Help with thyroid results please

[Flay]

Hi, can someone kindly help with interpreting my 14 y/o daughters recent thyroid blood test please?

Blood test was taken at 4.30pm and she missed that mornings dose of Levothyroxine (100mg).

TSH 0.23

T4 15.8

T3 4.3

The nurse refused my request for a full screening - my daughter normally has her Vit levels tested because she has low iron and vit D (she is currently taking vit D and ferrous Fumarate to help with this, but I’m unsure if the dose is adequate).

She was taking 125mg levo until xmas 2020, then changed to 100mg because I was concerned she was showing hyperthyroid symptoms - dizzy spells/fast heart rate etc).

It’s probably worth mentioning that she is strictly gluten free due to having coeliacs disease.

The symptoms she is currently experiencing at the moment:

- Flushing (face becomes bright red , especially in cold weather and she is very conscious about this)

- Hair loss (also a concern and she is upset/tearful about this)

- Weight gain

- Concentration issues

- Aching legs

Also, I think she had covid just before the pandemic hit the headlines and her symptoms afterwards went off the scale (and too many to list!) , she was referred to many different NHS departments, who did not know what to do with her. But I now realise she probably was suffering from long covid (of which she is just about recovered).

It was a year of health hell for her and I think her thyroid was affected by this - her thyroid results during that year varied: TSH barely registering to nearly 2 (although she stayed on the same dose of levo). TSH from 19 down to 15. Her T3 was not monitored.

Do you think her recent thyroid results look ‘normal’? Because this is the response she is receiving!

Thank you

[fuchsia-pink]

Hi Flay

Can you add the lab ranges for these results please? - these vary from lab to lab. You can edit your post using the "more" button on the right

They may well be "in range" or "normal" but they're clearly not optimal! But we really need lab ranges to say more x

[SlowDragon Administrator]

As she’s coeliac she should have vitamin levels retested at least annually

Presumably she has autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Does she always get same brand levothyroxine at each prescription

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Blue horizon allows testing of children

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins.

Recommend paying the extra for private blood draw

bluehorizonbloodtests.co.uk...

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

If taking iron supplements stop these a week before testing iron/ferritin levels

If taking any supplements that contain biotin stop these a week before ALL BLOOD TESTS as biotin can falsely affect test results

[nellie237]

Hi Flay,

Iron

NICE guidelines are clear on monitoring where there has been a diagnosis of anaemia based on haemoglobin of <118g/L (females & children over 12yrs) and Iron has been prescribed ie

Check haemoglobin (FBC) at 2-4 wks.........if there is a response to supplements...

Check FBC again at 2-4 months to ensure Hb levels are normal

Then.........

"Once haemoglobin concentration and red cell indices are normal:

Continue iron treatment for 3 months to aid replenishment of iron stores, and then stop.

Then monitor the person's full blood count every 3 months for 1 year." Thereafter annually.

If a prophylactic dose is prescribed (200 mg ferrous sulfate daily), and Coeliac is listed as one of the problems where this would be considered appropriate, there aren't any guidelines for monitoring, which seems crazy if the on-going dose requirement has not been established.

cks.nice.org.uk/topics/anae...

Ferritin

"If results of the FBC show a low haemoglobin and low mean cell volume (MCV) check the ferritin level — check the ferritin level in all people with an MCV less than 95 femtolitres."

"In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency."

Unfortunately there are not any monitoring requirements for ferritin levels, apart from the above.

cks.nice.org.uk/topics/anae...