diagnosis?

[mrthroat]

I 've been feeling tired on and off for 18 months, with throat and upper chest irritation. I used to run a lot but found myself struggling to recover afterwards, with nausea and fatigue. I recently had bloods back with TSH - 3.83, T4 - 9.1, and with lowish red blood cell count - 4.24 and Haematocrit 38.6. From my reading this looks like a hypothyroid condition. Looking for comment here, as I can't get an appt with the GP for three weeks! Are there any further tests I should push for?

[SeasideSusie Remembering]

mrthroat

For us to be able to interpret your results and comment we need to know the reference ranges that came with your results. Can you please post these, eg

TSH: 2.5 (0.27-4.20)

FT4: 15 (12-22)

etc

Also, with thyroid tests it's important to test a certain way. Did you test as we advise:

Always advised here, when having thyroid tests:

* 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.

Were any iron tests done, eg Ferritin or full iron panel?

Were Vit D, B12 and Folate tested?

[mrthroat in reply to SeasideSusie]

Hi sorry, new to this, and thanks for the tips:

TSH 3.83 (0.57-3.6)

T4 9.1 (7.9-14.0)

RBC 4.24 (4.5-6.5)

Haematocrit 38.6 (40-50)

mean corpuscular Hb conc. 351 (315-345)

So TSH, RBC and Haematocrit are just below the range, and T4 at the low end of the reference range. These tests were done mid afternoon - alongside a suite of other tests.

B12 and folate were normal (well within ref range), Vit D wasn't tested. No Iron tests were done.

[SlowDragon Administrator in reply to mrthroat]

please add actual results for B12 and folate

Any autoimmune disease is family?

ALWAYS Test thyroid levels early morning

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning. Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

[mrthroat in reply to SlowDragon]

B12 - 413 (>203)

folate 6.9 (>4.0)

Thanks for the advice on testing - I will certainly follow it next time. These tests were among many others - thyroid function wasn't even on my radar before the results came in.

[SlowDragon Administrator in reply to mrthroat]

Are you vegetarian or vegan

Low B12 symptoms 

b12deficiency.info/signs-an...

[mrthroat in reply to SlowDragon]

no I'm not a vegetarian. I have a nephew with Crohn's I believe that is thought to be an autoimmune disease?

[SlowDragon Administrator in reply to mrthroat]

sorry….I read that as your B12 result was 203

B12 413 is slightly low ….but not overly low

SeasideSusie …..see my comment

[SeasideSusie Remembering in reply to mrthroat]

mrthroat

B12 - 413 (>203)

Do you have the units of measurement for this, ie pmol/L or pg/ml or ng/L? Was there no range with a lower and upper limit?

[mrthroat in reply to SeasideSusie]

it says >203 ng/l no upper limit given on the printout

[SeasideSusie Remembering in reply to mrthroat]

mrthroat

OK, thanks for clarifying

B12 - 413ng/L (>203) - ng/L is the same as pg/ml mentioned below

This is low but I would not class this as extremely low and necessarily indicative of B12 deficiency.

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."

So first of all, check for symptoms of B12 deficiency here:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

If you do have any then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.

If you don't have any then it should be OK to supplement with a B12 sublingual along with a good quality B Complex to balance all the B vitamins.

Suggestions for B12 supplements which include two forms of bioactive B12 - methylcobalamin and adenosylcobalamin which you might want to check out:

Cytoplan sublingual B12 lozenges

cytoplan.co.uk/vitamin-b12-...

Nature Provides sublingual liquid

amazon.co.uk/Bioactive-METH...

Note that the Nature Provides supplement contains a much higher dose than the Cytoplan one.

For 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).

[mrthroat in reply to SeasideSusie]

that's very helpful - thank you!