Hello! Can anyone help me with my blood test results please? My symptoms are tiredness, weight gain, brain fog, difficulty forming sentences, heart palpitations, joint pain, inflamed gallbladder. I’ve described my symptoms to the GP and have been dismissed three times now, and can’t afford to pay for private care. Ironically, I need help articulating enough to advocate for myself.
TSH - 2.82 (0.270 - 4.2)
Free T3 - 5.7 (3.1-6.8)
FT4 - 20.9 (12-22)
Thyroglobulin Antibodies- 30.6kU/L (0-34)
Thyroid Peroxidase Antibodies- 77kIU/L (0-34)
T4 - 154 (59-154)
Thank you so much in advance
**Edit - I am not on any medication and am following a gluten free diet (as of two weeks ago)
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Are you already medicating or wanting a diagnosis? Your TPO antibodies are raised so symptoms could be due to early onset Hashimotos Autoimmune Disease which is generally a progressive condition. Antibodies cause bodily inflammation and immune changes that can alter how thyroid hormones are utilised.
Thyroid hormone levels are great and why your GP is being dismissive. However, it is possible to have good labs but still be hypothyroid on a cellular levels so will be symptomatic because we need adequate iron and nutrients to ensure thyroid hormone works as best as they can (whether medicated or not). We also need to keep inflammation under control to encourage best thyroid function.
Ask for an iron panel, Vit B12, folate and Vit D to be tested and post results including ranges (numbers in brackets) for members to comment. Adopting a gluten free diet can help in lowering the immune response to Hashi and reduce antibodies. Unfortunately brain fog is a typical symptom of Hashi inflammation.
Thank you so much for coming back to me. I'm awaiting a diagnosis and started on a gluten free diet two weeks ago. I should have put my other levels - they were tested earlier this year:
Serum ferritin: 22 (10-291)
Serum folate: 2.4 (3.2-12.2)
T4 (in April): 15.6 (11.5-22.7)
TSH (in April): 1.53 (0.55-4.78)
Serum B12: 284 (211-911)
I don't think I have my vitamin D results - if I do, I can't work out what they are. I have serum sodium/potassium/urea/creatinine, GFR, cholesterol/triglycerides, oestradiol, A1c but not sure if I have been tested for vitamin D.
Well, at the time of the tests there were major problems here. Was anything done about these results at the time? Are you prescribed anything or taking supplements for any of these. If not then discuss with your GP and ask for new tests to check levels, my comments assume nothing was done:
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
You need an iron panel to confirm iron deficiency and a full blood count to see if you have anaemia. You can have iron deficiency with or without anaemia.
Serum folate: 2.4 (3.2-12.2)
This was folate deficiency and required your GP to prescribe folic acid. See:
If you have any 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.
Vit D test will say something like Vit D 25 Hydroxy Vitamin D3 and the unit of measurement will probably be nmol/L (rarely ng/L).
Thank you so much, I'm actually a bit weepy now for having received your thoughts. I felt something was wrong. Nothing was done about the results at the time and the GP had a look through them the other day as well when I was there and said nothing was wrong with me.
I did try taking iron (not prescribed) but it made me very constipated so I stopped (also suffering from a fissure and don't need extra things making me constipated).
Symptoms of iron deficiency can mirror or coincide with those in thyroid disease. They include:
◾Persistent fatigue
◾Pale skin
◾Shortness of breath
◾Headaches
◾Dizziness
◾Heart palpitations
◾Dry skin
◾Brittle hair and hair loss
◾Swelling or soreness of the tongue or mouth
◾Restless legs
◾Brittle or ridged nails
All iron tests should be done after a 12 hour fast (water allowed) so for convenience an early morning test is best so that you don't go without food during the day.
You've just described me - I don't know if I have pale skin, but I have everything else. I was taken to A & E with heart palpitations last month (so pronounced they woke me up in the middle of the night) and asked the doctor there and my GP afterwards if it could be linked with any deficiencies (hormone or otherwise) and dismissed by both.
Unfortunately doctors learn, and know, virtually nothing about nutrients and wouldn't know how to recognise signs of deficiency. If a result comes back even one point within the lower limit of the range they are going to say that everything is fine. Only numbers make sense to them, unfortunately they have lost the art of "doctoring", symptoms mean nothing any more, only the number on the computer. They probably wouldn't even consider looking at the guidelines to try and learn when a patient presents with symptoms. This is why we have to gather so much evidence ourselves and fight our corner
It's so frustrating isn't it? I think the thing I struggled with was that the GPs have always been so staunch in their opinions. Maybe I do need to go private. I've been up against the GP for such a long time over something else (I felt it was linked with hormones, they felt it was viral and it went on for 20 years before I had the mirena coil fitted via a private consultant and the problem disappeared) and I'm kind of losing my fight. It would be really good just to speak to someone I don't have to stand up to. I think that's why this forum has made me feel so weepy - no one's taken me seriously before.
Sending a hug as I've been there as have many of us ;
Please ask your surgery about this ferritin level - just write down what you need to say - this is what I resorted to doing as I too couldn't find the words and my cognitive function severely compromised.
Iron tablets can constipate and it's suggested you take them well away from any other medicines with vitamin C to bowel tolerance.
A preparation that is iron bisglycinate - branded as a Gentle Iron - is likely easier on the stomach but first and foremost you need to get this checked out with your doctor and I had to undergo a colonoscopy and endoscopy before I was prescribed anything.
Taking into consideration the situation we are all going through I sincerely hope you don't need to wait too long for any procedures.
I found myself looking at low ferritin on the internet to try and understand what was happening to me, and landed on this forum, followed the advice, regarding first off, vitamins and minerals and it was my best leap of faith ever.
I am now so much better and come back in purely to help others, where I can, as it was simply disappointing and I was misguided in believing my doctor knew best,
I think when so poorly we haven't the reasoning, stamina, or confidence and easily dispensed with, I was offered anti depressants and called a conundrum.
You will improve your health and well being but you may well need to kick start this yourself, starting off with getting answers on these low vitamins and minerals.
Thank you so much. I think I was using Gentle Iron - it was a Vitabiotics one, but I didn't know about the vitamin C making it more gentle on the stomach.
Vit C doesn't make it more gentle on the stomach, taking Vit C at the same time as the iron tablet helps it's absorption. Also can help prevent constipation.
If so it's not iron bisglycinate, it's ferrous fumerate which is bog standard iron used in prescription tablets and not gentle on the stomach.
Another problem with that supplement is that it contains other active ingredients - all the wrong form and poorly absorbed - and the iron would affect their absorption anyway. There are much, much better supplements than Vitabiotics.
It was exactly that one, yes! No wonder it caused constipation. I've had some supplements recommended below so will try those instead. And apologies, I misread about taking with vitamin C making it more gentle on the stomach.
The vitamin C you take to bowel tolerance meaning you take as much as you need to allow smooth passage at the other end.
It doesn't have to be as a drink of vitamin C -
I now take daily 1 x 1000mg vitamin C tablet labelled as with Bioflavonoids and Rosehip : I eat about 7 fruit and vegetables a day plus 3/4 natural dates.
Hi I'm not an experienced member but your ferritin and folate look very low, are you taking folic acid or iron tablets?
I've had anemia many times and it can make you feel very ill and mimic many of the symptoms of underactive thyroid.
In fact none of your vitamin levels look great, the B12 is low as well. B12 deficiency again can imitate many hypothyroid symptoms, fatigue low energy, breathlessness, aches and pains. Left untreated it can cause neurological issues. Brain fog being just one.
I'm sure Slow Dragon, Shaws or Seaside Susie will advise you but it might be an idea to get supplementing to get vitamin and iron levels optimal.
They are all desperately low! ... but probably dismissed by your GP?
Your ferritin shows iron deficiency so indicating supplementation is required, but ask your GP for an iron panel first to assess serum iron levels because iron mechanisms can work strangely when other health conditions are present. GP should then prescribe iron and conduct all follow up tests.
Folate need supplementing as does Vit B12. Members find the methylated versions more easily absorbable so raising levels faster.
The chances are Vit D is low also. Ask your surgery for Vit D results or GP to (re)test Vit D. When GP's are uncooperative members conduct their own private tests & post results for others to comment. There is a forum recommended private Vit D test company but I can't remember who it is. SlowDragon , can you please supply.
A good read to understand the workings of Hashi and how best to manage it is a book called The Root Cause by Isabella Wentz.
Hi SlowDragon, thank you for coming back to me. I've not been prescribed anything and am not self supplementing with any vitamins. I'm not veggie or vegan (but don't eat loads of meat). I eat fruits/vegetables/salads etc and avoid processed foods. The GP I spoke to after the initial consultation suggested I eat some spinach.
My recent check for thyroid antibodies was done via a postal test with Thriva, so I'll repeat that in 6-8 weeks and add fit D.
** Edited to add, I don't eat tonnes - I'm around 2 stone overweight and can't seem to lose it, despite <1650 calories a day and daily walks/weekly swimming training.
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
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
Thorne Basic B or Jarrow B Right are recommended options that contains folate, but both are large capsules. (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
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.
I really appreciate you sending me these links, and I am going to action everything on the list. Could you confirm I would have the data to back up saying the below to the GP. Sorry I'm needing so much hand holding, my brain's a mess.
"My blood test results from earlier in the year show:
1. Low Ferritin (my result was 22 and anything below 30 is considered low and should be treated according to NICE guidelines);
2. Low Folate (my result was 2.4 and anything below 7 should be treated according to NICE guidelines)
Taking folic acid will not support the low folate, because it is metabolised in the liver and more difficult for the body to access.
When my concerns were not taken seriously, I paid privately for a full thyroid test, which showed me to have thyroid antibodies of 77, indicating Hashimoto's hypothyroidism. Hashimoto's is probably the root cause of my deficiencies.
I would like you to:
1. Run a full iron panel test for anaemia
2. Test for a vitamin D deficiency
3. Begin treatment of Hashimoto's.
I am already following a healthy, gluten and dairy free diet."
Do I need to add anything? I will read everything you've posted and am beyond grateful to you for taking the time. I will start buying some of the supplements too.
Hi Just a quick correction, the NHS won't treat folate deficiency once it's in range at 3.2, not 7. However yours was below range at 2.4 so you should have been offered treatment.
Serum ferritin level is the biochemical test which most reliably correlates with relative total body iron stores. Low levels indicate low iron stores except in women who are in the second or third trimester of pregnancy.
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
2. Low Folate (my result was 2.4 and anything below 7 should be treated according to NICE guidelines)
Be careful with this one. Check the unit of measurement. The guidelines say
◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.
Whichever it is you are lower than that figure anyway, but just be sure to let them know you know what you're talking about by being accurate with what you're quoting.
I will start buying some of the supplements too.
What supplements? Everything being discussed here should be addressed by your GP, on prescription and your levels monitored regularly. You should not be self supplementing for anything at this stage. You should be tested for B12 deficiency if you have any symptoms on the B12 list, then GP should start B12 injections or supplements. You should be started on folic acid for the folate deficiency after starting on B12. You should be prescribed something for the iron deficiency. None of this should be self supplemented. Only when you've reached acceptable levels which no longer come under requiring a prescription should you then self supplement if needed.
Come back and tell us what your GP is going to do, if he wont test Vit D then you need to do that yourself, come back with the result and I can tell you what dose of D3 you need and what important cofactors are necessary when taking D3.
Thank you so much for going through this with me. I was going to get some of the Jarrow B12 suggested up thread but will hold off. I found the Thriva thyroid test really easy to use, so will probably order the iron and Via D versions and test with them so I'm going in armed with the right information.
Thank you. I have all of the low B12 symptoms, I’ve ordered a private B12/full iron/vitD via Thriva and will await the results. I’m very pleased to be better informed.
Sounds like your GP is about as useless as mine, I wonder if they're related or attended the same medical school? As Susie said all they do is look at numbers, you are no longer a person with symptoms, you are just a set of numbers on a screen.
Even if you are just in range that'll be enough. I always feel like asking if they would be happier and less stressed with £1 in their current account, so in "range", ie not in the red, or would they prefer to see £50 instead.
I don't know why the NHS doesn't employ accountants instead of doctors. It would be cheaper and we'd still get the same treatment. Most of them use Google anyway to look things up. I can do that and save myself the time and trouble of talking to them.
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.
Thank you. I think my practice need a lot of pushing-they did talk me through the results of my tests but didn’t prescribe (beyond the spinach). This has been really really helpful and I’m very grateful.
Didn’t know whether to start a new thread, or whether this will be seen? I had some blood results and am coming back to share results as suggested by SeasideSusie
My blood haemolysed so I don’t have the full iron profile but I’ve put what I’ve received below:
Ferritin: 36 (13-150) (previously 20 in April)
Vit D: 50 (75-175)
B12: 214 (300-569)
Any advice would be gratefully received. I’m most likely going to book privately to see an endocrinologist.
Good idea to add to this thread as it keeps all important information together, otherwise if you start a new thread you'd need to link to this one for the information aloready given.
Ferritin still low, needs to be half way through range (82 with that range) although some experts say the optimal level for thyroid function is 90-110ug/L.
Have you been taking anything?
Vit D is recommended by the Vit D Society and Grassroots Health to be 100-150nmol/L with a recent blog post on Grassroots Health recommending at least 125nmol/L. To reach that level from your current level of 50nmol/L you could consider supplementing at 4,000-5,000iu D3 daily. The cheapest way would be to buy the 5,000iu dose and take 6 days a week rather than 7 (eg have Sundays off).
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The company has told me the K2-MK7 is the Trans form
Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
You haven't given the unit of measurement for this but I'm guessing pmol/L. If so then this equates to 290pg/ml.
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."
Many people with a B12 level in the 300s have been found to need B12 injections and I think your GP should do further investigations due to this very low level, point out that your result is below the range at 214.
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.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
As your blood haemolysed, is the company sending you another kit? You need to know your folate level as your previous result showed folate deficiency.
Thank you so much, that's all really helpful. I'll contact Thriva and ask for a replacement kit to be sent out, and will speak to my GP about vitamin B12 levels too. I definitely have B12 deficiency symptoms, big time - very confused and disorientated, poor memory, restless legs, awful insomnia, palpitations, light headedness, cracked corners of the mouth, constipation. I'll get the supplements you recommended - thank you so much for so much detail.
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