Bloods taken this morning and just received a call from the GP saying they want to reduce meds again despite me feeling worse from the last reduction. Levothyroxine was gradually increased from diagnosis in Dec 2020 to 125 then 2 reduced months ago to 100 and GP wants to reduce to 75 now. I asked for a full range of tests today because I knew I had felt a lot worse since the last reduction. Any ideas from these results of why I don't feel well if it is not lack of thyroxine. Bloods taken at 08.10no meds since last night, no food etc
TSH 0.26 (0.31 - 5.6)
FT3 5.6 (4 - 6.6)
FT4 13.4 (no range given)
B12 219 ng/L (120 - 625)
Ferritin 46 ug/L (no range)
Folate 2.8 ug/L ( no range)
Total 25-OH Vit D 24nmol/L (no range)
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Emmastace
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It would appear to be classic case of looking ONLY at TSH and seeing it is very slightly below the reference interval (range).
Please ask for the reference intervals for the ones you didn't get. You are absolutely entitled to them and it should be achieveable without any difficulty - but we sometimes hear otherwise.
Many labs post their reference intervals on the pathology website for the hospital where they are located. You could try searching for that as it is already end of week.
I urge you not to reduce further - at least, not for now. (Let's see what is what and the opinions of others.)
Thank you. I asked GP to leave it for now as he had not received the Folate, ferritin, Vit D and Vit B12 results when he spoke to me. I have received them in my online account since then. I gathering stuff to go back to him with next week.
As Helvella says, you need the other reference ranges. If you don't have online access to your results, and your surgery doesn't offer this facility, ask the receptionist (not the doctor) for a print out of your results, the ranges should be alongside the results on the print out.
Regardless of your thyroid results, these all pose a problem:
B12 219 ng/L (120 - 625)
This could possibly be B12 deficiency. Many people with a level in the 300s have been found to need B12 injections.
Do you have any signs of B12 deficiency – check here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.
"Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 25 nmol/L.
For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders.
* Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."
Your GP should provide these loading doses. Please come back and tell us if he does and what he has prescribed. There is further information to pass on about treating with Vit D but I don't want to overload you at the moment.
If GP doesn't give loading doses as above, or only gives you 800iu or 1,600iu, please come back and tell us as you should then treat yourself, it's easy enough to do following the guidance above, and I can then tell you what else you need.
Ferritin 46 ug/L (no range)
The range will be something like 13-150, 15-300 or maybe even 20-400. Whichever it is this is low. Because of all your other dire nutrient levels I would be inclined to ask your GP to do an iron panel to see if you have iron deficiency and a full blood count to see if you are anaemic. You can have iron deficiency with or without anaemia.
If you are not iron deficient or anaemic you can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
Don't consider taking an iron supplement yourself unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
These dire nutrient levels will definitely have been caused by your Hashimoto's which often affects gut/absorption. I will ask SlowDragon to comment when she is around as she has lots of links about this.
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.
Same applies to low B12 - extremely common in hypothyroid patients
All patients who are hypothyroid should have B12 tested
There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,
Patients with AITD have a high prevalence of B12 deficiency and particularly of pernicious anemia. The evaluation of B12 deficiency can be simplified by measuring fasting serum gastrin and, if elevated, referring the patient for gastroscopy.
Levothyroxine can decrease serum homocysteine level partly; still its combination with folic acid empowers the effect. Combination therapy declines serum homocysteine level more successfully.
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.
Hashimoto’s is complex disease as it can and does frequently badly affect gut absorption, leading to low stomach acid, poor nutrient absorption and low vitamin levels
This is frequently way beyond many GP’s understanding
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Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
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