Advice please - thyroid, vitamins, ferritin. Dr only wants to give statins?

[TaraJR]

My sister's surgery only seem interested in giving her statins, but I'm concerned about some of her other results instead. Please can someone else give their views? I wonder if I'm right or not.

She's just 60 and has been on levo for about 30 years. Sorry, results are a bit long!

Serum FT4 – normal 13.8 (7.9 – 14.4)

Serum FT3 – normal 3.8 (3.8 – 6.0)

Serum TSH – normal 3.2 (0.38 – 5.33)

Liver function - normal

Serum total protein 71 (60.0 – 80.0)

Serum albumin 42 (35.0 – 50.0)

Serum ALT level 13 (0.00 – 35.0)

Serum alkaline phosphate 45 (30.0 – 130.0)

Serum total bilirubin 10 (5.0 – 21.0)

Serum globulin 29 (18.0 – 36.0)

Serum ferritin – normal 20 (11.0 – 306.8)

Renal profile – normal

Serum sodium 140 (133.0 – 146.0)

Serum potassium 4.2 (3.5 – 5.3)

Serum creatinine 89 (49.0 – 90.0)

eGFRcreat (CKD-EPI)/1.73m*2 61 ml/min

Serum C reactive protein – normal 3 (0.0 – 5.0)

B12/folate – normal

Serum Vit B12 147 (133.0 – 675.0)

Serum folate 17 (3.1 – 19.9)

Differentiated white cell count – normal

Neutrophil 3.6 (1.9 – 7.5)

Lymphocyte 1.9 (1.0 – 4.0)

Monocyte 0.7 (0.2 – 1.0)

Eosinophil 0.3 (0.0 – 0.4)

Basophil 0.1 (0.0 – 0.1)

Full blood count – normal

Haemoglobin estimation 142 (115.0 – 164.0)

Total white cell count 6.5 (4.0 – 11.0)

Platelet count 266 (150.0 – 400.0)

Red blood cell count RBC 4.75 (3.9.0 – 5.6)

Haematocrit 0.425 (0.36 – 0.47)

Mean corpuscular volume MCV 89.5 (78.0 – 96.0)

Mean corpusc. haemoglobin MCH 30 (28.0 – 34.0)

Mean corpusc. Hb. conc. MCHC 335 (320.0 – 360.0)

HbA1c - normal 41 (25.0 – 41.0)

! Serum lipids – review results at NHS Health Check follow up

! Serum cholesterol 5.5 (<5.20)

Serum HDL cholesterol 1 (1.0 – 3.0)

Non-HDL cholesterol 4.5

Serum cholesterol/HDL ratio 5.5

QRISK2 cardiovascular disease 10-year risk 12.3%

You will note that your overall cardiovascular risk (Q-risk score) is greater than 10%. In such cases, our advice is that alongside lifestyle changes, you should consider starting a medication called a “statin” to help reduce your risk of a heart attack or stroke

[Lalatoot]

"This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.". This is the NHS guidance on statins.

eu.marconews.com/story/life...

The above discusses that hypos are more at risk of muscle problems if they take statins.

Your sister is undermedicated and needs an increase in levo. This is shown by her ft4 and Ft3 being low in range and her TSH being over 2 - on levo TSH is best under 2 and closer to 1 or lower with ft4 and ft3 at least over 50% through their ranges.

[Timetraveler67 in reply to Lalatoot]

I want my son Who is hypo with hashi to stop statins will he have withdrawals do you know please thank you

[Lalatoot in reply to Timetraveler67]

Sorry i don't know. Put up a new post with that question and hopefully somebody will know.

[Timetraveler67 in reply to Lalatoot]

I will do that thank you for replying

[greygoose]

Oh, these ignorant doctors! I want to put them all up against a wall and shoot them! They are playing with people's lives with no idea of the possible consequences.

High cholesterol - not that it's that high, anyway! - is not due to life-style choices, nor statin deficiency. It's due to that very low FT3 of hers. Poor lady! She must feel dreadful. She's under-medicated. Her TSH is too high, and her FT4 and FT3 are too low. But, because they're somewhere within the range, they're counted as 'normal'. Doctors have next to no idea how to interpret blood test results! Lord knows why they're so keen to do them when they don't understand the results.

Her B12 is so low - dangerously low - she should be tested for Pernicious Anemia. Her ferritin is so low that she should have an iron panel done to find out why - honestly, with a range of 11.0 – 306.8, how can they imagine that it's 'normal' all the way through? It just defies logic. I'm surprised she's still standing with a level that low. She must be exhausted.

So, they do all those tests, and they're only interested in the damned cholesterol which isn't even relevant to anything - except as an indicator of low T3. She should refuse statins catagorically, because they are not recommended for women, and certainly not for hypos! They can do great muscle damage when taken by hypos. The cholesterol won't kill her, but the statins might!

[DelicateInput in reply to greygoose]

You say the Vit B12 level is low but mine was lower than that (230 on a range of 200 to 900) yet every doctor, specialists included, said that was perfectly normal. I have recently started taking Vit B12 tablets and they have made a huge difference to energy and mental issues.

[greygoose in reply to DelicateInput]

Well, one of the problems with doctors - and there are many as you probably know! - is that they are not taught to interpret blood test results. They just don't understand what ranges are, so they believe that anything within that range, however low, has to be good. Have to say, they're a bit lacking in logic, as well.

In the real world, B12 should be over 550, and ranges in Japan start at 500! Below that, irrepairable neurological damage is likely. But, as doctors know nothing about nutrients, they don't know about the dangers of low B12 either. I sometimes wonder if they spend their time in med school just learning how to dismiss, belittle and gaslight patients! Because they don't seem to know anything much that's useful.

[DelicateInput in reply to greygoose]

I seriously think that the problem is the NHS. I lived abroad for two short periods in the early 70s (Germany and Switzerland) and I never encountered the attitudes. I had a Canadian flatmate and she said she steered clear of doctors trained in the UK, largely because of their attitude.

The NHS always waits to see if you get worse before doing any tests, as if they don't want to spend any money.

If I had my way, I would abolish the NHS and just provide a free medical service for children and young people up to the age of 25. If people have not learned to look after their health by then, that would be their problem. I have worked for 56 years and every time I have needed treatment, I have had to pay because I am "not bad enough". Meanwhile, we get so many who never work and abuse the free service.

[greygoose in reply to DelicateInput]

I agree with you, the way the NHS is run is a huge problem. And, yes, they are always trying to avoid spending money. They haven't the education or the intelligence to understand that if they treated thyroid correctly, they would actually save millions. It's all false economy.

But, I think you're a bit harsh sayind this: I would abolish the NHS and just provide a free medical service for children and young people up to the age of 25. If people have not learned to look after their health by then, that would be their problem. Are you insinuating that if I have a debilitating thyroid disease it is somehow my fault, and therefore I should pay for my treatment (I do, anyway, but that's another story)? It doesn't matter how well you look after yourself, ill health can always strike you down at any age, through no fault of your own. I just cannot agree with you there.

[DelicateInput in reply to greygoose]

No, I am not saying that at all. However, it is clear from all these posts that the thyroid is not treated anyway. I would rather therefore have a private system and pay for my own treatment rather than be told there is nothing wrong with me and endure the immense suffering that I have.

What I am saying is the NHS puts a great priority on self inflicted conditions - I can hardly call being obese with resultant obesity, diabetes, collapsed joints and all the rest of it an illness. By also treating the worst cases first and those it considers bad enough to treat, it encourages people not to help themselves when they could probably alleviate their condition themselves and it causes them to put on the agony to get priority.

[greygoose in reply to DelicateInput]

So, you're saying that if you're obese, it's all your fault. Frankly, I'd rather not go on with this discussion, I find it in bad taste.

[DelicateInput in reply to greygoose]

Yes it has been well proven that it is. Don't worry I won't respond to you again. I'm not worried about bad taste after all the suffering I have endured.

[jade_s in reply to DelicateInput]

I've lived in the Netherlands, Belgium, UK, US, and the middle east in the last two decades and have encountered medical stupidity everywhere. When it comes to autoimmune diseases - they're all in the same category. If you need a surgery or something they can see on a scan - you're fine, but not if you're dealing with invisible disease. So no need to vilify just the NHS, almost all countries medical systems are the same. They're trained that way.

I'd also be weary about talking about abusing the system. I'd bet many are just labeled hypochondriacs but they have undertreated hypothyroidism, low B12, low iron, or (some collection of) other autoimmune diseases. Very unhelpful to blame sick people - you can't change your metabolism or autoimmunity. This isn't just a UK problem either, it's worldwide. Look at the increasing rates of childhood obesity and diabetes in China, the introduction of western diet in indigenous populations causing obesity and diabetes, etc. We are not built to deal with the crap that we find to eat. You might say "eat clean", great idea when people can't even access food - there are food deserts in the US (probably in the UK as well) where there are no proper grocery stores. School lunches full of carbs and sugar. When I travel I can't live off a salad, so you eat what's available. This is a societal problem, don't start blaming "obese people" as if it's just a matter of what they put in their mouths - on a hypothyroidism forum no less.

[DelicateInput in reply to jade_s]

That was a side issue. The main issue is that I would prefer a private system. I am sick of paying high rates of income tax (for 56 years) when I can't get medical treatment. I could not even get it as a child. I've paid for numerous conditions. How is it that some people get absolutely everything treated and never have to pay, I wonder. I am entitled to my preferences.

[helvella in reply to DelicateInput]

Please stop making replies which are absolutely nothing to do with the original post and are political. (References to tax rates are inherently political.)

[DelicateInput in reply to helvella]

Pardon???? I do not know what you are talking about. The whole of the site is bitterly complaining about the NHS and at the same all the administrators advocate the use of private treatment, giving long lists of private services. Why do they not suggest raising the issue with the NHS???

I do not "make" replies so I take it you misunderstood me - otherwise your allegations are grossly offensive. My reply to one poster had everything to do with the original post.

[SeasideSusie Remembering]

TaraJR

Serum FT4 – normal 13.8 (7.9 – 14.4)

Serum FT3 – normal 3.8 (3.8 – 6.0)

Serum TSH – normal 3.2 (0.38 – 5.33)

The other two replies here are stating that the FT4 result is low. From what I can see her FT4 is close to the top of the range, it's just FT3 that is low.

Her TSH is too high for a treated hypo patient but one wouldn't expect to see a top of range FT4 with that TSH.

What time did she do the test?

Did she take water only before the test and no food or other drink so that nothing affects TSH?

When did she take her last dose of Levo before the test - it should be 24 hours to avoid a false high or false low FT4 result.

There is the possibility of poor conversion of T4 to T3 here and her poor nutrient levels aren't helping.

Serum Vit B12 147 (133.0 – 675.0)

This is a dreadful result. Does she have any signs of B12 deficiency - check here:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

She should be tested for B12 deficiency and Pernicicous Anaemia.

Serum ferritin – normal 20 (11.0 – 306.8)

According to NICE this is iron deficiency:

cks.nice.org.uk/topics/anae...

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Her GP needs to do an iron panel consisting of serum iron, transferrin saturation, total iron bindind capacity plus ferritin.

Her full blood count doesn't suggest anaemia, you can have iron deficiency with or without anaemia.

Was Vit D tested?

Were thyroid antibodies tested?

Cholesterol is probably high due to her thyroid not being optimally treated. She should refuse the statins.

[Lalatoot in reply to SeasideSusie]

Spot on SeasideSusie noticing the ft4 result and range. My mistake assuming that the range would be up to 22. Thanks for noticing.

[TaraJR in reply to SeasideSusie]

SeasideSusie thank you. Apparently she forgot to leave her levo dose, so took it at about 7am, a couple of hours before the test at 9am, so that's not an accurate T4 level. I don't know how much difference it makes?

I'm shocked that the B12 and ferritin have been marked normal. Only cholesterol was highlighted

[SeasideSusie Remembering in reply to TaraJR]

Some people say that the difference in the result is about 20% but to be honest I wouldn't like to guess. But her TSH is too high for a treated hypo patient if it's an accurate result and nothing interfered with it.

[SlowDragon Administrator in reply to TaraJR]

So Ft4 is falsely high if she took levothyroxine before test

TSH is too high for someone on levothyroxine. She needs 25mcg dose increase in levothyroxine

And meanwhile work on improving terrible vitamin levels

Retest thyroid levels 6-8 weeks after increasing dose

Monitor My Health Is cheapest for just TSH, Ft4 and Ft3

Retest vitamins in 4-6 months

[SlowDragon Administrator]

Does she have Hashimoto’s

She needs vitamin D tested

What vitamin supplements is she currently taking……looking at results….probably nothing

Has she had coeliac blood test

Is she on strictly gluten free diet

TaraJR …….Have you had Dio2 gene test done?

If you test positive…..it’s likely she does too

First step is to get all four vitamins tested and optimal

Retest thyroid, making sure test is ideally before 9am and last dose levothyroxine 24 hours before test

Does she always get same brand levothyroxine at each prescription

If not, she likely needs to do so

Assuming Ft3 remains low in say 3-6 months….likely to need T3 prescribed alongside levothyroxine

[TaraJR in reply to SlowDragon]

SlowDragon thank you. Her antibodies were negative a few months ago, so I don't know about Hashis. Initially in about 1990, she was very ill for months, put on 4 stone, freezing cold, gave up work, slept all day wrapped in a sleeping bag in the summer, all tests were 'normal'. She was an inpatient for several days, all tests were 'normal'. The consultant said her thyroid results were ok, but tried levo 'just in case'. A few weeks later, she was massively better. Familiar story? She doesn't have those records.

I'll ask about vitamin D. I think it was tested quite recently. No she's not gluten free.. I don't think her brand stays the same.

I tested DIO2 and I'm heterozygous! I had Graves, RAI, then hypo, fine on levo for 25 years, then very ill for 2 years, finally started T3, which was transformational.

So you think she may be going down the same path as me?

[SlowDragon Administrator in reply to TaraJR]

Has she had BOTH TPO and TG thyroid antibodies tested

NHS only tests TG antibodies if TPO are positive

Significant minority of Hashimoto’s patients only have high TG antibodies, and remain undiagnosed if only test via NHS

20% of Hashimoto's patients never have raised antibodies

Get ultrasound scan of thyroid if TG antibodies are negative

Quite likely find thyroid has completely atrophied after all these years. That would confirm autoimmune Ord’s thyroiditis

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Ask her which brand levothyroxine suits her best

Then always get same brand

Get her a Dio2 gene test. I think it highly likely she’s also heterozygous

Coeliac blood test BEFORE considering trial on strictly gluten free diet

Her B12 is dire

Is she vegetarian or vegan?

Ferritin similarly awful.

[DelicateInput]

With regard to cholesterol, you might want to consider taking lecithin which reduces cholesterol in the gut. It is perfectly safe and I have been taking it for the best part of 50 years. It also reduces weight by about 3 lbs initially as it is diuretic.

Also, charcoal tablets are supposed to reduce cholesterol. I have been taking them for a few months but as I have not retested my cholesterol, I cannot say for certain. They are perfectly safe.

Grapefruit is supposed to reduce cholesterol. I have eaten it every morning for about 40 years but have stopped the last couple of years because it interferes with the absorption of a lot of tablets, including anti histamines. I find it very refreshing but now just eat berry fruit in the mornings.

[Popeye44]

The serum creatinine is very high and the eGFR is low. It would suggest that your sister's kidneys may be struggling. This will make her very tired and unwell so her issues may well not be thyroid related. I would suggest she asks the GP to take another look at her blood results. I have been through a similar problem with my husband and he's supposed to be monitored for familial kidney disease! I think they only look at what they are looking for and ignore the rest. I had to tell the GP "What do you think of my thyroid result?" She was only looking for inflammatory markers connected with low back pain. 🤔

[humanbean in reply to Popeye44]

I noticed the kidney results too, and thought they showed there might be a problem developing.

My husband had an eGFR in the 50s a few years ago, and his doctor wasn't remotely interested, It seems they only show an interest if it drops to the low 30s or below i.e. when the kidneys have started failing.

I now dose my husband with B vitamins and vitamin D (it's all I can get him to agree to take) and his eGFR was in the mid 60s in his last test, so it can be improved to some extent.

[Popeye44 in reply to humanbean]

There's a website called goodhealthnaturally.com and they have a product called Kidney Rescue. My husband tried them and they did improve his eGFR. When he got gout the GP said she was concerned about his poor kidney function. I suggested she read the letter on file from his father's nephrologist 15 years ago which said please monitor this man for familial kidney disease. He lost 10% of GFR in 1 year but no action was taken and like most men he wouldn't take it up with them. He's 78 so I doubt they will bother now either.

[humanbean in reply to Popeye44]

I had a look at the ingredients and have never heard of most of them.

Sadly it costs too much for my budget. I'll send the link to my husband and see if he wants to pay for it himself.

[DelicateInput in reply to Popeye44]

I think a GFR of 61 is normal for her age of 60. At that age, mine dropped suddenly from 90 to 60. (I used to pay for various screenings regularly.) I was told that this was due to age and it would drop further. It has dropped to the mid 50s and I was told it was only considered serious if it dropped to about 30.

I notice that Slow Dragon has come up with an explanation that this is related to the thyroid. I will be interested in the results of my next set of blood tests.

I really do feel that doctors who have spent years on training cannot genuinely make so many mistakes when interpreting blood test results and reason is just that the NHS only treats the really severe cases on cost grounds.

[SlowDragon Administrator]

Low GFR and poor kidney function linked to low Ft3

ncbi.nlm.nih.gov/pmc/articl...

The GFR is reversibly reduced (by about 40%) in more than 55% of adults with hypothyroidism[40] due to several reasons.