Blood tests - advice requested please

[Wired123]

Hi all, please see my 65 year old Hashimoto’s mother’s recent bloods.

I’ve had her GP increase her Levo following January bloods which I was told were “normal” and had a right to at the GP for.

I find the results a bit erratic since, her TSH is low but I suspect some fluctuation is through Hashi’s?

Her FT4 and FT3 don’t look good to me and I’m sure you will agree.

She is due to see an NHS Endo who does prescribe T3, but I suspect they will focus on the low TSH and tell her she’s fine!

It’s surprising the TSH is so low despite very low levels of T4 and the suppressed TSH is perhaps lowering conversion to T3.

The B12 result is high but that’s more a function of just having had the B12 jab a week before the test - unfortunate timing really.

[fuchsia-pink]

The fluctuations in free T3 are a bit weird - but free T4 is consistently too low for someone on levo-only. So I'd say she definitely needs at least another dose increase of levo initially ...

It's to be hoped that an endo won't be too TSH-focused - actually I don't know why I wrote that as sadly they so often are - but I'd ask her to list out her hypo symptoms on her current level of meds to take with her and if possible can someone accompany her to the endo? - it's so useful to have someone else remember things that you the patient forget an have a third party say how you're not propely "you" and what was better before

Good luck -please let us know how she gets on x

[Lalatoot]

Wired I am 65 and have spent the last 2 years on levo and lio. Taken me 2 years to adjust both doses to get a big improvement in symptoms. Below is the evidence I used with an NHS endo to get my trial of T3. I had it prepared and handed it to her.

Text

[Wired123 in reply to Lalatoot]

This is a great example! I would even email it in advance so the secretary has attached it to your records then the doctor can’t dismiss it or fob you off.

[SlowDragon Administrator]

Vitamin D much better

Her ferritin is still low, but improving from last test in January

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.

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

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

HBa1c is quite high….looks like she eats high percentage of carbs ?

[SlowDragon Administrator]

I wonder if variation/drop in Ft3 is because she recently had B12 injection

Though conversion often gets worse with low TSH

Might consider trying splitting levothyroxine into 2 smaller doses per day, waking and bedtime. Might increase TSH, but obviously it’s more to remember

Or ask Endo to trial liquid levothyroxine. This can improve TSH

gov.uk/drug-safety-update/l...

if a patient is persistently symptomatic after switching levothyroxine products, whether they are biochemically euthyroid or have evidence of abnormal thyroid function, consider consistently prescribing a specific levothyroxine product known to be well tolerated by the patient

if symptoms or poor control of thyroid function persist despite adhering to a specific product, consider prescribing levothyroxine in an oral solution formulation

[Wired123 in reply to SlowDragon]

Thanks for the advice, let’s see what the Endo says…