take some K2 with that also. You get Vit D primarily from the sun and only minimally from some foods but you need Vitamin D to be able to absorb calcium from your food (that it's primary function) - did he check your calcium as you won't have been absorbing much at all with levels like that especially if not getting adequate amounts in your diet? Your body may have been stripping it from your bones though.

B12 not good either and really could do with a stronger dose - maybe at least 3000 as low B12 can be dangerous and become irreversible but what form of B12 did he prescribe ? Probably should have done a few further tests to check for pernicious anaemia and opted for injections if he decided you were deficient perhaps. will need a good B complex with folate to go along with it. You can only get Vit B12 from animal products (or vegan foods that have been especially fortified) so if you're not eating adequate amounts (which appears likely) you will probably want to always be supplementing B12 1000+ per day once levels are optimal. B12 deficiency can mask iron deficiency in blood tests so if your labs regarding iron are looking okay at the moment, you should retest them in three months once your B12 levels are optimal.

Your TSH indicates you are hypothyroid but I'm not used to your ranges so not sure at what point they would medicate where you are and it's too late at night for me to figure where you are percentage wise Are you on thyroid meds? Someone else who knows more will let you know shortly I'm sure.

Hopefully you'll feel better soon, Sarah x

[vink123 in reply to Saggyuk]

Hi Saggyuk,Thanks for the reply. This is super helpful.

I was tested for Iron / calcium / red blood cell 2 months ago and results were normal -copying here:

Calcium 9.7 range 8.6 - 10.3

Iron, total 78 range 50-180

PSA , Total 1.1 range < 4

Red blood cell count 4.72 range 4.2 - 5.8

He prescribed me Vit B12 1000 MCG daily tab and vit D 50,000 IU tab weekly

I am not on any meds for thyroid. Dr says my thyroid is in normal range.

Perhaps lockdown/ indoor situation has created vit D deficiency

I am starting to take milk hoping that it would help with calcium and Vit B12 in addition to the tabs that Dr prescribed. BTW I am 44 Male if that is relevant.

Thanks.

[Gingernut44 in reply to vink123]

I think the range you put for TSH is wrong- should the upper limit be 4.5 ? It would also help if you added a little more info on your profile so that members would know that you are male and what country you are in. It aids in answering your questions as ranges for vits and minerals are sometimes higher for men.

[Saggyuk in reply to vink123]

Hi Vink123

Apologies, I should have been more specific if you're not so used to blood tests but it was late last night. I meant Cbcs rather than Rbcs - this would include red cell count, haemoglobin, haematocrit, mcv, mch, mchc, rdw... Also for iron panel, this would include ferritin, total iron binding capacity (TIBC), transferrin saturation, ect.

Calcium seems higher in range but as mentioned, it will strip it from your bones to ensure blood levels are okay. You don't want to supplement calcium (unless advised for medical reasons) so you just want to make sure eating enough of it for now to get some back in your bones so yes milk will help in this respect. Do retest this alongside all in a few months to double check still okay level.

In regards to b12 food/milk is unlikely to make a difference at this point as food can only really maintain the levels you have rather than increase (same with iron) so once you hit a B12 deficiency, you'd have to medicate with a high dose supplement.

I imagine you are iron deficient too so if you haven't got full iron panel and cbc for a full picture and because you are low in B12, do retest this after B12 has become satisfactory anyway.

In regards to the form of B12 he's prescribed, the vitamin comes in different forms - some much better than others. It should state it on the packet. If it's just cyanocobalamin, this is not the best one in regards to your ability to absorb and make use of it. You should get a good quality more active version like methylcobalamin at around 3000 which you can buy yourself online.

Yes, as gingernut mentioned, do recheck your TSH range as not quite making sense to me. They look quite elevated if this is the range which doesn't fit with doctor saying they are in range. Upper range would normally be 4 point something where I live.

If thyroid is just in range, then sorting out the deficiencies could help. My friend who is a vegetarian was showing raised TSH and Low T3 and nearly all her female relatives were autoimmune hypothyroid and she was feeling quite unwell as is a gym instructor. However, once she dealt with the iron, vit d and B12 deficiency (which I've seen often in vegetarians) her thyroid levels corrected themselves and she hasn't had a problem in the five years since . However with raised thyroid antibodies ( check this range as well), you will have to keep a closer eye on this. However, if the ranges for TSH are correct, then you seem quite high above this and maybe indicates you need medication.

Also ensure you are getting enough selenium and iodine in your diet as your thyroid needs these to work effectively. You don't want to supplement iodine as can make things worse for those with thyroid issues already and testing is sketchy anyway but check you are getting enough sources from your food. In regards to selenium, you can take supplements no more than the recommended daily amount required but again better off to get it from your food and let your body take what it needs rather than forcing it upon yourself. You can eat 2-3 brazil nuts per day instead of supplementing but make sure they are good quality/organic as these are more likely to contain enough themselves.

[vink123]

Thanks Gingernut44, Saggyuk, Jonathan1956 for your replies. This is really helpful.Few points:

My latest TSH is 4.33 range 0.4 to 4.5 (it was a typo)

I was looking at my old reports and in 2018 my TSH was 4.04 while in 2019 it was 3.5 so, generally it seems to be at higher side but in range.

I have no symptoms or any issue at all. I feel completely fine.

I was tested for CBCs , 2 months ago (WBC/RBC/MCV/MCH/MCBC/RDW/HEMOGLOBIN/HEMATOCRIL/Total Iron ) and everything was within normal range.

I live in USA and am of South Asian/ Indian heritage.

Thanks again for the input. I will follow the suggestions wherever possible.