Thoughts on thyroid results?

[BlueBlobs1]

Hi I got thyroid test done for my wife as the GPs one showed low TSH out of bottom range, so I wanted to get antibodies checked with a private test. While I was at it, I got my own done too.

Wifes:

Magnesium H 1.05 0.7 - 1.0 mmol/L

Cortisol (Random) 424.0 6am - 10am 166 - 507 nmol/L 4pm - 8pm 73.8 - 291

Thyroid Function

TSH 0.34 0.27 - 4.20 mU/L New range & unit

T4 Total 110.0 66 - 181 nmol/L

Free T4 18.1 12.0 - 22.0 pmol/L

Free T3 3.84 3.1 - 6.8 pmol/L New range

Immunology

Anti-Thyroidperoxidase abs <9.0 <34 IU/mL New units

Anti-Thyroglobulin Abs 11 <115 IU/mL New units

previous

0.18 mu/l [ 0.34 - 5.6 mu/l ]

Free T4 17 pmol/L ( no range given )

Free t3 5.7 pmol/L [ 4-6.6 ]

B12 295 ng/L [ 120-625 ]

---

Mine:

Biochemistry

Magnesium 0.84 0.7 - 1.0 mmol/L

Hormones

Cortisol (Random) 330.0 6am - 10am 166 - 507 nmol/L 4pm - 8pm 73.8 - 291

Mine:

Thyroid Function

TSH 2.49 0.27 - 4.20 mU/L New range & unit

T4 Total 95.3 66 - 181 nmol/L

Free T4 16.4 12.0 - 22.0 pmol/L

Free T3 5.24 3.1 - 6.8 pmol/L New range

Immunology

Anti-Thyroidperoxidase abs <9.0 <34 IU/mL New units

Anti-Thyroglobulin Abs 13 <115 IU/mL New units

Previous 3 tests from 2013

T4 16 (10-24)

TSH 3.1 (.3 - 5.5)

---

TSH 2.7 ( only TSH done and didn't write down range )

---

free T4 18 pmol/L (10-22)

free T3 4.9 (3.1 - 6.8)

TSH 1.9 (.3 - 5.5)

---

Both done before 9am, no food, only a little water.

The GP comment said my wife's magnesium level should be checked again in a few months to make sure it isn't rising.

Any thoughts appreciated

[NWA6]

Hi BlueBlobs1 are there any other reasons why you have done thyroid tests? Any symptoms or history?

[BlueBlobs1 in reply to NWA6]

I have bad fatigue and my HR gets very low sometimes like 47bpm. My wife is more acutely unwell, GP thinks the thyroid is a incidental finding but they don't think it's related. I would say she fitted the hyperthyroid symptoms before becoming unwell though. Particularly fast HR, anxiety and palpitations.

[SlowDragon Administrator in reply to BlueBlobs1]

Your wife has very low Ft3

Negative thyroid antibodies

However 20% of Hashimoto's patients never have raised antibodies

Suggest you consider getting ultrasound scan of thyroid

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

She needs vitamin D, folate, ferritin and B12 levels tested

Common with low Ft3 for vitamins to be low ….or vice versa…..low vitamin levels result in low Ft3

What’s her diet like?

Vegetarian or vegan?

Previous test shows low B12

B12 295 ng/L [ 120-625 ]

[BlueBlobs1 in reply to SlowDragon]

Well, she hasn't been eating well at all because she has had pain in her mouth with trouble swallowing. Mostly yogurt, milk and cream. Not great but better then no food at all.

These were from 6th Oct by GP. Vit D not done.

Serum folate 6.1 ug/l

Serum ferritin 34 ug/L

B12 295 ng/L [ 120-625 ]

Thanks very much for your reply

[SlowDragon Administrator]

Are either of you diagnosed as hypothyroid and on levothyroxine?

Have either of you had Covid recently?

What prompted testing?

Any particular symptoms

Are these tests via Blue Horizon

Were vitamin D, folate, B12 and ferritin tested

[BlueBlobs1 in reply to SlowDragon]

Neither of us diagnosed or on levothyroxine. For her the GP was doing a broad test as no one knows what's wrong with her and the low TSH was the only thing out of range. She has a burning pain in her gum, palatte and throat, dry mouth and dysphagia. Frequent passing out and periods of confusion.

Neither had covid.

My old tests where the GP looking for cause of fatigue, which I still have so I thought I'd check again just to see if it had changed form before.

They were blue horizon.

These were from 6th Oct by GP. Vit D not done.

Serum folate 6.1 ug/l

Serum ferritin 34 ug/L

B12 295 ng/L [ 120-625 ]

Thanks for your reply

[SlowDragon Administrator in reply to BlueBlobs1]

How old is she?

Anything happened prior to illness, eg head trauma, whiplash, severe virus, Gladular fever etc

Burning mouth syndrome

Note - linked to hypothyroidism and low B vitamin levels

B12 is highly likely too low at under 500

Getting full testing for Pernicious Anaemia before starting on any B vitamins

pubmed.ncbi.nlm.nih.gov/172...

mayoclinic.org/diseases-con...

sciencedirect.com/science/a...

livestrong.com/article/4746...

Perhaps Ask for referral for her for Sjögren's Syndrome too

nhs.uk/conditions/sjogrens-...

Meanwhile getting ultrasound scan of thyroid

Sjögren's Syndrome Often linked with autoimmune thyroid disease

Swallowing and Sjögren's Syndrome

pubmed.ncbi.nlm.nih.gov/264...

[BlueBlobs1 in reply to SlowDragon]

There things that happened in the past but nothing recently. Just looking at full pernicious anaemia test on medichecks, some of the things listed were done.

Thank you for the links and good suggestions for possible cause. The doctors are all stumped. I think a referral for Stogrens is good idea. I will see if GP will refer on Monday.

This may not be readable as so many. Noticed a few say abnormal. GP didn't mention that.

Total white cell count

7.09 10*9/L

4.0 - 10.0

Normal

06 Oct 2021

Red blood cell (RBC) count

4.51 10*12/L

3.8 - 4.8

Normal

06 Oct 2021

Haemoglobin estimation

128 g/L

120 - 150

Normal

06 Oct 2021

Haematocrit

0.400

0.36 - 0.46

Normal

06 Oct 2021

Mean corpuscular volume (MCV)

88.7 fL

83 - 101

Normal

06 Oct 2021

Mean corpusc. haemoglobin(MCH)

28.4 pg

27 - 32

Normal

06 Oct 2021

Mean corpusc. Hb. conc. (MCHC)

320 g/L

315 - 345

Normal

06 Oct 2021

Platelet count

291 10*9/L

150 - 410

Normal

06 Oct 2021

Red blood cell distribut width

14.4

11.6 - 14

Abnormal

06 Oct 2021

Neutrophil count

3.46 10*9/L

2 - 7

Normal

06 Oct 2021

Lymphocyte count

2.69 10*9/L

1.0 - 3.0

Normal

06 Oct 2021

Monocyte count

0.53 10*9/L

0.2 - 1.0

Normal

06 Oct 2021

Eosinophil count

0.19 10*9/L

0.02 - 0.5

Normal

06 Oct 2021

Basophil count

0.04 10*9/L

0.02 - 0.10

Normal

06 Oct 2021

Large unstained cells

0.17 10*9/L

0.0 - 0.16

Abnormal

06 Oct 2021

[SlowDragon Administrator in reply to BlueBlobs1]

Red blood cell distribut width 14.4 (11.6 - 14)

High red cell distribution width suggests low B12, folate or ferritin

healthline.com/health/rdw-b...

Large unstained cells 0.17 10*9/L (0.0 - 0.16)

Abnormal

healthmatters.io/understand...

Be aware NHS only tests and treats vitamin deficiencies

Low, but not deficient vitamin levels are frequently ignored to detriment of patients

B12 range is often too wide

Many patients have low B12 symptoms long before reaching bottom of range

Low B12 symptoms

b12deficiency.info/signs-an...

B12 at 295 (120-625) could easily be too low for her

Folate is likely also low - you need range

range is typically either 3-20 8-60 or 3-999

Folate and B12 work together

[BlueBlobs1 in reply to SlowDragon]

Hmm. Interesting, low B12 could explain a lot and that Red blood cell distribut width could be low B12. She has had issues before with low iron stores, it made her very unwell. Looking at the symptoms, low B12 could explain a lot as she's been having confusion and passing out. It could also be a cause of burning mouth syndrome as you say. Thank you so much.

[SlowDragon Administrator in reply to BlueBlobs1]

Could it be B12 …book and movie

amazon.co.uk/Could-Be-B12-E...

b12deficiency.info/films/

[helvella in reply to BlueBlobs1]

High RDW often implies simultaneous iron deficiency and B12 deficiency.

Low B12 on its own tends to cause increased size of red celles - macrocytosis.

Low iron on its own tends to cause reduced size of red cells - microcytosis.

Both together can more or less cancel each other out in terms of mean red cell sizes. But RDW rises.

This has caused many mistakes in diagnosis over the years. Before we had RDW, it was a bit more understandable. Now, there really is no excuse for a trained medic to miss that.

[BlueBlobs1 in reply to helvella]

Very interesting. It's concerning how many blood tests and medics have ignored this considering she has text book symptoms of anaemia and has a history of anaemia. Sadly though, I am not surprised.

[SlowDragon Administrator in reply to BlueBlobs1]

These were from 6th Oct by GP.

Vit D not done.

Serum folate 6.1 ug/l

Serum ferritin 34 ug/L

B12 295 ng/L [ 120-625 ]

Are these your results or wife’s

All low

What vitamin supplements are you/wife taking

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[BlueBlobs1 in reply to SlowDragon]

They are my wifes. She had been taking B12 spray, iron tablets and D spray. But not much much lately. I will get get a D test thank you and I need to supplement her vitamins whilst she can't eat solids.

[SlowDragon Administrator in reply to BlueBlobs1]

Ferritin is low

She needs FULL iron panel test for anaemia

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

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.

healthunlocked.com/thyroidu...

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 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...

[BlueBlobs1 in reply to SlowDragon]

Thank you, I am not surprised, this has been an issue before

[SlowDragon Administrator in reply to BlueBlobs1]

Thousands of hypothyroid patients have low vitamin levels

Being hypothyroid lowers stomach acid leading to low nutrient absorption and low vitamin levels as direct result

Low Ft3 shows she’s either hypothyroid, causing low vitamin levels

Or low vitamin levels result in poor thyroid function

You will see many thousands of posts on here discussing low vitamin levels, low stomach acid and low Ft3

Has she had kidney function tested or cholesterol

High cholesterol is linked to being hypothyroid

Low GFR (kidney output) linked to low Ft3

Testing for low stomach acid

healthygut.com/articles/3-t...

Thousands of posts on here about low stomach acid

healthunlocked.com/search/p...

Web links re low stomach acid and reflux and hypothyroidism

nutritionjersey.com/high-or...

articles.mercola.com/sites/...

thyroidpharmacist.com/artic...

stopthethyroidmadness.com/s...

naturalendocrinesolutions.c...

meraki-nutrition.co.uk/indi...

huffingtonpost.co.uk/laura-...

lispine.com/blog/10-telling...

Protect your teeth if using ACV with mother

healthunlocked.com/thyroidu...

[Dancing_dragonfly in reply to SlowDragon]

A serum B12 is not a very accurate test for B12 deficiency. By the time it shows as low, you are REALLY deficient! A much better test for B-12 is methylmalonic acid. If it is high, your b12 is low and vice versa… I didn’t see a reference range for your iron labs and I am in the states, so different type of results… but it seems low.

[BlueBlobs1 in reply to Dancing_dragonfly]

Thank you. I will get that test for B12. Some of the results didn't have ranges, no idea why

[BlueBlobs1]

No kidney or cholesterol tests done

[SlowDragon Administrator in reply to BlueBlobs1]

Come back with new post once you get more results

[BlueBlobs1 in reply to SlowDragon]

Will do. I really appreciate your help.