Can you give me advice on my blood results please?

[bubbatetley]

Full blood count Monitoring

Total white blood count 4.7 10*9/L [3.9 - 10.2]

Red blood cell count 4.48 10*12/L [3.9 - 5.2] Haemoglobin

concentration 144 g/L [120.0 - 156.0] Haematocrit 0.449 L/L [0.355 -

0.455]

Mean cell volume 100.1 fL [80.0 - 99.0]

Above high reference limit

Mean cell haemoglobin level 32.1 pg [27.0 - 33.5]

Red blood cell distribution width 12.6 % [11.0 - 16.0] Platelet count -

observation 241 10*9/L [150.0 - 370.0] Plateletcrit 0.240

Mean platelet volume 9.8 fL

Platelet distribution width 49 %

Neutrophil count 2.30 10*9/L [1.5 - 7.7]

Lymphocyte count 1.78 10*9/L [1.1 - 4.5]

Monocyte count - observation 0.34 10*9/L [0.1 - 0.9] Eosinophil

count - observation 0.12 10*9/L [0.02 - 0.5] Basophil count 0.05

10*9/L [0.0 - 0.2]

VITAMIN B12 Monitoring

Serum vitamin B12 level 291.0 ng/L [211.0 - 911.0]

25OH VITAMIN D (GP ONLY) Monitoring

Serum total 25-hydroxy vitamin D level 74.3 nmol/l

Ranges below relate to TOTAL 25-OH Vitamin D

Below 30 nmol/L is deficient

30 - 50 nmol/L: may be inadequate in some people

Above 50 nmol/L: is sufficient for almost the whole population

There is some evidence that levels nearer 75 nmol/L may be

beneficial for the frail elderly at risk of falling (see CUH Trust

Guideline)

Above 500 nmol/L: Toxicity likely

For advice on management please s

ee NOS publication :

Vitamin D and Bone Health: A Practical Clinical Guideline

for Patient Management and/or CUH Trust guidelines Ca

and Vitamin D supplements to adults with GFR>30mL/min/1.73m2

FOLATE (SERUM) Monitoring

Serum folate level 5.04 ug/L [> 5.38]

Full blood count Monitoring

Total white blood count 4.7 10*9/L [3.9 - 10.2]

Red blood cell count 4.48 10*12/L [3.9 - 5.2] Haemoglobin

concentration 144 g/L [120.0 - 156.0] Haematocrit 0.449 L/L [0.355 -

0.455]

Mean cell volume 100.1 fL [80.0 - 99.0]

Above high reference limit

Mean cell haemoglobin level 32.1 pg [27.0 - 33.5]

Red blood cell distribution width 12.6 % [11.0 - 16.0] Platelet count -

observation 241 10*9/L [150.0 - 370.0] Plateletcrit 0.240

Mean platelet volume 9.8 fL

Platelet distribution width 49 %

Neutrophil count 2.30 10*9/L [1.5 - 7.7]

Lymphocyte count 1.78 10*9/L [1.1 - 4.5]

Monocyte count - observation 0.34 10*9/L [0.1 - 0.9] Eosinophil

count - observation 0.12 10*9/L [0.02 - 0.5] Basophil count 0.05

10*9/L [0.0 - 0.2]

VITAMIN B12 Monitoring

Serum vitamin B12 level 291.0 ng/L [211.0 - 911.0]

25OH VITAMIN D (GP ONLY) Monitoring

Serum total 25-hydroxy vitamin D level 74.3 nmol/l

Ranges below relate to TOTAL 25-OH Vitamin D

Below 30 nmol/L is deficient

30 - 50 nmol/L: may be inadequate in some people

Above 50 nmol/L: is sufficient for almost the whole population

There is some evidence that levels nearer 75 nmol/L may be

beneficial for the frail elderly at risk of falling (see CUH Trust

Guideline)

Above 500 nmol/L: Toxicity likely

For advice on management please see NOS publication :

Vitamin D and Bone Health: A Practical Clinical Guideline

for Patient Management and/or CUH Trust guidelines Ca

and Vitamin D supplements to adults with GFR>30mL/min/1.73m2

FOLATE (SERUM) Monitoring

Serum folate level 5.04 ug/L [> 5.38]

Below low reference limit

Serum Folate Reference Range = Greater than 5.38 ug/L If the

patient cannot be fasted be aware that a folate rich meal, eaten less

than 3 hours prior to venesection, may increase serum folate

concentrations.

CALCIUM CORRECTED FOR ALBUMIN

Serum calcium level 2.56 mmol/L [2.08 - 2.65] Serum albumin level

38 g/L [35.0 - 50.0] Serum adjusted calcium concentration 2.64

mmol/L [2.2 - 2.6] Above high reference limit

Urea and electrolytes Monitoring

Serum sodium level 142 mmol/L [133.0 - 146.0]

Serum potassium level 4.2 mmol/L [3.5 - 5.3]

Serum creatinine level 71 umol/L [44.0 - 97.0]

eGFR using creatinine (CKD-EPI) per 1.73 square metres 78 mL/

min/1.73m*2 eGFR result is consistent with CKD Stage 2, provided

AKI has been excluded.

NICE no longer recommends adjusting eGFR for adults of

African-Caribbean or African family origin (NG203, updated August

2021).

FERRITIN Monitoring

Serum C reactive protein level < 4 mg/L [0.0 - 6.0]

Serum ferritin level 24.6 ug/L [10.0 - 291.0]

A normal ferritin may not exclude iron deficiency if levels are at the

lower end of the normal range or in the presence of inflammation.

PHOSPHATE Monitoring

Serum inorganic phosphate level 1.11 mmol/L [0.8 - 1.5]

Thyroid function test Monitoring

Serum TSH level 0.84 mU/L [0.35 - 5.5] Serum free T4 level 13.6

pmol/L [10.5 - 21.0]

FREE T3 Monitoring

Serum free triiodothyronine level 3.4 pmol/L [3.5 - 6.5] Below low

reference limit

[SlowDragon Administrator]

Serum vitamin B12 level 291.0 ng/L [211.0 - 911.0]

Serum folate level 5.04 ug/L [> 5.38]

Serum ferritin level 24.6 ug/L [10.0 - 291.0]

Serum total 25-hydroxy vitamin D level 74.3 nmol/l

Serum TSH level 0.84 mU/L [0.35 - 5.5]

Serum free T4 level 13.6pmol/L [10.5 - 21.0]

Serum free T3 level 3.4 pmol/L [3.5 - 6.5]

Below low reference limit

Looking at previous posts

Are you currently taking just levothyroxine or levothyroxine plus T3

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

T3 - day before test split into 3 smaller doses spread through the day and last dose 8-12 hours before test

Ft4 is too low. Likely to need increase in dose levothyroxine

Vitamins are terrible

Ferritin is deficient

You need full iron panel test for anaemia

Likely to need iron supplements

B12 and folate insufficient

Are you currently taking any vitamin B complex or separate B12?

[bubbatetley in reply to SlowDragon]

Hi SlowDragon, I hope you are hanging on in there. Thank you for the reply.

Levothyroxine just been increased form 50 to 75mcg by my new Endo on Monday .

I take Folic acid 400mcg once daily and Pro D3 Vitamin's 3,000 daily and that's all i've ever been told to take .

I have just had more bloods done by Endo which are

HBA1C

B12

CRP

Oestradiol

ESR

FSH

Luteinising Hormone

Prolactin

IGF1

Cortisol - which had to do a 24 hour collection of urine

I have a small Benign Pituitary tumour and am waiting for brain scan.

He thinks I may have trouble with my Adrenals.

I feel so ill and have no energy and just staying in bed, not eating and loosing weight.

So very tired, but can't seem to sleep and severely constipated.

Any advice greatly appreciated, especially on what vitamins and nutrient's I need to take.

Thank you so much

Take care

Best wishes

Bubba🌺🌷🌺

[bubbatetley in reply to bubbatetley]

I forgot to say the T3 was stopped because I became Toxicosis from being over medicated.🌺

[SlowDragon Administrator in reply to bubbatetley]

can you elaborate…what were the actual results that were defined as too high (toxicosis)

Clearly you’re now very under medicated

Low B12 and low folate

When you finish folic acid prescription

You might consider supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12

Low B12 symptoms 

b12deficiency.info/signs-an...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 drops 

healthunlocked.com/thyroidu...

or

B12 sublingual lozenges 

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

How other member saw how effective improving low B vitamins has been 

healthunlocked.com/thyroidu...

[SlowDragon Administrator in reply to bubbatetley]

endocrinologist should have also done full iron panel test for anaemia with such low ferritin

Low ferritin levels

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

Also See page 7 on here 

rcn.org.uk/-/media/royal-co...

Look at increasing iron rich foods in diet 

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

An article that explains why Low ferritin and low thyroid levels are often linked 

preventmiscarriage.com/iron...

 

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin 

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin 

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron 

Medichecks iron panel test 

medichecks.com/products/iro...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Good explanations of iron 

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

[bubbatetley]

Thank you so much for all that useful information. I will get what you have suggested in the way of supplements. I will get my GP to do the necessary bloods too.

I was taking 100mcg of Levothyroxine and 20mcg of Liothyronine daily for nearly 18 months and became very ill. So Endocrinologist stopped the T3 immediately. I then remained on The 100mcg Levothyroxine and then moved counties.

My new GP then did bloods and said I need to reduce Levothyroxine and then changed my dose to 50mcg 6 months ago, since then I've been going down hill.

The new Endo has now increased my Levothyroxine to 75mcg since Monday.

[Lemondrizz1]

I am sorry that you are feeling so poorly - I am not sure if I have anything to offer but was asked to contact you with regard to a T4 test ?? Is this something that you were asking about ?

Lemondrizz

[ON72]

Hi, the FT4 which is reserved hormone is meant to convert to FT3. In your case FT4 is on the lower end of normal value. In my humble opinion it should be ideally somewhere between 17 and 20. However FT3 is the active hormone and should be higher than it is now. i. e. 4.8 to 5 or so. I'm not sure if you under medicating or having issues with conversion of FT4 into active hormone FT3. Blood testa are a snapshot and hormones do go up and down, so when you repeat the test your results may be slightly different. Nevertheless I would try to supplement with selenium to improve conversation of FT4 to FT3 and review your treatment plan. Hope this helps somehow. All the best.

[bubbatetley in reply to ON72]

Thank you so much.🌷

Take care

[redmoon]

hi bubbatetley, Im redmoon, I unfortunately am not the best person to advise you, I have never had the extensive tests that u have listed above. Only thing I will say is that for a period of time I stopped taking Omeprazole (its for help with reflux etc) and my levels on my blood test changed, Doctor thought I had been taking something else or more eltroxine as he said I was borderline hyper, the only thing I had done was removed the omeprazole as I had read here that people found that it interfered with the absorbtion of thyroid medication, obviously that is correct. as for my doctor, I have no faith in him at all, as when I said this, he dismissed it, still refused to give me T3 despite my telling him I felt better on it when I took it in Turkey, he put my weight issues down to diet/obesity, maybe pre diabetic, even though my glucose tests have Never indicated I was any where near being at risk of diabetes. he wouldnt give me a prescription for the T3 but did give me a prescription for an obesity/addiction type drug to curb my appetite which costs €1,000 per month. Im sorry I couldnt help you but for me none of my blood tests ever help me and never get a comprehensive enough round of tests or timely tests to be able to make any sense of it. its months since my last test and wont have another until October, the earliest I can get an appointment. Im certain most people on here are more knowledgeable on the subject and more able to help you. hope you are making progress with your health. take care.

[bubbatetley in reply to redmoon]

Thank You So much for the reply. I hope you are hanging in there. I am going to see a Neurologist on Monday as I still am having numbness in the head and very unsteady with my walking and balance.

Keep ya posted

Take 🌷care

[KnackeredKaty]

Hi, sorry for my late reply. Ive changed my email and not checking this one much. According to your blood results you seem very healthy. Your thyroid results are borderline and if you feel unwell you should get your endocrinologist to check if a change of dose is necessary. Your ferritin is also within normal limits for the prescribed ranges but you might feel better if you boost your ferritin level. Your T3 level is only 1 point outside the lower limit of normal, which might have an effect on how well you feel. Again, speak to your endocrinologist before messing about with your doses yourself. You might do more harm than good without checking first.

[bubbatetley in reply to KnackeredKaty]

Thank you so much.

Take care🌷

[humanbean]

I hope bubbatetley is still checking back for replies to this post.

Mean cell volume 100.1 fL [80.0 - 99.0]

Serum vitamin B12 level 291.0 ng/L [211.0 - 911.0]

Serum folate level 5.04 ug/L [> 5.38]

Serum ferritin level 24.6 ug/L [10.0 - 291.0]

Your vitamin B12 level is much too low for good health despite being in range, and so is your folate which is below range, and both desperately need to be improved a lot. Both of these low levels will be contributing to your Mean Cell Volume (MCV) being over the range.

Mean Cell Volume is a measure of the average volume of your red blood cells and, amongst other things, it is affected by nutrients levels.

If MCV is high in range or over the range (i.e. red blood cells are large) it indicates that your vitamin B12 and/or folate are probably too low. This condition is referred to as macrocytosis.

If MCV is low in range or under the range (i.e. red blood cells are small) it indicates that your iron and/ferritin (iron stores) are too low. This condition is referred to as microcytosis

If someone is low in iron, ferritin, B12, and folate, MCV can't be relied on to indicate which of these low nutrients is worst and they all need to be tested and treated.

If red blood cells are too big or too small your red blood cells will be inefficient/poor at carrying oxygen around your body. Energy levels will be low, and I would assume that you get breathless on even slight exertion.

Please note that if someone supplements with folic acid or folate without B12 it might reduce their MCV, and in doing so it could disguise the fact they are also B12 deficient.

...

Have you ever been tested for Pernicious Anaemia (PA)? If you haven't been then you need to ask for testing ASAP. For more info on what is involved in PA testing please join the PA forum on this website and post the results that I've picked out at the start of this reply. (You can join as many communities on HealthUnlocked as you like, you aren't restricted to just this one.)

healthunlocked.com/pasoc

The treatment for PA is Vitamin B12 injections. Please don't take B12 supplements until you have been investigated for PA. I would also suggest you stop the folic acid supplements for now until you have started B12 injections, but check with the PA forum first.

...

Since your B12 is still in range (although extremely low in range), some doctors will say your level is absolutely fine and will refuse to test for PA. This is shocking, but not uncommon.

If that happens then you have the choice of buying your own B12 injections (the PA forum could help with this) and learning how to inject yourself. You can use B12 injections to help with B12 deficiency with or without PA and I think you should do this if you can.

The last (and slowest - and possibly pointless) option is to take B12 supplements. If you have PA then you will probably fail to absorb enough B12 to raise your levels. But if you don't have PA then you might absorb the B12 and do well.

Note that for the body to make use of B12 it also needs sufficient folate. But for various reasons you should take B12 for a week first before adding in folate supplements.

...

If you are forced to supplement with tablets...

Vitamin B12 - Best supplement in tablet form is methylcobalamin. This is easily found on Amazon, Ebay, and other online sites that sell supplements. Don't bother trying Holland & Barrett or Tesco or other bricks and mortar shops. Online you will have much greater choice and much lower costs. You might want to start with a dose of 1000mcg methycobalamin a day for a week or two, then increase up to 5000mcg per day.

Another option for a B12 supplement is one that contains methylcobalamin AND adenosylcobalamin. They are both active forms of vitamin B12 that the body can make use of immediately without converting it to another form. SeasideSusie has information on some good methylcobalamin + adenosylcobalamin supplements.

When you start supplementing B12 in any form, injections or pills, note that your body's need for potassium will increase dramatically, at least for a while. There are lots of lists of potassium rich foods on the web if you do a search, but here's one to get you started :

webmd.com/diet/foods-rich-i...

Low potassium is a common cause of people having side effects when they start supplementing B12. Such side effects are a sign of needing more potassium, not a sign that you should give up B12.

Note that your aim should be to get your B12 level up to the top of the range or higher. B12 is unusual in that going over the range isn't dangerous or toxic in any way, and the reference ranges are often extremely low.

...

Once you've had your first B12 injection or been on B12 tablets for a week, hopefully your B12 levels will have improved. Then you should add in folate supplements. Give up on the folic acid and don't take it again. Read these links for the reasons why methylfolate is a much better option than folic acid:

takecareof.com/articles/ben...

chriskresser.com/folate-vs-...

The best folate supplements are methylfolate. Your aim should be to get your level up to the upper half of the range. But if the range has no upper limit then stick to getting your level into double figures or 15 - 20 mcg/L.

You could start on taking 400mcg methylfolate, but higher doses are available. I wouldn't suggest going higher than 1000mcg per day though.

...

Whatever the cause of your B12 deficiency, it is obvious that you are not absorbing nutrients very well. As I commented above, potassium is often low when low B12 is being treated.

There are other nutrients that could be low too, for example low vitamin C, other low B vitamins, low zinc, low magnesium, and your ferritin (iron stores) is obviously low too. But I would suggest trying to do some research as you get better into what you might have a problem with in addition to B12, folate, and iron.

[bubbatetley in reply to humanbean]

Hi humanbean, I hope you're hanging on there. Please could you recommend what supplements to get for B12 deficiency and folate too. My Gp will only give me Folic acid and Cyanocobalamin, the meds don't seem to be helping. She also said I am not Anemic, even with such low ranges. I have an appointment to see a Neurologist on Monday for body paresthesia and head numbness.

Thank you for all the advice you have given to me.

Take care and stay safe 🌻

[bubbatetley]

Hi Humanbean, I hope you are well.

So sorry for the delay in responding, but i've been in hospital with a suspected stroke/ heart attack and had lots of tests/scans. The heart scan came back and I've been diagnosed with Micro Vascular Angina, and will probably need surgery, not forgetting now that this so called GP said it was all anxiety. I kept telling her how ill I felt with chest pains and palpitations, I was then rushed into hospital by ambulance unable to breathe properly. The cardiologist did lots of tests and prescribed me Ranolazine to open up the small arteries as they were lacking blood and oxygen. I could not tolerate the medication and was then changed to another heart med which I have been taking now for 2 months and waiting for a follow-up appointment,with a view of probably stents or a pacemaker.

I've also now got high Cholesterol and high BP, again being medicated which I hate taking any of the meds because of Levothyroxine and interactions.

I have also moved and my GP reduced my Levothyroxine from 100mcg to 50mcg as she said I needed to decrease. I have been on this dose for 6 months and OMG I thought I was dying, my whole body is now full of Paresthesia and I feel so very ill again if not worse now because of the heart condition.

These are my recent blood results

T4 11.4 ( 10 .5 - 21 .0)

TSH 0 .97 ( 0 .35 - 5 . 5)

B12 329 . 0 ( 211 . 0 - 911 .0

The GP has now put my Levothyroxine up to 75mcg as I phoned my previous Endocrinologist

up and explained what was going on , and she was so angry that the GP had reduced my med's even after my Endo had sent her a letter about me. My Levo Needed to be increased and not decreased. My Endo sent her another letter telling her she was wrong as im a very complex patient and she always treated my symptoms and not my ranges. I am so scared now as do I take the full 75mcg or take it slowly.

The GP has now started me on Folic Acid 400mcg 1 daily and Cyanocobalamin 50mcg 1 daily. Also she has given me Vitamin Pro D 3 , 1000 IU 3 times a day.

Please, please can you advise as I don't know what to take or do.

Sorry for such a long post and thank you for all the advice you have given me in the past

I have lost faith and trust 🌺🌺🌺🌺in all the medical professional's and am very

scared!!!!!

Take care and stay safe and thank you!

[bubbatetley in reply to bubbatetley]

Sorry, also I have very poor appetite and eat very little. I take TEVA Brand. 🐬🐬