I did an advanced thyroid test via medichecks, have started taking a folate supplement, changed my doctor because I did not get any help from the previous one, I gave the new doctors my blood test results and they said my tsh is okay because it is within the range they use. They asked me to go in and do a new blood test just for TSH, which they say has come back that I am just in their range. I did not take my levothyroxine for 48 hours beforehand and did it first thing in the morning.
Still tired, cold and aching, have had to finish work because I feel so bad, tried 6 different doctors and get no further forward.
Laboratory Report ( Advanced Thyroid Function Blood Test )
CLIENT
Surname
ForenameObservation Date : 22-MAR-2022
D.O.B. :
Sex :FLaboratory :Eurofins County Pathology Ltd
Our laboratories are regulated by the CQC and are fully UKAS accredited.
Doctor's Overview
Hello Kathleen,
Thank you for choosing Medichecks to monitor your health.
Looking at the information provided, I understand you are taking this test to investigate symptoms whilst on levothyroxine.
Your thyroid stimulating hormone is high and you have decreasing free thyroxine and T3 which suggests that your levothyroxine dose
is too low.
As you are experiencing symptoms I recommend that you see your GP to discuss this further.
Your thyroglobulin antibodies are positive. These antibodies are associated with autoimmune thyroid diseases, especially Hashimoto’s
disease.
You have low serum folate. I recommend increasing your intake of folate rich foods such as broccoli, brussels sprouts, asparagus,
peas, chickpeas and brown rice. You may also want to consider an over the counter folate supplement.
Whilst your CRP does not indicate inflammation the type of CRP test that you have had is one which can also indicate future risk of
cardiovascular disease. I recommend repeating this test in 6-8 weeks to see whether it remains above 3. If it does then I recommend
that you take a more aggressive approach to managing other cardiovascular risk factors such as blood pressure, cholesterol, diet,
smoking and exercise levels.
You have healthy iron stores and an optimal level of active B12 and vitamin D. Best Wishes,
I gave the new doctors my blood test results and they said my tsh is okay because it is within the range they use.
It doesn't matter whether it's within their range, outside of their range, upside down or what, if the range is different you can't use a result from one lab and put it with a range from a different lab. You'd think doctors would be clever enough to know this 🙄
Regardless of that, TSH should always be below 2 according to GP online which your doctor can check:
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
I did not take my levothyroxine for 48 hours beforehand and did it first thing in the morning.
This will make no difference to the TSH result. The timing of Levo before a test affects the FT4 result. And it should be 24 hours, no more because you'll get a false low FT4 result, and not too close to your test because you'll get a false high FT4 result.
CRP HS4.58 mg/L(Range: 0 - 5)
This is an inflammation marker and the lower the better. Your level is almost top of range, suggesting some possible inflammation somewhere. As it's a non-specific marker it can't tell you where the inflammation might be.
Ferritin38.20 ug/L(Range: 13 - 150)
Ferritin can be raised with infection or inflammation. As your CRP is close to top of range it's possible that your ferritin could be higher than normal too, possibly not by much. Regardless of whether or not it might be slightly higher than normal, it is a very low level and less than 30 confirms iron deficiency according to NICE.
It would be worth doing an iron panel consisting of serum iron, total iron binding capacity, transferrin saturation plus ferritin, this will show if you have iron deficiency. Also, a full blood count is a good idea as this would show if you have anaemia.
Ferritin is recommended to be half way through range (about 82 with that range) although some experts say the optimal level for thyroid function is 90-110ug/L.
Do not self supplement with iron tablets, you need the iron panel done because if you have good serum iron and saturation levels and take iron tablets then it will take these levels too high and lead to toxicity. If iron and saturation levels are good then ferritin should be raised through diet or possibly with some iron prescribed and regularly monitored by GP.
Pretty good result. 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.
As we're coming into the summer months you may be able to make Vit D naturally from the sun and it would raise this level. It would be a good idea to retest in October/November to check your level to see if you need to supplement during the winter months when we can't make Vit D naturally.
Thyroid test with Medichecks - did you leave your Levo off for 48 before this test as well?
TSHX - 4.52 mU/L(Range: 0.27 - 4.2)
Free T3 - 3.14 pmol/L(Range: 3.1 - 6.8)
Free Thyroxine -15.800 pmol/L(Range: 12 - 22)
Over range TSH, FT4 only 38% through range, FT3 a measly 1.08% through range. If you left 48 hours since last dose of Levo then FT4 is showing a false low level. However, even allowing for that these results show that you need an increase in your Levo, they may improve when ferritin is at an optimal level. 25mcg increase now, retest in 6-8 weeks.
The aim of a treated hypo 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, if that is where you feel well.
Suggests autoimmune thyroid disease aka Hashimoto's which is where the immune system attacks and gradually destroys the thyroid.
Fluctuations in symptoms and test results are common with Hashi's.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.
Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies and may be the cause of your low ferritin and folate deficiency.
Thanks for that, for the medichecks bloods I took my levo 24 hrs before, doctor said I do not need folic acid from them, just get supplements, which I have. they said my antibodies are fine, My tsh is just under 5 which is within their range, so wont increase my levo, been 3 years now and have never felt good, I have been reading the book by Paul Robinson, recovering with t3 and am now thinking about trying this method, when I mentioned T3 to my doctor previously they said they would stop my levo if I took it, but as the doctors are not helping me to feel better I think I need to do whatever I can to help myself.
Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.
If he says you can't have folate deficiency because your B12 is normal then he can arrange red cell folate test mentioned in the same link:
If there is a strong clinical suspicion of folate deficiency but normal serum levels, red cell folate can be measured once cobalamin deficiency has been ruled out.
A red cell folate level below 340 nanomol/L (150 micrograms/L) is consistent with clinical folate deficiency in the absence of vitamin B12 deficiency.
He should investigate the cause of your folate deficiency:
Your Thyroid Peroxidase antibodies are fine, and that's all they test at primary level. Thyroglobulin antibodies may get tested at secondary level. You can have Hashi's with negative TPO antibodies but positive Tg antibodies. But even if it is Hashi's the treatment is the same, Hashi's isn't treated, it's the resulting hypothyroidism that's treated.
My tsh is just under 5 which is within their range, so wont increase my levo,
I have given you the link about TSH should be below 2.
Here is another one which says TSH should be below 2.5:
Fine tuning of the dose could be necessary in some patients
* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary
Guidelines state that TSH should be within range but if symptoms persist dose should be adjusted to achieve wellbeing but avoid TSH suppression, so there is plenty of room to increase your Levo:
1.4 Follow-up and monitoring of primary hypothyroidism
Tests for follow-up and monitoring of primary hypothyroidism
1.4.1 Aim to maintain TSH levels within the reference range when treating primary hypothyroidism with levothyroxine. If symptoms persist, consider adjusting the dose of levothyroxine further to achieve optimal wellbeing, but avoid using doses that cause TSH suppression or thyrotoxicosis.
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
You can obtain a copy of the article which contains this quote from ThyroidUK:
tukadmin@thyroiduk.org
print it and highlight Question 6 to show your GP.
You need to show/discuss these to your GP or see another GP in the practice.
I have been reading the book by Paul Robinson, recovering with t3 and am now thinking about trying this method, when I mentioned T3 to my doctor previously they said they would stop my levo if I took it, but as the doctors are not helping me to feel better I think I need to do whatever I can to help myself.
T3 can benefit some people, but before you know if T3 can help you you need to get your TSH down to below 1, FT4 as high as possible in range to see how well you convert T4 to T3 - this will show by looking at the FT4 and FT3 results from the same blood draw - high FT4 and low FT3 when TSH is below 1 suggests poor conversion.
Conversion can be impaired by sub optimal nutrient levels so you need to check key nutrients for deficiencies and address these before considering adding T3, so again your folate deficiency and low ferritin must be addressed.
If you are going to go it alone then the first thing you should do is buy some Levo not T3 but you really should take all this information to your GP, tell him that guidelines are just that and not set in stone but even so they do not discount an increase in your Levo to improve your levels. If your GP wont help then you should see another one.
I've not seen that video before so thank you SeasideSusie. Later in the video he talks about being happy for the TSH to be suppressed when on Levo only, and that we should aim to have the Frees towards the top of the range, even FT4 over if that is what is needed to get FT3 to a decent level. But he's not happy to have TSH suppressed on combination treatment. I think he also said that the patient on combo should not have the Frees towards the top of range. He want's the equivocally in the range. What do you think about that? It's not what we talk about here really.
I always make sure when I post that I mention that this is when on Levo only. I'm aware of him saying that on combo treatment he says TSH should be in range. I think this is where people have to decide for themselves.
I have been on Levo plus T3 since 2015. My TSH has been suppressed for as long as I've kept a record of my results - since 1994. I've been on Levo since 1975 and I have no idea what my TSH was before I started keeping a record.
I have no idea why my TSH was suppressed on Levo only, I didn't have thyroid cancer so it wasn't a necessity to keep it suppressed, I still have what might be left of my thyroid but I imagine it's pretty useless after 47 years of hypothyroidism. My GP knew about the suppressed TSH but was happy to continue with my dose of Levo because I was still symptomatic. I don't think she knew much about it and she retired years ago, and the other GPs don't seem to know much about treating hypothyroidism either - but that's no surprise is it!
There was no way my TSH would magically come into range when I added T3 so for me, personally, I don't worry about it but that's not to say I advocate this is right for everyone.
I keep a close eye on my levels myself, regularly doing MonitorMyHealth tests and my frees aren't top of range so I'm just happy to leave things as they are, I know I have no symptoms of overmedication. To be honest, I'm too old to worry about it and risk becoming bedbound by trying to get my TSH into range so I'm doing what's right for me.
Thank you. Good answer. I've not managed to get my TSH below 1.5 yet despite 60mcg T3 and 50 Levo so it's not been an issue for me. Although I do wonder why my TSH is still visible. It just threw me a bit when he said that. He didn't seem to have a real understanding of why he thought that though. Like the lady who asks about heart issues, his answer to her is not really convincing either. Overall a good talk though.
HiSeasideSusie has given you the best information you are going to get in her replies here. Print them out. Use them as a list of things that need to be achieved and ticked off.
Sadly most GPs are proving to be useless for thyroid. So it is up to us. Believe me, you don't want to go down the T3 route yet. You could be fully recovered if you were taking enough Levothyroxine, you don't know that yet. Taking Levo is easy and cheap as chips used to be(!) and you can get it for free. T3 is tricky to dose, will cost you a lot of money over the course of your life and will leave you on your own with it.
When you have printed out the replies from Susie, gather together all the tests she recommends and print out the documents she's linked for the GP to say why you need them and go back armed and make your request for the tests.
Also tell them that the aim of a hypo treated patient is that they feel well, not that their blood fits into a range (just about) and show the evidence Susie has linked for you for that part. Ask for a 25mcg dose increase now and a retest in 8 weeks time. And tell them you want to aim for a TSH under 1.
We should not have to do all this. But we do. Thousands of us have to fight, push and request strongly for what we need from our doctors and we have to give them the back-up reports and studies to show them why.
T3 is a last resort. Don't go there early. Good luck.
You addressed that "everyone" thanks to me only. So if you want to thank everyone you need to go up a level I the thread and reply to your own original post. Odd I know, but almost no one will see this here because it's tagged to me.
It can be done by fingerprick but the option of a venous blood draw is there at extra cost and you can arrange phlebotomy yourself or go to one of their clinics or arrange a home nurse visit if they're still offering them. Some of us find fingerprick tests easy enough to do, some people struggle and can't do them at all.
If you've not done a fingerprick test before (they send a microtainer requiring 0.6ml of blood which is enough for all the tests included in this bundle) and would like some tips then please ask and I will post them for you.
Plenty of us don't have a problem, some members can't do it at all.
TIPS FOR DOING FINGERPRICK TEST
* Be well hydrated, drink plenty of water the day before, and before you do the test.
* Some people take a shower before hand, some run up and down the stairs to get blood flowing. Personally, as I can't run up and down the stairs, I circle my arm round, windmill style.
* Have a bowl full of hot water, dip hand in and out, swish around, hand needs to go red. If blood flow stops, you can always swish round in the hot water again.
* Stand up to do the test. Make sure your arm is straight down when collecting the blood. Either use a small step stool to raise yourself well above the work surface, or put the collection tube on a lowish shelf or use an ironing board to get the perfect height.
* Prick finger on the side, not the tip. I find that half way between the nail bed and tip is about right, or maybe slightly nearer the nail bed rather than the tip. I use my ring finger, but middle finger is next best for me.
* Do not squeeze your finger to get the blood out, it can damage the blood and it may not be usable
I've recently done 2 tests. The first one there was very little blood coming out which was unusual for me so I used a second finger and between the two I gradually filled the tube. However, when I checked the prick site for the first finger the actual cut was very small and as I've had some of these lancets fail before I put it down to that. When I did the second test this is what I did
* Prick my finger as usual, at the same time try and make a very slight twist with the lancet (the blade retracts very quickly so you have like a nano second to twist the lancet). I'm not talking 90 degrees or anything, just a very slight twist to make the cut just slightly bigger, it doesn't hurt or cause a blood bath! This made a big difference, 11 generous drops of blood filled the tube in less 2 minutes.
If you supplement with Biotin, or a B complex containing it (B7), leave it off for 7 days before doing any blood tests as it can give false results when biotin is used in the testing procedure, and most labs do use it.
Sometimes the sample has haemolysed, ie the red cells rupture. This may be due to:
* bacteria (so clean area thoroughly and allow to dry)
* intense exercise (so don't go mad trying to get the blood to flow prior to the test)
* squeezing the finger to get the blood out (you can gently "milk" the finger but don't squeeze)
* shaking the tube vigourously instead of gently inverting it.
* sample collection was prolonged
* if there was a long delay between sample collection and analysis
* there is too little blood in the tube and too much coagulant for the amount of blood
Sometimes there's not enough blood in the tube to do all of the tests so it's important to fill the tube to the line or slightly above.
I did a finger prick test at 8.30 this morning. I gave my hands a very good wash in very hot water, drank a full glass of water and swung my arm like a pendulum. I pricked my ring finger on the side about half way between the top of my finger and the cuticle end of my nail and filled the container in no time at all (in fact, it was like a blood bath and I had to hold my arm in the air for quite a few minutes to stop the blood flow 😱)Give it a try, it’s certainly much more convenient to do it yourself.
yes it is really easy, just put your hands under some warm water first to get your blood flowing. I prefer this method than getting it drawn by needle.
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
Afraid your Doc is going to be no good to you no matter what. Try and get them to refer you to an Endo - say you are really struggling with work, it’s affecting you relationships etc and you need to be on the right meds to give relief to your symptoms. Remind them the aim of meds is not to get numbers in range but to relieve symptoms. Getting your folate up will really help how you feel and possibly your f4 t3 conversion but it looks like you may need some t3. I’m taking 1000 mcg methyl folate to get my folate up quickly.
I’d pile on the agony! Tell them you’re scared your husband/wife will leave you and you’ll lose your job! I know it’s outrageous they withhold access to the consultant. I’d just keep on taking up the Doc’s time till they refer you!
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