Blood results: I have no idea what my bloods... - Thyroid UK

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Blood results

MARZY1969 profile image

I have no idea what my bloods should be, my GP wont test Free T3

How can they tell I don't need it

My hair still falls out and lost some of my eyebrows, I would be grateful for any info

Hope you can read this attachment

45 Replies
SlowDragon profile image
SlowDragonAdministrator

Vitamin levels need retesting

What vitamin supplements are you currently taking

Oct 2020

Folate and B12 both far too low

Have you been taking daily vitamin B complex and separate B12

Ferritin terrible at 17

Presumably GP did full iron panel test after such low ferritin result

Did you get prescription for iron supplements

No vitamin D result

Insist on vitamin testing now

Or test privately

Recent Thyroid levels from September

Test is completely inadequate

Ft4 low - suggests under medicated

No FT3

How much Levothyroxine are you currently taking

Was test done as early as possible in morning before eating or drinking anything apart from water and last dose Levothyroxine 24 hours before test

Do you always get same brand Levothyroxine at each prescription

Suggest you get FULL thyroid and vitamin testing done via Medichecks or Blue Horizon if GP is unhelpful over testing vitamins

If GP tests vitamin levels

Just test TSH, Ft4 and FT3 via Monitor My Health at £29 with 10% off if order via Thyroid Uk

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

I dont take any supplements as I didnt know I needed to, can you recommend? I am currently on 100mcg Levothyroxine, Gp not done any iron panel, no prescription at all for this, test was done first thing in the morning, I didnt take my Levo before blood test, waited until after. I take my medication first thing in the morning and it was 2 hours before my blood test. what do I need to do to get this done via Monitor my health. Thank you.

MARZY1969 profile image
MARZY1969 in reply to MARZY1969

sorry 24 hours before not 2

SlowDragon profile image
SlowDragonAdministrator in reply to MARZY1969

Recommend using Medichecks or Blue Horizon as you need vitamin levels testing

Can choose DIY finger prick test or pay extra for private blood draw

SeasideSusie may pop along with tips on how to do test

thyroiduk.org/help-and-supp...

Medichecks often on offer on Thursdays

medichecks.com/products/adv...

Blue horizon

bluehorizonbloodtests.co.uk...

Only do private test early Monday or Tuesday morning and post back via tracked postal service

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

thank you so much for all your help, 🙂

How can they tell I don't need it

I think that's the whole point of not testing FT3 - if you don't know you need it, you can't ask for it, because they don't want to give it!

However, looking at your results, your TSH is too high, and your FT4 is only mid-range. So, judging by those two results, your FT3 is more than likely going to be low - FT4 is usually lower in range than FT4.

Also, your cholesterol is high, and that is usually caused by low T3. But, I doubt your doctor is capable of drawing those conclusions, he doesn't know enough about thyroid - none of them do - and would probably just tell you that the FT3 test is inreliable, anyway. So, the only way to know for sure is to get private testing, I'm afraid.

MARZY1969 profile image
MARZY1969 in reply to greygoose

thank you

SlowDragon profile image
SlowDragonAdministrator

Ferritin under 30 = deficiency

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.

Are you vegetarian or vegan

Suggest you read as many posts and replies by humanbean about iron and ferritin

On Levothyroxine we must have optimal vitamin levels

Ferritin at least around 70

Folate at least half way through range

Serum B12 over 500

Vitamin D at least around 80nmol

High cholesterol is strongly linked to being hypothyroid so this also suggests you are under medicated

hi, I am not vegi or vegan, thankyou for your reply, do you think I should go back to Doctor with this? the reply from doctor was, bloods normal, no further action required. we are supposed to be able to trust our Doctor. thanks again.

SlowDragon profile image
SlowDragonAdministrator in reply to MARZY1969

So what happened last year with low vitamin levels?

Recommend getting FULL thyroid and vitamin testing done privately if you can afford it

Alternatively make appointment with GP and request vitamin D, folate, ferritin and B12 tested

SlowDragon profile image
SlowDragonAdministrator

How much Levothyroxine are you currently taking

How much do you weigh in kilo approx

I take 100 mcg Levothyroxine, I am overweight, I cant seem to lose weight, my current weight is about 73 kilo (11.5 Stone) I am only 4ft 11, so very overweight. very frustrating!

SlowDragon profile image
SlowDragonAdministrator in reply to MARZY1969

If prefer

Before testing privately

See/contact GP

Request 12.5mcg dose increase in Levothyroxine (100mcg and 125mcg on alternate days)

Plus request GP test vitamin D, folate, ferritin and B12

Point out ferritin was deficient last year and folate and B12 low

Do you always get same brand Levothyroxine at each prescription

Which brand suits you best

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

73 kilo x 1.6 = 117mcg per day

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

Thank you, I will check with GP again, if I get nowhere I will get it done privately, thank you

SlowDragon profile image
SlowDragonAdministrator in reply to MARZY1969

Are you currently taking any other medications or supplements

Do you always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after

No other medications or supplements within 2 hours

Some like iron, vitamin D, magnesium within 4 hours of levothyroxine

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

the only other meds I am on are blood pressure tablets 10mg Ramapril, if I could lose weight my blood pressure would probably come down.

SlowDragon profile image
SlowDragonAdministrator in reply to MARZY1969

Did you read this post

healthunlocked.com/thyroidu...

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

I missed that one, very interesting, thanks again, I will let you know how I get on with Doctor, you have helped me more than my Doctor has. I am not sure how they will react to me asking them to do the tests you have asked me to request, wish me luck 😀 you know yourself when you dont feel right and look to your doctor to help, they havnt helped me, telling me my bloods are fine when clearly they are not.

Doctors have always said my bloods were fine

SlowDragon profile image
SlowDragonAdministrator in reply to MARZY1969

Yet NICE guidelines show Ferritin is deficient and GP should have done full iron panel test last year

Ferritin likely even lower now

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

thank you

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

I contacted my Doctor this morning this was her reply

I'm sorry to ear that you are still feeling unwell despite your levothyroxine. Some people need higher free t4 levels to feel better but we must be cautious in going too high and essentially over treating your hypothyroidism as this is not without risk. I think it is reasonable to trial you on an increased dose by 12.5mcg on alternating days.

We can then repeat your bloods in 3 months time. At this stage we can repeat your folate and ferritin, but looking back your levels have always been within the normal range and so I think it is very reasonable for these bloods to be done in 3 months time alongside your repeat thyroid function.

I will send your new prescription to your usual pharmacy.

Best wishes,

Dr Steven"

SlowDragon profile image
SlowDragonAdministrator in reply to MARZY1969

Obviously GP going to be obtuse and unhelpful

B12 and folate you will need to self supplement to improve

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Thorne Basic B is a recommended option that contains folate, but is large capsule. You can tip powder out if can’t swallow capsule

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

so I will order B12 and B complex and see how I get on with these, thank you

MARZY1969 profile image
MARZY1969 in reply to MARZY1969

Vitamin B Complex 180 Tablets 6 Month Supply Contains All 8 B Vitamins in 1 Tablet, Vitamins B1, B2, B3, B5, B6, B12, Biotin & Folic Acid, High Strength Vitamin B Complex Vegetarian & Vegan

vitamin b, is this vit b ok to take, the only thing is it has folic acid in it
SlowDragon profile image
SlowDragonAdministrator in reply to MARZY1969

Low ferritin

Will tag

humanbean and SeasideSusie

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

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.

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 ever supplement iron without doing full iron panel test for anaemia first

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Why low ferritin needs improving

healthunlocked.com/thyroidu...

Iron/ferritin and restless legs

healthunlocked.com/thyroidu...

Helpful post about iron supplements and testing

healthunlocked.com/thyroidu...

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

Vitamin B Complex 180 Tablets 6 Month Supply Contains All 8 B Vitamins in 1 Tablet, Vitamins B1, B2, B3, B5, B6, B12, Biotin & Folic Acid, High Strength Vitamin B Complex Vegetarian & Vegan

is this vitamin B complex ok to take? sorry Im not sure what ones to buy

MARZY1969 profile image
MARZY1969 in reply to SlowDragon

Vitamin B Complex 180 Tablets 6 Month Supply Contains All 8 B Vitamins in 1 Tablet, Vitamins B1, B2, B3, B5, B6, B12, Biotin & Folic Acid, High Strength Vitamin B Complex Vegetarian & Vegan

Im sorry for all the questions, is this ok to take?

SlowDragon profile image
SlowDragonAdministrator in reply to MARZY1969

a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B is a recommended option that contains folate, but is large capsule. You can tip powder out if can’t swallow capsule

Or Jarrow B right

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

MCV - Mean Cell Volume tells you the average size of Red Blood Cells.

If it is below range or low in range it can indicate that serum iron and/or ferritin (iron stores) is low.

If it is above range or high in range it can indicate that vitamin B12 and/or folate is low.

If both iron and/or ferritin is low and vitamin B12 and/or folate is low then MCV could be anywhere and can't be used reliably to indicate low iron/ferritin or low B12/folate.

Your Haemoglobin is quite high in range indicating that you aren't anaemic.

You might find the following papers of interest :

Title : Iron deficiency without anaemia: a diagnosis that matters

Link : ncbi.nlm.nih.gov/pmc/articl...

Title : Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial

Link : ncbi.nlm.nih.gov/pmc/articl...

Both the above papers can be viewed/downloaded/printed as PDF files.

...

If I was in your shoes I would want to increase the B12 quite dramatically and I would take methylcobalamin to do it.

I would also want to increase the folate to upper half of the range i.e. 11.4 - 20 with the range you've supplied, and I would take methylfolate to do it. See this link :

chriskresser.com/folate-vs-...

Your ferritin is also very low and needs increasing, as has already been mentioned in other replies. If I was in your shoes I would want a level of ferritin of about 50% - 75% of the range which would be approximately 110 - 155 with the range you've been given.

Although self-supplementing vitamin B12 and folate is generally safe without further info, that isn't true of ferritin. Before supplementing ferritin I would always want to do an iron panel to check not just ferritin but other iron-related levels as well before supplementing.

For reasons why I say this, please read this thread :

healthunlocked.com/thyroidu...

MARZY1969 profile image
MARZY1969 in reply to humanbean

thank you

Hi 👋 I’m relatively new to all this thyroid stuff but coming in this site a couple of years ago and learning from all the very talented and knowledgeable people on here gave me the confidence to speak to my gp . I explained that I had joined this group ( which is the link on the NHS website) and that I had educated myself. If you write down what you want to say and add things like “ the Nice guidelines state this” etc it shows that you are not just talking out of your ****e 😁. I have found knowledge is power 🙌. I read every morning on this site and can now talk to my GP with confidence.Good luck

thank you

Hi MARZY1969. Your FT4 is only 50% through range, so for me personally I would reject that advice from the GP and request that you increase your Levo by 25mcg per day amd not the 12.5mcg increase every other day that she has suggested. When this is done for at least 6-8wks then you should request a retest. So again reject her advice to retest in 3mths, that’s too long.

Also, you need to get b12 and folate tested and as you haven’t been supplemtjng you will get an accurate result, so please don’t take any supplements untill you test.

Folate is a co factor of B12 and helps utilise it.

B12 and folate help in the conversion of T4 to T3 so they are important to get optimal.

If your results are low, go for MMA testing and PA testing before you begin any supplements (because of your high MCV value) you are not vegan, so should be get enough B12 in your diet (meat, greens, dairy)

Oral B12 tablets only help those with dietary restrictions. B12 injections and folate tablets are needed for all other reasons. HTH

MARZY1969 profile image
MARZY1969 in reply to NWA6

thank you

MARZY1969 profile image
MARZY1969 in reply to NWA6

why is my doctor still insisting that my bloods are fine and within the normal range 🤨

Because they only look at the reference ranges of the tests and anything within the range they consider "fine". They are lazy. They don't learn about this stuff. Someone who is 1 point inside the bottom of the range for FT4 will have a very different life to someone who is 95% through the range. And for Ferritin, they think anything will do, but for us thyroid patients we need to be over 80 to have good conversion of Levo into active thyroid hormone T3.

I think you said above that "we should be able to trust our doctors shouldn't we?" I'm afraid you need to get over that idea really fast now. They will only keep you sick. Learn all you can. It's your body and you know what feels right and wrong and then you can tell them what you need them to do from a position of strength. Start with saying that you have thought about it and understand the risks (there really aren't any at this stage) and you would prefer to go ahead with an increase of 12.5mcg a day, and retest in 8 weeks time. Be polite but assertive. If they say no, quote the NICE guidelines at them.

the doctor has already agreed to increase, I copied and pasted what she said above, thank you though, it's terrible that we have to tell them what we need.

I thought she'd agreed a 12.5mcg increase every other day? ie so small you won't notice it. I was suggesting you ask for at least 12.5mcg every day, if not a full 25mcg a day. You are nowhere near overdose levels. But do what you are comfortable with. Don't expect much change on such a tiny dose, but work on the vitamins ready for the next dose increase. Do try to get your blood test in 8 weeks not 12.

NWA6 profile image
NWA6 in reply to MARZY1969

Mine told me for 10yrs that my results were fine. A typical result for me could be

FT3 - 3.5 (3.5- 6.5)

FT4 - 19 (12 - 22)

As you can see they are in range, so why was I so symptomatic for 10yrs? Thinking I was going mad, GP’s treating me like a nuisance, telling me I might have fibromyalgia or bi polar, testing for arthritis, heart conditions, brain scans.

Turns out that T3 of 0 % through range just isn’t working for me

I use this calculator to work out my through range number from every blood test.

chorobytarczycy.eu/kalkulator

I needed T3 (Liothyronine) added to my Levothyroxine as I don’t convert well. I’m all lol so just finding out that I need B12 and folate to help conversion too, so now I’m looking at tests.

You however just don’t have enough T4 yet and do need a Levo raise, once that is raised to at least 70% through range, you can assess the T3 at the same time and begin to build a picture of whether or not you convert well.

MARZY1969 profile image
MARZY1969 in reply to NWA6

thank you

MARZY1969 profile image
MARZY1969 in reply to NWA6

just out of curiosity, if doctor asks where I am getting all my info from, what do I tell her? I appreciate all the help I am getting, more than the doctors are giving me 😊

NWA6 profile image
NWA6 in reply to MARZY1969

I doubt GP’s will be interested, they have no time. But there’s loads of references out there and NICE guidelines too. You can say patient to patient support - those who have experienced the high s and lows of thyroid health. ThyroidUK have a good reputation too. Tell GP that you understand the risks - of which they’re really aren’t any but play the game and say you are making an informed choice to raise your FT4 and you’d like to know your FT3 but that I’d the GP isn’t willing to do that, you will use private blood tests.

You have loads of ‘wiggle room’ to take more Levo. Definitely increase by 25mcg per day.

Be bold! Be confident! Be your own advocate 🤗

MARZY1969 profile image
MARZY1969 in reply to NWA6

thank you so much 😀 I really need to stand up for myself

You do. I think you test result says your FT4 is 15 in the last test. Using the Polish calculator that NWA6 linked for you above (book mark it, it's worth its weight in gold) you FT4 level is just 50% through the reference range. Half-way. Most of us need to be in the top third or top quarter of the range before we start to feel good. And we only feel good then if our conversion is good.

You have plenty of scope for an increase. Meanwhile, your GP is worried because your TSH is below 1 (where it needs to be) and she feels a dose increase might move that number outside of the reference range when she will squeal "hyperthyroid!" and try to reduce your dose. But you won't be hyper. GPs don't understand thyroid blood results well at all. They give all the focus to the TSH which can be low for all sorts of reasons, not just thyroid.

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