My results from MMH

[MaggieSylvie]

Good evening, thyroid friends, I sent my sample off (extremely thick, sticky blood taken at 08.30) yesterday afternoon and have already received my results. MMH says

Overall comment

24/08/2022

Good news, your thyroid hormone levels are all normal (known as euthyroid). There is no indication of thyroid gland disorder. This interpretation is based on the assumption you do not have a pre-existing thyroid condition and/or receiving thyroid treatment.

TSH 0.33 (0.27 - 4.2) an increase of 23 from the last count on 16/08/22

FT4 13.2 (12 - 22) an increase of 1.2 from the last count on 16/08/22

FT3 4.8 (3.1 - 6.8) on a level with the last count on 2/12/21.

My reasoning for not testing Vit D, B12, Ferritin and Folate was that if there were any concerns, they could be tested without going privately, according to the advice of the GP. Their last readings, reported on this forum in December were as follows:

Vit D two weeks ago was 91 (50 - 140) I'm taking Evacal D3 twice daily;

Ferritin, which was 467 (13 - 150) on 2 Dec; I guess this was high because I have MDS and the immature haemaglobin cells hold onto the iron.

B12, which was 45.300 (37.5 - 188) on 2 Dec and

Folate Serum was 13.29 (more than 3.89) on 2 Dec

Autoimmunity which were deemed fine last time.

Can anyone see any flaws in this?

[SlowDragon Administrator]

B12 is extremely low

Any active B12 below 70 needs investigation

Are you vegetarian or vegan?

What vitamin supplements are you currently taking

[SlowDragon Administrator]

Have you been tested for hemochromatosis (iron overload)

Hemochromatosis can be a cause hypothyroidism

If you Google MDS and high ferritin there’s loads of research papers suggests possible links

[MaggieSylvie in reply to SlowDragon]

SlowDragon, I did as you advised, and found that people with MDS often have high ferritin but the amount of iron that gets distributed around the body is not enough to worry about. The blasts hold on to the rest. What I want to know now is: if my bloods are normal at 08.30, why are they so very worrying (indicating central hypothyroidism) when the sample is taken at 14.00? Does the condition worsen during the day or does it return to normal in the evening?

[SlowDragon Administrator in reply to MaggieSylvie]

TSH is a pituitary hormone that should increase as Ft4 and Ft3 drop …

TSH is the message from pituitary to thyroid to tell thyroid to make more thyroid hormones

TSH has a pronounced circadian rhythm

Highest in very early morning ….lowest after lunch and evening

YourTSH is not responding to low thyroid hormones

it’s your low Ft4 and Ft3 that are showing it’s likely you are hypothyroid

[MaggieSylvie in reply to SlowDragon]

Thank you, SlowDragon, for getting back to me so quickly. After doing an early morning test, MonitorMyHealth says my results are fine! I can see, though, that FT3 and 4 are on the low side of normal, with FT3 remaining level. I have just over two weeks before I see the surgery nurse.

[SlowDragon Administrator in reply to MaggieSylvie]

MMH (like most medics) only looking at TSH

[MaggieSylvie in reply to SlowDragon]

So should I push for a prescription of T3?

[SlowDragon Administrator in reply to MaggieSylvie]

Definitely not

Standard starter treatment is always levothyroxine

Vast majority of patients do fine on levothyroxine

Levothyroxine is Ft4 and is converted to Ft3 in cells

Standard starter dose levothyroxine when 65 years or older, is 25mcg

Bloods should be retested 6-8 weeks after each dose increase or brand change in levothyroxine

[MaggieSylvie in reply to SlowDragon]

Aha! Thanks for that. I shall be more knowledgeable now. I dread taking Levo as I'm already on one drug that I have to take twice a day with nothing else either side of it for 30 minutes (I take it when I wake up early and when I go to bed).

[SlowDragon Administrator in reply to MaggieSylvie]

If you reliably get up for the loo in the night ….take levothyroxine then

Retest bloods 6-8 weeks after each dose increase…last dose levothyroxine 24 hours before test

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[MaggieSylvie in reply to SlowDragon]

I'm taking Pregabalin to stop me getting up in the night and it works really well a lot of the time. This is, in fact, how I take the morning dose of EvacalD3 - on my last perceived visit to the loo. Otherwise, breakfast is delayed.

Well, I haven't been prescribed Levothyroxine yet (since last year, that is) and I'm not going to request it! I'll wait and see what they say. They might have a surgery meeting perhaps and get more than one brain on it.

However, your advice on how to manage doses around testing may come in very helpful, and I thank you for that.

😊