thyroid results- need guidance

[Gillybean55]

Hi, I have been following this group for awhile now. I first got a higher than normal TSH reading in 2014 (6.1) from my annual health insurance checkup. Over the next couple of years it went up and down. My symptoms were not too worrisome except for the constant weight gain and muscle pain so my GP suggested monitoring annually. Over the last couple of years I have been feeling worse (tired, anxiety, poor sleep, tinnitus, muscle and bone pain) . My latest GP tests (May 22) TSH 5.8 and T4 10. GP wanted to retest in 6 months. I decided to get my levels checked privately before I see my GP again so that I can ask to now be treated. Not sure I want to wait until November! See results below. Any advise on these results would be greatly appreciated. Thanks

[SeasideSusie Remembering]

Hi Gillybean55

TSH: 8.69 (0.27-4.20)

FT4: 10.8 (12-22)

FT3: 3.65 (3.1-6.8)

An over range TSH with a below range FT4 tells us that you are hypothyroid. Show these results to your GP and ask to be prescribed Levothyroxine. Unless you are over 60 or have a heart condition you should be started on 50mcg, retested 6 weeks later, increase by 25mcg, retest 6-8 weeks later, repeat increasing/testing until your levels are where they need to be for you to feel well. This may take months and we usually find that hypo patients generally feel best when TSH is 1 or below with FT4 and FT3 in the upper part of their reference ranges, it's very individual so that's not set in stone, you need your levels where you need them to feel well.

If necessary refer to NICE guidelines:

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

If the TSH level is above the normal reference range, the free thyroxine (FT4) level should be measured in the same sample.

Suspect a diagnosis of primary hypothyroidism if TSH levels are above the normal reference range (usually above 10 mU/L) and FT4 is below the normal reference range.

Thyroid antibodies are low so showing negative for autoimmune thyroid disease. Not all hypothyroidism is autoimmune although it is a very common cause.

Cortisol is high, discuss with your GP who should arrange further testing for you.

CRP is nice and low, this is an inflammation marker so the lower the better.

Iron panel is OK.

Vit D is OK, it's recommended to be 100-150nmol/L by the Vit D Council, Vit D Society and Grassroots Health. I would retest end October/November time to see if your level has dropped which may mean you need to supplement over the winter.

Easy dried blood spot fingerprick test costs £29 with an NHS lab who offer this to the general public if that is all you want to test at the time:

vitamindtest.org.uk/

B12: 355pmol/L (145-569) = 481pg/ml

This is on the lowish side.

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."

Consider supplementing with a good quality, bioavailable B Complex.

I have used Thorne Basic B for a long time and always been happy.

If you look at different brands then look for the words "bioavailable" or "bioactive" and ensure they contain methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid). Avoid any that contain Vit C as this stops the body from using the B12. Vit C and B12 need to be taken 2 hours apart.

When taking a B Complex we should leave this off for 3-7 days before any blood test because it contains biotin and this gives false results when biotin is used in the testing procedure (which most labs do).

Folate is OK, it is recommended to be at least half way through range which is 35 plus with that range. The B Complex will help raise both B12 and folate, it wont hurt for your folate to be higher in range.

[Gillybean55 in reply to SeasideSusie]

Thank you so much for advice and guidance. As I am over 60 (61) what dosage would a knowledgeable GP look to start me on? I currently take a multi B supplement but I’m thinking I shall switch to the Thorne Complex and add a B12 supplement for a few weeks until my B12 rises to the optimal level. Not sure why Cortisol is so high, could be another reason I feel jittery nauseous and anxious!! Blue Horizion mentioned possible Cushions disease but I don’t have any of the suggested symptoms for this so just hoping this is a blip that can be fixed by the GP. Thanks again Susie.

[SeasideSusie Remembering in reply to Gillybean55]

Gillybean55

Guidelines do state starting at 25mcg if over 60, personally if you are otherwise healthy I can't see why you couldn't start at 50mcg. Hopefully your GP will accept these results without requiring further tests through the surgery.

Let us know how it all goes.