deciphering blood results

[Dondays]

could someone help with these test results please? My ferritin was 15 managed to get it up a bit but I feel so desperately tired still… currently on 75 Levo daily, thank you x I also have FBC results but too long to post x

[SlowDragon Administrator]

well done on improving ferritin

Keep going … at least over 70

Meanwhile you now need dose increase in levothyroxine

FT4: 16.5 pmol/l (Range 12 - 22)

Ft4 is only 45.00% through range

75mcg is only one step up from starter dose

How long have you been on 75mcg levothyroxine

Approx how much do you weigh in kilo

Aim of levothyroxine is increase the dose slowly upwards in 25mcg steps until TSH is ALWAYS below 2

Which brand of levothyroxine are you currently taking

Request vitamin D, folate, B12 tested if not tested recently

[Dondays in reply to SlowDragon]

I weigh 91 kilos and been on 75 for 4 years? My doctors never check in or do a review, I had to battle to get it up to 75 and even then they said every other day but I’ve been taking it every day, what’s ft4 please and the 45% what does that mean? I’m on the brand with star in it, at work currently so can’t check, thanks for your help x will email to request the other bloods

[SlowDragon Administrator in reply to Dondays]

reading your reply below that you normally take levothyroxine at bedtime….

Did you do so night before test. Last dose levothyroxine should be 24 hours before test

Guidelines on dose levothyroxine by weight is approx 1.6mcg levothyroxine per kilo per day

91 kilo x 1.6mcg = 145mcg as an approximation of daily dose likely to require

Dose levothyroxine should be increased SLOWLY upwards in 25mcg steps until TSH is always below 2

Bloods should be retested 6-12 weeks after each dose increase

print out these guidelines

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

Request 25mcg dose increase in levothyroxine

Also request they test vitamin D, folate, B12

Or test privately at next test after dose is increased to 100mcg daily

[humanbean in reply to SlowDragon]

SlowDragon, the suggested level of 70 applies to a reference range of 13 - 150 which is approx 42% of the way through the range.

If someone has a level of 70 with a range of 30 - 470 it is only 9% of the way through the range. Results with such different ranges can't be thought of as equivalent.

Dondays' current result of 51 with a range of 30 - 470 is under 5% of the way through the range, so no wonder he/she feels awful.

...

Dondays I would suggest using percentages to determine optimal level for ferritin because the ranges vary so often from lab to lab, and also often vary according to whether the patient is a male, a menstruating female, or a menopausal female.

The optimal level that I personally use for ferritin is 50% to 70% of the way through the range for ferritin. With your range of 30 - 470 this equates to an optimal level of 250 - 338.

If you think about it, the huge ranges like yours that get used by labs make no logical sense. The lab is saying that a level of 30 is fine, but so is a result nearly 16 times higher (i.e. 470).

With a common range of 13 - 150, labs are saying that 13 is fine and so is a result over 11.5 times higher. It's clearly nonsense.

Please note that when you plan to get a ferritin test and/or an iron panel done, it is essential to stop taking iron supplements 5 - 7 days before the test, and have the test done having fasted overnight and before you eat or drink anything (except water) on the morning of the blood draw.

...

Ferritin is a measure of iron stores.

Iron is more complicated than a lot of nutrients, and people shouldn't rely on just a ferritin test. Another important test is an iron panel - but doctors rarely order them. An example of an iron panel can be found here :

medichecks.com/products/iro...

If you ever decide to get an iron panel done you can get a discount code from this page:

thyroiduk.org/help-and-supp...

If you register with Medichecks (and other companies that sell private tests) most of them will send you an email when they have special offers and sales.

Medichecks often has money-off offers on a Thursday.

...

Since you've got the results of a Full Blood Count, can you tell us the results of the following, including the reference ranges:

Haemoglobin (Hb)

Mean Cell Volume (MCV)

and any results which are out of range.

...

If you decide to treat your own iron, please read these links first. Ignore the stuff about pregnancy in the second link :

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

[Dondays in reply to humanbean]

Hi that makes sense what you’ve just said about iron results, the other results are underneath in reply to SeasideSusie

[SlowDragon Administrator in reply to humanbean]

whoops ….sorry

Yes you’re completely correct

I should have noticed vast range on ferritin

[SeasideSusie Remembering]

Dondays

Are any of the results of the FBC out of range?

Are you doing your thyroid tests as we advise:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.

In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:

healthunlocked.com/thyroidu...

If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

Also, are you taking your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.

[Dondays in reply to SeasideSusie]

here’s the other results Susie x

Colour

[Dondays in reply to Dondays]

and more

Colour

[Dondays in reply to Dondays]

last bit

Colour

[SeasideSusie Remembering in reply to Dondays]

Nothing out of range.

[humanbean in reply to Dondays]

Your sodium level is quite low in range. If you eat a low salt diet you might benefit from including a little bit more salt in your diet (not a lot more). It's good for the adrenal glands. See these links :

stopthethyroidmadness.com/a...

therootcauseprotocol.com/fa...

[humanbean in reply to Dondays]

Your haemoglobin level is fine, showing that you are not currently anaemic. But people can be iron deficient with or without anaemia, and the deficiency needs treating, with or without anaemia. Anaemia tends to develop quite a bit later than low iron/ferritin.

You might find these of interest - the second one only if you are female:

onlinelibrary.wiley.com/doi...

cmaj.ca/content/cmaj/184/11...

Your Mean Cell Volume (MCV) is a good thing to keep tabs on. It tells you the average size of your red blood cells.

If your vitamin B12 and/or folate are low, MCV becomes high or over the range.

If your ferritin and/or iron are low, MCV become low or under the range.

If both b12 / folate AND iron/ferritin are low the effect on MCV is unpredictable.

[Dondays in reply to SeasideSusie]

I take my Levo last thing at night on an empty stomach with water, I also am taking ferrous fumerate to get ferritin up and I take that in the morning so they don’t affect each other’s absorption these bloods were four early morning after no food just water and no meds x

[SeasideSusie Remembering in reply to Dondays]

The range for your ferritin is very wide, that's generally a male range and for females it's often 13-150 or 15-300, so take note of what humanbean has said above about your level is actually very low. Is your ferrous fumarate prescribed?

Presumably you took your Levo the night before the test? If so, depending on the time of your test then there may have only been about 12 hours between last dose and blood draw, in which case your FT4 might be showing a bit higher than your normal circulating amount. We always suggest adjusting time of dose a couple of days before testing to give the 24 hours we advise, eg if testing on a Monday morning at 9am you'd adjust dose as follows:

Saturday night - delay dose until Sunday morning

Sunday night - delay this dose until after the test on Monday morning

Monday - take Sunday night's dose after the test then take Monday night's dose as normal

This will give a more accurate measure of your normal circulating hormone.

So your current results suggest that you are undermedicated and need an increase in your dose of Levo. The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well. You could do with an extra 25mcg now, retest in 6-8 weeks, possibly further increases may be necessary.

what’s ft4 please and the 45% what does that mean?

FT4 is a test of the amount of free T4 (T4 = thyroxine) that is in your blood at the time of the test.

45% means that your result of 16.5 (12-22) is 45% through the reference range.

[You can work out percentage through range with calculator here: thyroid.dopiaza.org/ ]

Most people would feel best when the FT4 is around maybe 70%, possibly more, through the range.

I’m on the brand with star in it

Do you mean Northstar brand?

Do you have 50mcg and 25mcg prescribed?

The 50mcg Northstar tablets are made by Accord.

The 25mcg Northstar tablets are made by Teva.

Many members don't get on with Teva, it gives them adverse reactions, although for some they prefer Teva tablets. It's really best to stick to one brand just to rule out any problems, so to achieve 75mcg you could ask for all Northstar 50mcg tablets to be prescribed and halve a 50mcg tablet and take one and a half tablets a day, or take 100mcg one day and 50mcg the next day.

[humanbean]

For future reference - information on blood test results generally - usually worth consulting when you want to check out your own results :

labtestsonline.org.uk/