Since having my thyroid removed in September 2021, I've had a number of blood tests including some last week. As I had an early morning appointment at my GP surgery, I was able to follow the guidelines that are on here about medication etc.
Serum free T4 level - 17pmol/L (range 9-19pmol/L) - normal
Serum ferritin- 28ug/L (range 5-204ug/L) - normal
Serum B12 - 686ng/L (range 189-883ng/L - normal
Serum calcium - 2.2mmol/L (range 2.2-2.6mmol/L)
Serum folate - 4.1ug/L (range 4.8-19.0ug/L) - abnormal - my GP has prescribed folic acid tablets for three months.
I previously said to my GP that I don't really understand the thyroid function test results and he said that was just as well or else he would be out of a job! and I haven't heard anything from him after the latest blood tests in regard to this although he did prescribe the Folic acid tablets.
Am I to assume that the abnormal TSH level is OK? I don't feel great but have other health issues going on which may not be helping. I don't feel as tired as I did during the day, but can't stay awake in the evening! I'm taking 150mg Levothyroxine Mon-Friday and 175mg Sat and Sunday.
Sorry, but I can't seem to get my head around the thyroid results and what is ok - am thinking that maybe the thyroid levels don't matter if you're feeling ok?
Thanks
Written by
FeelingBluey
To view profiles and participate in discussions please or .
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
Thanks for your very informative reply. Yes, I take my meds at opposite ends of the day. I also take Sertraline which I believe can affect thyroid meds as well so I take that at a different time of day.I don't currently take any vitamin supplements apart from the B12 medication prescribed by my GP. I do eat red meat but not that often, but do like liver so will have to increase my intake.
My ferritin has dropped from 48ug/L in November 21 to 28ug/L now so seems to be tumbling so will speak to my GP about a full iron panel test for anaemia, although he's never very receptive to my suggestions! But looking at the symptoms of low ferritin levels, I seem to have them all.
In reply to your other message, I'm not taking any Vitamin D supplements and the alfacalcidol that I was taking was stopped by the hospital in Nov 21.
Have you had a parathyroid test since you had your thyroid removed ?.Parathyroids control calcium and they sit right next to the thyroid and can be effected by thyroid removal. Theres four of them each of them the size of a grain of rice and can quite easily get a bit knocked about and not work so well and need time to recover. They can also be removed if not seen by the surgeon, its rare but it does happen and its one of the risks of a TT.
I lost my parathyroids in a TT and I know if my calcium is 2.2 Id be doing something about it, you dont want it to get any lower.
Your vitamin D needs testing you need good levels to absorb calcium better.
And as SlowDragon said your folate and ferritin are too low
Thanks for your reply. My PTH was tested in Nov 21 and was 28, but my GP didn't test it this time. My calcium had been 2.38 in November 21 and the hospital stopped the alfacalcidol tablets I had been taking. The calcium tablets were stopped a few months ago.
Well, in answer to your question, you are correct in thinking that the TSH is of little importance as you haven't a thyroid.
What is important however is our T3 result and range which hasn't been run.
You must be dosed and monitored on your T3 and T4 blood test results for optimal wellness with the aim of both these vital hormones being balanced in around a 1/4 ratio - T3/T4 and likely sitting in the top quadrant of their relevant ranges
Your T4 is just around 80% through the range but without a corresponding T3 result this doesn't tell us much either.
The body runs on T3 and your body needs to be able to convert the inert T4 into T3 in order to power you through the day, kick start your metabolism and restore your health and well being.
Your ability to convert the storage hormone T4 - Levothyroxine into T3 the active hormone can be compromised by low levels of vitamins and minerals, especially those of ferritin, folate, B12 and vitamin D, plus any physiological stress ( emotional or physical ) will have a bearing as will depression, ageing and dieting.
So I too do not have a thyroid and finding I feel at m best with a ferritin at around 100 : folate around 20 :serum B12 500++ and vitamin D at around 100 :
My ferritin came in at 22 and I was eventually prescribed iron tablets after an endoscopy and coloscopy.
Everywhere I researched low ferritin and hypothyroid suggested one needed a ferritin of at least 70 for any thyroid hormone replacement to work effectively.
There is a lot to read and understand and I'm afraid if you sit anywhere in the NHS ranges, some of which are too wide to even be sensible, you are perceived as " normal " by the computer which dictates the doctors next action.
However it is " not normal " not to live without a fully functioning thyroid.
Your doctor should apply his knowledge of the patient's medical history and ensure optimal vitamins and minerals to support the thyroid hormone replacement working effectively.
You too may find you are up against a brick wall and I resorted to private testing to establish where my T3 and T4 sat.
I then had the evidence of poor conversion and a referral to endocrinology where I hoped to have a trial of T3 - Liothyronine added to my monotherapy of T4 Levothyroxine.
I failed to get any hep as I was told my TSH was too low and that I was overmedicated and need a dose decrease in T4 - which I totally disagreed with and decided I needed to go my own way as the stress of trying to get the right treatment simply exacerbated my symptoms.
I have been self medicating now for coming up to 4 years and take full spectrum thyroid hormone and replacing all the same known hormones that my thyroid once supported me with and am much improved.
I just arrange a yearly full thyroid blood panel more to see where my vitamins and minerals sit, as I need to supplement these myself as well.
Thanks for your very helpful reply which has increased my understanding of what needs to happen to ensure I feel at my best. As you say some of the ranges are so wide that it doesn't make sense to just say you are within the normal range when you are at either end of the scale and don't have a thyroid. I was hoping to stay under the care of the hospital for a bit longer or at least until I felt I was on an even keel, but they have discharged me back to my GP, although I do have a delayed telephone appointment booked with for this week to discuss the tests they did in November so will be asking a few more questions.
Yes, I think you're right, as under the hospital my T3 and T4 were always run together, and I'm afraid it all seems to go wrong in primary care.
Whether it's lack of thyroid knowledge and or restrictions on what blood tests can be run - or a mixture of both, it doesn't help us.
Maybe ask that you be referred back ?
Are the November results you need to discuss with the hospital within your previous posts - have we covered these November results with you and given you a better understanding of what it all means ?
Thanks and yes I did post my results although they were just typed into a letter with no ranges:
T4 26.2, T3 4.4, TSH 0.03, Adj Ca 2.38, PTH 28, Ferretin 48, B12 > 128
My GP thought that the 'more than' symbol included in the B12 result may have been a typo so I asked if it could be re-tested which it was last week.
I did mention to the registrar that I saw at the hospital that I was a bit concerned that my GP wouldn't be very proactive, but will mention that again, although I guess they have targets around discharging patients back into the care of their GP.
Well yes, there are targets, and yes, discharge is a very popular target to achieve but at what cost to the patient ?
You are not well and these results show a glaring imbalance in your T3 and T4 levels :
Doctors can only prescribe T4 and it's not working well for you :
You need to be back in endocrinology and your thyroid hormone replacement option reassessed to include T3 - Liothyronine.
Getting T3 prescribed on the NHS is a post code lottery, and sad to say, driven by finance and not patient need :
You need medical assistance and if you hit the brick wall ask for a second opinion to one of the specialist on the list held by admin, in the head office of Thyroid UK the charity who support this forum.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
understanding my results
Understanding Thyroid Test Results 
Understanding my results? Hyperthyroidism?
Understanding my results 
