I posted a few weeks ago after having some odd blood test results via Monitor Your Health which possibly indicated central hypothyroidism. My GP carried out her own tests and apparently all is well and there is nothing to worry about. My latest results are:
B12 - 79 pmol/L (37.5 to 150)
Folate - 28 nmol/L (8.83 to 45)
Ferritin 13 ug/L (11 to 307)
TSH - 1.72 mIU/L (0.27 to 4.2)
FT4 - 12 pmol/L (12 to 22)
No FT3 or vitamin D tests done.
I certainly don’t feel fine! I’m exhausted, my joints hurt, my hair is falling out, my skin is dry and itchy etc.
Not on any medication apart from HRT. GP blood tests first thing in the morning after just water.
Does anyone know if these tests indicate a thyroid issue please?
Many thanks
Written by
kb53
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I am going to say exactly the same as last time. Your FT4 was below range then, this time it's come in on the very bottom limit of the range. I still think this could possibly be Central Hypothyroidism. Did you give your GP the evidence Iinked to previously? Did yourGP read it?
Ferritin 13 ug/L (11 to 307)
What has GP said about this result? I am assuming because it's scraped into the bottom of the range yourGP is saying it's fine? Well it's not and here is the proof you can show your GP, from the NICE Clinical Knowledge Summary:
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Iron deficiency can significantly lower circulating levels of both T4 and T3 and can reduce conversion of T4 to T3. So if you don't have Central Hypothyroidism then your ferritin level and probably iron deficiency is very likely playing a big part in how you feel and your thyroid hormone levels.
Please get back to your GP and ask for an iron panel (which would show iron deficiency) and a full blood count (which would show anaemia).
My GP refused to accept my previous blood test results despite them being carried out at an NHS lab!
My ferritin has risen from 5 ug/L but it’s taken a long time as I can’t tolerate oral iron supplements and can only really take Spatone. I had an iron infusion a few years ago but won’t get another as my level is now over 10 ug/L which is the cut off point for eligibility. I can’t really afford to have one privately.
I did have my haemoglobin tested and that was:
154 g/L (115 to 165)
Red blood cell count 5.00 10*12/L (3.8 to 5.8)
Unfortunately she is the only GP currently in the practice so I’m a bit stuck.
Am really at a loss to know how to proceed, like you say the symptoms are so similar it’s difficult to know if it’s my ferritin or my thyroid causing the problems.
So you don't appear to be anaemia. You can have iron deficiency with or without anaemia and I'm pretty certain this is at the root of your problem and I don't think anything will get much better until your ferritin level and possible iron deficiency is resolved.
Maybe suggest to your GP that due to your low FT4 level she can take advice from an endo or refer you. The trouble is most endos are diabetes specialists so know little about thyroid problems, and those that do have probably not come across Central Hypothyroidism as it's not as common as Primary Hypothyroidism.
Other than that, make a nuisance of yourself, it's the squeaky wheel that gets the oil. Do you have a partner who can advocate on your behalf (I know it's unlikely that you'll get a face to face appointment whereby someone can accompany you, but maybe a letter or phone call?) and say how much your lives are affected?
I’ll try and get a telephone consultation booked in with my GP to discuss how to proceed. I think they are fed up with me!
Will also have another try with iron tablets and see how that goes. At least I’m working from home now so won’t have the embarrassment of being horribly sick in the office which is what happened last time.
Being fed up with you is a good sign 😁It means they are about to concede.
Keep going there with the evidence provided on the first post and keep requesting an Endo.
In fact, maybe I would research an Endo which specialises with Thyroid problems and then ask to be referred there.
Anywhere in the country might work as well as most people are doing online consultations, so that might be a good protocol to keep up later on as well if you can’t get to the clinic.
Hi kb53 - I’m following you as your thyroid results are similar to mine ie. all low. I’ve suspected that I’m central hypo for some time but my gp and nhs endo keep saying the results are normal. Frustrating.
I did have a bad car accident many years ago which kept me in hospital for a few days with concussion and head trauma
Your going to need to see a pituitary and thyroid specialist endocrinologist ….
Have you had cholesterol levels tested
High cholesterol levels linked to being hypothyroid thyroid
Have you had thyroid antibodies tested
TPO and TG antibodies tested for autoimmune thyroid disease also called Hashimoto’s
Clearly your ferritin is dire
Are you vegetarian or vegan?
What iron supplements are you currently taking
There are other supplement options to consider
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
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
Thank you for your detailed reply. My cholesterol is high at:
6.29 mmol/L ( 3.5 to 5.2)
Thyroid antibodies were normal at:
<4 iu/mL (0.0 to 30.0)
Not vegetarian or vegan but don’t eat a lot of red meat. Currently taking a couple of sachets of Spatone a day with orange juice. Went through all the strong iron tablet options and they all made me incredibly sick unfortunately. GP refused another iron infusion.
GP said no to Vit D test as I spend a couple of hours a day outside therefore she felt it was unnecessary.
My FT3 was tested as part of my original private tests and was:
4.3 pmol/L (3.1 to 6.8)
It wasn’t done this time for some reason.
I’m based in Wiltshire but have no issues with travelling if I can get to see someone who can help.
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.
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.
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.
You need to ask for a referral to an Endocrinologist. Failing that pay for one yourself if you can.
Yes your t4 is low in the range and your T3 not very high. Point is that with statistical ranges, most will feel well but not all will feel well. And your symptoms clearly show you don’t feel well.
You could move docs or make a complaint … a drastic action but hey clearly you need help and aren’t getting it.
As people have said here, having any vitamins or minerals low in range tends to give symptoms so do start supplementing.
And ultimately it may be that to get better you need to start self medicating…but don’t jump there yet. X
Well I’ve spoken to my GP this morning and have been refused a referral to an endocrinologist. Apparently all my test results are fine and I might benefit from some help with my obvious health anxiety!
Think I now need to start thinking about going private.
Sadly no GP practices in the area are currently taking new patients who are already registered at a surgery as they are all at capacity.
My ferritin has risen from 5 ug/L but it’s taken a long time as I can’t tolerate oral iron supplements and can only really take Spatone.
So, which iron supplements have you tried? There are lots of them available.
The thing which makes the difference between one iron supplement and another is the amount of iron it contains, and it has a major impact on who can tolerate any particular supplement. The higher the amount of iron the fewer people can tolerate it.
The strongest iron supplement the NHS ever prescribes contains 100mg pure iron per tablet.
Spatone sachets contain 5mg pure iron.
There are a lot of options in between those two extremes.
I discussed various iron supplements in this reply to someone else :
Please note that prescribed iron supplements can be bought without prescription from Pharmacies in the UK. You need permission from a pharmacist to buy it. I've bought iron supplements quite frequently over the years and only been refused once - by Boots. If you get refused just go to another pharmacy. I generally buy mine from Tesco or Lloyds or independent pharmacies.
To make iron supplements more tolerable you can take it in the middle of a meal. And to help absorption iron can be taken with vitamin C in some form e.g. a vitamin C tablet or a glass of orange juice.
I’ve had all three of the commonly prescribed iron tablets and tried them all with and without food. All have made me vomit spectacularly after a couple of days on them. Reducing the dose to one tablet every other day stopped the vomiting but left me with constant nausea which was just as debilitating.
Had an iron infusion a few years ago and should have had another blood test as a follow up but my GP (different one but same practice) decided it wasn’t necessary. I didn’t actually feel any better after it if I’m honest.
It’s so frustrating. I’d think about paying privately for another infusion but it’s a lot of money if I’m not going to feel any better. The cut off point for another one on the NHS is a ferritin level under 10.
I’ve been tested for coeliac disease and had an endoscopy and colonoscopy, neither of which showed any issues. I’m now 18 months post menopause so can’t really understand why my level is so low.
I do eat gluten - probably a couple of slices of bread a day. Have become increasingly dairy intolerant so only really have a splash of milk in tea and coffee. My son is vegan so we mainly have dairy free yoghurt and margarine.
Not sure I could give up gluten completely. I’ve got oral allergy syndrome so many nuts and fruit are excluded already unless cooked. Eating is a chore rather than a pleasure!
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