Blood results

[Janeylou69]

Hi I just wondered if anyone could tell me what these blood results mean thanks .

[nellie237]

Hi Janey,

I'm no expert, but your results look very anaemic (Iron). These results are 2 months old, and I'm hoping that you have received treatment and further testing since then?

[Janeylou69 in reply to nellie237]

My doctor gave me iron tablets ,and he's got me to do a fit test (stool test ) which takes a while to get results back ,I'm worried as I've had loose stools ,feels like hemeroids and cramps, it doesn't look good for me at the moment ,I don't know what to do . Thanks for your reply.

[SeasideSusie Remembering]

Janeylou69

There are no iron tests there but your low haemoglobin, low haematocrit, low MCH, low MCV and bottom of range MCHC all suggest anaemia.

What did your GP say about these results?

[SlowDragon Administrator]

Have you got Thyroid results too

TSH, Ft4 and Ft3

Plus Vitamin D, folate and B12 and ferritin results

[Janeylou69 in reply to SlowDragon]

I think they just tested serum tsh for my thyroid

Little misty

[SlowDragon Administrator in reply to Janeylou69]

Was test done early morning, ideally before 9am and last dose levothyroxine 24 hours before test

your TSH is far too high for someone on levothyroxine

Ideally you should have TSH, Ft4 and Ft3 tested together as next step

Plus vitamin D, folate, ferritin and B12

Request GP does this

Or test privately

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

gponline.com/endocrinology-...

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

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Persevere - have all guidelines printed and be ready to quote them

healthunlocked.com/thyroidu...

Approx how much do you weigh in kilo

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/files/docs/...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

healthunlocked.com/thyroidu...

jamanetwork.com/journals/ja...

[Janeylou69 in reply to SlowDragon]

Hi I can't remember what time the blood test was done , what does it mean when you say it's too high ,does that mean I should be on a higher dose of levythyroxine ,is that the UK standard rate of what tsh should be ,sorry I'm new to all this ,I know in that blood test they said my vitamin d was low and I'm aneamic ,I'm really confused thanks for your reply .

[SlowDragon Administrator in reply to Janeylou69]

TSH is the message from pituitary asking thyroid to make thyroid hormones

On levothyroxine TSH should be LOW when adequately treated

TSH higher than 2 suggests you need dose increase in levothyroxine

Request GP increase dose levothyroxine by 25mcg as trial increase

Bloods should be retested 6-8 weeks later

Always test thyroid levels early morning, and last dose levothyroxine 24 hours before test

[Janeylou69 in reply to SlowDragon]

Would I have symptoms with this tsh .

[tattybogle in reply to Janeylou69]

would you have symptoms with TSH 4 ? ... not necessarily , some people would feel ok, some not. But if you did have symptoms and TSH was still as high as 4, then increasing levo a bit to get TSH below 2 (where the majority of healthy people have theirs) would be the most obvious thing to try, to see if it resolved symptoms .

[SlowDragon Administrator in reply to Janeylou69]

I know in that blood test they said my vitamin d was low and I'm aneamic ,

What was vitamin D result

How much vitamin D has GP prescribed

low haemoglobin, low haematocrit, low MCH, low MCV and bottom of range MCHC all suggest anaemia.

Have you been prescribed iron supplements ?

If yes how much

Iron must be minimum 4 hours away from levothyroxine and any other medications or supplements

If not already tested ……Push GP to folate and B12 as per NHS guidelines

If you can afford to test TSH Ft4 and Ft3 yourself that would be helpful to see if Ft4/Ft3 are low

Low vitamin levels are linked to being hypothyroid

Suggests you’re not yet on high enough dose of levothyroxine

Approx how much do you weigh in kilo

Obviously with lots of small children your life is very hectic….so you need to be on high enough dose levothyroxine

[Janeylou69 in reply to SlowDragon]

Hi I'm a large lady so I weigh about 127 kg and not been very active as I've been depressed and worried about my health ,have been out a few times recently but not enough ,he said to carry on with iron tablets and he never mentioned me needing more levythyroxine, should I mention it to him ,it takes ages to get an appointment with my doctor .

[SlowDragon Administrator in reply to Janeylou69]

Absolutely yes

Request 25mcg dose increase in levothyroxine

So an increase to 125mcg

Retest thyroid levels 6-8 weeks after each dose increase

Likely to need further increase in levothyroxine after next test

Dose is only ever increased slowly upwards in 25mcg steps

Guidelines on dose levothyroxine eventually likely to need is approx 1.6mcg levothyroxine per kilo per day

127kg x 1.6mcg levothyroxine = 200.3mcg per day

Some people need higher dose, some don’t need so much

But with TSH over 2 you need next 25mcg dose increase in levothyroxine to 125mcg daily

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/files/docs/...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

healthunlocked.com/thyroidu...

jamanetwork.com/journals/ja...

Depression is extremely common hypothyroid symptom and should improve as dose levothyroxine is increased

List of hypothyroid symptoms

thyroiduk.org/if-you-are-un...

[SlowDragon Administrator in reply to Janeylou69]

What was vitamin D result

How much vitamin D has GP prescribed?

[Janeylou69]

This is some of my other test results

A little misty

[nellie237 in reply to Janeylou69]

Those kidney results look good. 😊

[annabianca]

Your GP needs to test your ferritin and other iron related factors to verify that your anaemia is caused by iron deficiency. There are a few other rarer causes of low haemoglobin and iron pills will not fix these.

Once it is confirmed that the issue is low iron, your doctor needs to investigate the three causes of low iron, which are blood loss, low iron intake or absorption and increased iron requirements. Iron pills will not fix the cause of your low iron, unless the cause is just low iron intake.

[Janeylou69 in reply to annabianca]

Hello I've had a fit test which came back normal, my diet was a bit rubbish and it could be absorption because I'm b12 deficient as well and low vit d thanks for your reply .

[annabianca in reply to Janeylou69]

You should at least ask your GP for the blood test for celiac disease, which often causes malabsorption issues, and also a test for zinc, another micronutrient that is often low with malabsorption.

[Janeylou69 in reply to annabianca]

I will definately ask my doctor to look into this further coz I need to have a better quality of life and im not ,my head is in a mess and it's hard to try not to show it in front of my kids .thanks for your reply .

[Janeylou69 in reply to annabianca]

Hi annabianca I've been having some weird symptoms, weight loss ,loose stools sometimes ,bloating ,wind ,weird sort of cramps in my abdomen ,could this be celiac disease ,I'm really worried about it ,I've contacted my doctor and they are giving me a call back on Monday .