Hi, I have long history of thyroid issues, mine was graves disease several years ago, treated with RAI, now undertactive but never been right ever since, family history on all counts have thyroid issues in some manner or other. However My daughter is showing multiple signs I associated with thyroid, but blue horizon tests look to be ok with a few exceptions on cortisol and Vit B12, but on the whole look ok. Her issues were weight gain, tiredness, thinning hair, depression, common complaints of throat swelling and pain, muscle aches and pains. Last few months her breathing has been awful, enough to stop working!!, although I dont believe to be thyroid related and under investiagtion by Dr. Really looking for confirmation that these looks ok, mentioned them to the Dr who doesnt seem that bothered (which is standard and I'm used to that with myself to be fair) 2nd opinion from those in the know would be appreciated. Rob
What strikes me is that her CRP is getting on for high. It's still in-range, but... And that might be falsely raising her ferritin, which isn't very high, anyway. And, low ferritin can cause a lot of problems, including breathing problems. Any chance of doing a full iron panel?
If the blood for all those tests was taken at 1 pm, the TSH would have been about at its lowest. Would be interesting to see what it is before 9 am.
But, even for 1 pm, her cortisol is very low. That really warrants further investigation.
Free T4 15.3 - Ref R (12.0 - 22.0)
Free T3 5.78 - Ref R (3.1-6.8)
Her FT4 is on the low side, but FT3 higher than average. This sometimes happens when the thyroid is failing for some reason. But, there's nothing in these labs to prove that it actually is failing. Nothing that would convince the average GP, anyway. But, given her symptoms, I think they should be taking a bit more active interest in her health.
Also, she's deficient in vit D, so that requires attention.
Not sure about the vit B12. I wouldn't have thought that it was high enough to cause concern, because the top of the range is very low. I would be more concerned about the accuracy of the range than her result.
Thank you for the detailed reply, really appreciated. Going to answer last post with some questions thas been raised from seaside susie, and have some new info thanks to here.
Her thyroid looks fine. I was hypothyroid with similar numbers but you would want more obvious / severe symptoms before being able to persuade a doctor to trial thyroid hormone. Her vit D is low so it makes sense to supplement with a high dose vitamin D for a a couple of months and then hopefully summer weather will keep it high until late autumn.
As already mentioned, her thyroid results don't immediately suggest a problem. A normal healthy person would generally have a TSH no higher than 2, often around 1, with FT4 around mid-range-ish, so her TSH meets that criteria but her FT4 is only 33% through it's range. However, as none of us are tested for a baseline in health, we don't know what's normal for us and that could be your daughter's normal level.
CRP 4.15 - (Ref R<5.0)
Ferritin 84.4 - (Ref R 13-150)
CRP is an inflammation marker so the lower the better. I agree with Greygoose about her CRP level is showing possible inflammation so her Ferritin level could be falsely raised due to inflammation too.
Last few months her breathing has been awful, enough to stop working!!, although I dont believe to be thyroid related and under investiagtion by Dr.
What investigations into her breathing? Any lung function tests? If her breathing is bad enough to stop her working then I would hope some urgent investigation is being done.
I have lung disease (COPD and Bronchiectasis) and this causes my CRP to be never at the low end, always mid-range or over, so I'm wondering if her raised CRP is something to do with her breathing problem.
Low iron or low ferritin can cause breathlessness so GP should do an iron panel to see if she has iron deficiency, ferritin on it's own wont show iron deficiency.
Vit D 47 - Ref R (Op 75-200/Adequate 50-75/Insufficinet 25 -<50/Deficient <25)
This is a very low result but it's not Vit D deficiency (that is when level is less than 25nmol/L).
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.
To reach the recommended level from your current level, she could supplement with 4,000-5,000iu D3 daily.
Retest after 3 months.
Once she's 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.
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 she does have any adverse reaction then she will know what caused it.
Vitamin B12 HIGH!!! 780 - Ref R (145-569)
Blue Horizon unit of measurement for B12 is pmol/L and her result translates to 1,057pg/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."
So even though it is classed as high, it's not any higher than that suggested by the above. Presumably she doesn't take a B12 supplement or a B Complex?
There are some medical conditions that cause high B12 so if your daughter is not supplementing then she might want to discuss this result with her GP if she has any concerns.
serum Folate 11.90 - Ref R (8.83 - 60.8)
This is low, not deficient but very low. Folate is recommended to be at least half way through it's range. I don't want to suggest any supplement for this until we know if she supplements B12.
Thank you for the detailed reply, really appreciate the taken time to answer.
The breathing issue is the main concern with added issues now of closing throat, sinisitus and blocked airways may be more the root issues . she’s been asthmatic since 15 and reasonably well controlled with Symbicort and the odd dose of prednisone until jan of 22, when it changed dramatically, gasping for air (air hunger) extreme chest pain, not able to get a full breath and nothing has helped thus far.
They believed it to be worsening asthma originally back in Jan, so inhalers changed to fostair, new Ventolin inhaler montelukast tablets and fexofenadine hydrochloride (suffers from bad allergies) also has had history of ENT issues, from glue ear, tonsilitis which were removed, enlarge adenoids, recurrent sinusitis.
fast forward 3 separate visits to A&E and multiple Drs, chest xrays, CT scans all appear ok, D-Dimer bloods were elevated so they ruled out PE as that was suspected at one point, but no result, or that was good news really, but no answers at this point
So went private and seen pulmonary specialist, who done a further spirometry test, that was also ok, so no further forward at present unfortunately.
With so much thyroid malfunction and a good few symptoms of what seem like hypo and some hyper symptoms, I thought I would at least rule this out anyway.
My mother had Pernicious anemia which I know is B12 deficiency so wanted to also rule this out but seem B12 is at opposite end and she is not supplementing B12 in any form, so would seem this elevation in B12 is maybe the result of another issue maybe and might explain why CRP and ferritin being raised also?
Results of VERY brief specialist visit was he believed it to be physiological respiratory or dysfunctional breathing/anxiety, but doesn’t add up to me or HER. so following this up with additional ENT specialist visit and Dr to try and get further answers
Sorry long winded explanation above, but thanks again, appreciated
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