Private blood test prior to my first NHS Endocrinologist appointment on Tuesday. Any thoughts welcome.
My previous blood test taken by GP 3 months ago;
TSH = 12.1 Free T4 = 13
Thank you
Private blood test prior to my first NHS Endocrinologist appointment on Tuesday. Any thoughts welcome.
My previous blood test taken by GP 3 months ago;
TSH = 12.1 Free T4 = 13
Thank you
mazza999
That is a very big difference in your TSH level in just 3 months considering you've been hypothyroid and on Levo for 15 years. I can't comment or compare FT4 result because you haven't given a reference range for your NHS FT4 test.
Did you do both tests as we advise:
* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH
* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
**
For your Blue Horizon test:
CRP is high, suggestion of inflammation somewhere.
Ferritin looks not too bad but as this can also be elevated when inflammation is present there's a chance your resut is falsely elevated and your normal ferritin level is lower than that suggested by this test.
Magnesium serum test is unreliable. About 99% of magnesium is stored in bone, muscles and soft tissues, leaving about 1% in the blood. So testing what's in the blood isn't giving an accurate picture of our magnesium status.
Cortisol seems OK providing test was done between 6am and 10am.
TSH: 0.22 (0.27-4.20)
FT4: 18.4 (12-22)
FT3: 4.78 (3.1-6.8)
Endo wont like your below range TSH but this is often the case when on Levo.
FT4 is 64% through range and FT3 is 45.41% through range.
The aim of a thyroid patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges.
Your FT4 and FT3 aren't particularly well balanced but I think your endo will say there's no problem as they're both within range.
Your T4 to T3 conversion rate comes in at 3.85 (18.4 divided by 4.78) and below 4 is said to be good conversion, above 4 not so good conversion.
Thyroid antibodies show no sign of autoimmune thyroid disease with those results.
Vit D at 71nmol/L could be better. The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L. If not already supplementing you could consider taking 3,000iu D3 during the winter months along with D3's important cofactors - Vit K2-MK7 and magnesium. Retest in March to check your level.
B12: 294pmol/L = 398pg.ml
This is on the low side. According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
If that was my result I'd be considering supplementing with some B12 sublingual lozenges until my level was over 550pg/ml (405pmol/L). My choice would be this one which contains two of the active forms of B12:
cytoplan.co.uk/vitamin-b12-...
When taking B12 we should also take a B Complex to keep all the B vitamins balanced.
I would use one bottle of the B12 along with B Complex then when that bottle is finished stop the B12 altogether then just continue with the B Complex.
For B Complex my preference is Thorne Basic B. If you look at different brands then look for the words "bioavailable" or "bioactive" and ensure they contain methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid). Avoid any that contain Vit C as this stops the body from using the B12. Vit C and B12 need to be taken 2 hours apart.
When taking a B Complex we should leave this off for 3-7 days before any blood test because it contains biotin and this gives false results when biotin is used in the testing procedure (which most labs do).
Although your folate test wasn't done due to blood being haemolysed, with a low B12 it's possible your folate level is on the low side. The B Complex will help raise your folate level.
That’s a brilliant answer to my question thank you. I did the test at 8am as soon as I got up, nothing to eat or drink and no thyroid meds or supplements for over 24 hrs. I’m going to have a good read of your advice now 👍🏻👍🏻
Excuse my thyroid ignorance! Is it an aim to get an endocrinologist to prescribe T3 to help or can I achieve good results with thyroxine and or supplements alone?
mazza999
Is it an aim to get an endocrinologist to prescribe T3 to help
Not for everyone, only those with poor conversion which is shown by high FT4 and low FT3. Many people do just fine with Levo only.
or can I achieve good results with thyroxine and or supplements alone?
Your current results show reasonable conversion (explained above). You may benefit from an increase in Levo which will increase your FT4 and your FT3 should increase as well.
Optimal nutrient levels are necessary for thyroid hormone to work properly so you need to improve your Vit D level, B12, probably Folate as well. Some experts say that the optimal Ferritin level for thyroid function is 90-110ug/L. I've mentioned that your Ferritin level may be elevated due to inflammation as your CRP is showing inflammation.
You can help raise Ferritin by eating iron rich foods regularly, particularly liver (maximum 200g per week due to it's high Vit A content), liver pate, black pudding, etc. You shouldn't take iron tablets unless you do an iron panel. If you already have a good serum iron level then taking iron tablets will raise it too much and can lead to toxicity, too much iron is as bad as too little.
Excuse my thyroid ignorance! Is it an aim to get an endocrinologist to prescribe T3 to help or can I achieve good results with thyroxine and or supplements alone?
Hey there again ;
Well your results are in range but obviously not where they need to be for you to feel well.
At the risk of repeating, the only thing over range is your inflammation marker that is coming at 6.05 and over range :
Do you have any idea about this, and are suffering with another health issue that accounts for this being so high ?
Your conversion of T4 into T3 is good and SSusie has detailed where your vitamins and minerals need be improved.
Your results obviously belie how you are feeling, so suggest you list all your symptoms and try to stay focused and convey these to the endo next week and wish you a good appointment.
P.S. SSusie will not see your last question as you haven't message her into the message - you need to press the reply button attached to her post to you :
Anyway the role of the endo is to try and optimise and improve your health and if it's thyroid related s/he may decide to run extra tests and or suggest an alternative thyroid hormone replacement option and or talk you through optimal vitamins and minerals :
My experience with the one and only endo I saw in 10 years after discharge out into primary care after RAI thyroid ablation and who was actually a diabetes specialist and just kept reciting that I was over medicated as my TSH was at 0.01 and that I needed a dose reduction in Levothyroxine, though my T3 was a just 25% through the range.
I now sell medicate and am much improved these past 4 years and manage myself.
Thank you pennyannie. I’m not aware of another health issue although I have in last year been told I’m prediabetic? I will do my homework over the weekend and try to be clear headed for the appointment 🤞🤞
Well, seeing as most endo's seem to be diabetes specialists that might actually play in your favour - please keep us in the loop -- and we'll mark your weekend homework after your appointment.
Fingers crossed - sorry don't know where the emojis live, though they do seem to look like chicken thighs to me !!!!
👍🏻👍🏻
Just thinking : -
Your TSH 3 months ago was 12,1 and way over range which generally has a top of range number of 4.20
Your TSH is now at 0.22 and has slid all the way down and out the bottom of the range.
I notice you have listed an assortment of brands of T4 - and I just wonder if you may have " better tolerated " and / or better absorbed a different brand of T4 these past few few months ?
This might explain why, on just TSH blood test readings it " looks like " you have gone from very undermedicated to overmedicated on the same dose on T4 thyroid hormone replacement.
Could there have been another medication change for something else that might have impacted on the results ?
I’ve got a chart of all of my TSH results since diagnosed 15 years ago and they swing like a pendulum! My dosage was 175mg for the majority of that time only last year 150mg. Nothing I can think of other than that…………
Well - first off - there's a question there to be explained.
Generally speaking most mainstream medics believe the TSH is the " gold standard " of all the bloods tests and why in primary care it's likely all you get at the yearly function test !!!
Look forward to an answer on this :