My latest blood results

[ChoH]

Hi all need some advice based on my latest blood results :

Thyroid Function Tests

TSH : 5.03H mIU/L (range : 0.27 - 4.20)

Free T4 : 15.4pmol/L (range : 12.0 - 22.0)

Free T3 : 2.6L pmol/L (range : 3.1 - 6.8)

So my TSH is slightly above the normal range and my Free T3 is below the normal range.

Ferritin : 164H ug/L (13 - 150)

My ferritin is above normal range.

My HBA1c and lipid tests were within normal range.

Full blood count :

White cell count : 3.71 (3.90 - 12.60) x10 to the power of 9

MCHC : 31.8 L g/dL (32.7 - 34.9)

Platelet count : 165L (186 - 454) x10 to the power of 9/L

MPV : 11.8H fL (7.3 - 11.3)

My white cell count is below range, MCHC below range, platelet count below range and MPV above range.

I have been taking Euthyrox 0.05mg for about a year now, prior to that I was taking Euthyrox 0.1mg and 0.05mg alternatively.

I have been having a problem with my menstrual cycle for the past 6 months, whereby I just get slight spotting. I haven’t been getting a proper period.

I am also taking mercilon tablets for a month now, previously I was taking minesse tablets.

My hair is also still falling quite a bit. And I also feel very cold and sometimes get cramps in my legs and feet.

I have been diagnosed with a thyroid problem for 2 years now. Dr has told me continue taking Euthyrox 0.05mg and gynae advised me to switch from minesse to mercilon.

I am very worried about my hair fall and my menstrual cycle. Any advice on what should I do?

Thanks

[hackman]

I also get cramps in my feet and calves when thyroid hormone is low (specifically FT3). Your FT3 is below range so I am not surprised that you are symptomatic. Your conversion rate of T4 to T3 is 0.1688. Below 0.25 is considered a poor converter of T4.

[ChoH in reply to hackman]

Thanks for the advice. My dr ha increases my Euthyrox dose to 0.075mg daily for 5 days and then 0.05mg for the weekend, and he said I should continue like this for a month and then repeat bloods. Do you think this dosing is ok ?

[SeasideSusie Remembering]

ChoH

TSH : 5.03H mIU/L (range : 0.27 - 4.20)

Free T4 : 15.4pmol/L (range : 12.0 - 22.0)

Free T3 : 2.6L pmol/L (range : 3.1 - 6.8)

These results show undermedication. The aim of a treated hypo patient on levothyroxine only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges. Your TSH is over range which should tell your doctor that you need an increase in your dose, your FT4 is only 34% through it's range and your FT3 is below range. All scream undermedication.

Here is some information to support your request for an increase in your dose:

From GP online

gponline.com/endocrinology-...

Under the section

Cardiovascular changes in hypothyroidism

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He confirmed, during a talk he gave to The Thyroid Trust, that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw(Not working as expected?)

You can obtain a copy of this article from ThyroidUK:

[e-mail]

print it and highlight Question 6 to show your GP.

However, one or two things to consider first to see if anything has affected your results.

Do you take biotin or any supplement containing biotin (eg B Complex or hair/nail supplement)? Biotin can give false results so needs to be left off for 3-7 days before any blood test.

Are you taking your Mercilon at least 4 hours away from your Euthyrox? It contains oestrogen, and oestrogen should be taken 4 hours away from levothyroxine. The following is taken from medicines.org.uk/emc/produc...

4.5.2 Laboratory Tests

The use of contraceptive steroids may influence the results of certain laboratory tests, including biochemical parameters of liver, thyroid, adrenal and renal function, plasma levels of (carrier) proteins, e.g. corticosteroid binding globulin and lipid/lipoprotein fractions, parameters of carbohydrate metabolism and parameters of coagulation and fibrinolysis. Changes generally remain within the normal laboratory range.

What were your results before starting Mercilon? It's possible that your Euthyrox is now not working as well due to the Mercilon.

Ferritin : 164H ug/L (13 - 150)

Do you take iron tablets? If not have you had high ferritin before? Did you have CRP tested?

CRP is an inflammation marker and ferritin can also be raised when there is inflammation or infection so when ferritin is high it's a good idea to look at CRP as well to see if inflammation is the cause.

My white cell count is below range, MCHC below range, platelet count below range and MPV above range.

Best discussed with your GP and maybe further investigation is required.

[ChoH in reply to SeasideSusie]

Thanks so much for all your advice. I met with my Dr, he suggested that I take Euthyrox 0,075mg daily for 5 days and on the weekends I should take the euthyrox 0.05mg for the two days and continue like that for a month and then repeat my bloods. One of my other drs suggested I increase my dose to 0.10mg daily for 3 months and then repeat bloods. What do you think?

I do take a multivitamin which I’ve been taking to try improve my hair fall and strength of my nails as they are also very brittle. It does contain a high dose of biotin, so I shall avoid taking my vitamins when I’m going for bloods. I also take omega 3,6,9 combination tablet.

I haven’t been taking any ferritin, and my multivitamin doesn’t have any iron in it. I have taken iron tablets in the past like awhile ago, but found them difficult to absorb, had bad stomach cramps, so stopped those.

With regards to my mercilon, the gynae switched me from minesse to mercilon because I havent been getting my period, he feels the mercilon might help. But not sure if my absence of periods is due to my thyroid issue. I take the mercilon at night before I sleep and the euthyrox in the morning after I shower. So they are quite well spaced apart.

I have stomach problems, very sensitive stomach, so I take a probiotic every morning. Do you think that is affecting anything?

[SeasideSusie Remembering in reply to ChoH]

ChoH

I do take a multivitamin which I’ve been taking to try improve my hair fall and strength of my nails as they are also very brittle. It does contain a high dose of biotin, so I shall avoid taking my vitamins when I’m going for bloods.

First thing to say is if you didn't leave this off for 7 days before the test you may have false results and it may be worth repeating the test using our suggestions:

* 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.

If we assume that your results are correct then:

I have been taking Euthyrox 0.05mg for about a year now, prior to that I was taking Euthyrox 0.1mg and 0.05mg alternatively.

Here in the UK we are used to our Levo being in mcg and I get mixed up when mg is used. So I will refer to mcg in my replies. Sorry if that's confusing for you but I'm coping with severe facial pain at the moment and don't want to give you any wrong information based on me messing up numbers because I can't concentrate properly.

0.05 = 50mcg

0.075 = 75mcg

0.1 = 100mcg

So you've been taking 50mcg x 7 days for a year = 350mcg per week

Prior to that you were taking an average of 75mcg daily = 525mcg per week

TSH : 5.03H mIU/L (range : 0.27 - 4.20)

Free T4 : 15.4pmol/L (range : 12.0 - 22.0)

Free T3 : 2.6L pmol/L (range : 3.1 - 6.8)

These results are on 350mcg per week and you are very undermedicated.

I met with my Dr, he suggested that I take Euthyrox 0,075mg daily for 5 days and on the weekends I should take the euthyrox 0.05mg for the two days and continue like that for a month and then repeat my bloods.

So that's 75mcg x 5 = 375

50mcg x 2 - 100

Total 475mcg per week.

One month is too soon to repeat bloods after a dose change, minimum 6-8 weeks is better to allow time for levels to settle.

One of my other drs suggested I increase my dose to 0.10mg daily for 3 months and then repeat bloods. What do you think?

So that's 100mcg x 7 = 700mcg per week.

There is a big difference in the total amount there.

It's generally said that when increasing Levo dose the increase should be in 25mcg increments. Therefore the most sensible thing to do, in my opinion, would be to increase to 75mcg daily for now and retest in 8 weeks noting how you feel and your levels. A further increase may be necessary which could be the full 25mcg daily or, depending on results, maybe 12.5mcg daily.

I have stomach problems, very sensitive stomach, so I take a probiotic every morning. Do you think that is affecting anything?

As long as it's 2 hours away from your Levo that should be fine. Levo should be taken on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours (calcium, Vit D, magnesium,HRT, oestrogen, PPIs, iron). Check to see if your multi contains iodine or kelp, we should not take iodine unless tested and found to be deficient. We don't recommend multi's here due to them generally not having enough of any active ingredient to help low levels, too many ingredients that may not be a good idea to be taken at the same time, certain ingredients that should be tested for first and only supplemented if found to be deficient.

I am not medically qualified, my responses are based on my own experiences and reading.