Latest blood results interpretation please :)

[Chasing-rainbows]

Hi,

I've had my latest blood test results today. I am on Levothyroxine 50mcg.

TSH 1.47

FT4 15.8

TPO 441.8

I've been strictly gluten/dairy free for 6 months and I would say that all over the summer I was feeling really well, but then, at the beginning of September, I got ill with a viral infection and have felt like it has set me back, tiredness, brain fog etc.

What would these latest results suggest? Continue on 50mcg? Or dose increase needed?

Considering going back to eating gluten and dairy also as this set back has made me feel like it's not worth the effort of being so strict when there are so many other factors outside of my control.

[SlowDragon Administrator]

please add range on Ft4 result

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

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you currently taking

[Chasing-rainbows in reply to SlowDragon]

Hi, yes test was done at 8:30am and 24 hours after last dose.

Vit D, Folate, Ferritin and B12 last tested in March through Medichecks

Folate 13.9

Vit B12 Active - 100 (Range 25.1-165)

Vitamin D 112

Ferritin 20

I can't find a range for the FT4 unfortunately, but I do know that the last time it was 17.6 and that was in June.

I take Selenium, Folate, B12, Vitamin E daily and when I remember I take magnesium at bedtime.

[SlowDragon Administrator in reply to Chasing-rainbows]

Ferritin deficient

What have you been doing to improve ferritin?

Low ferritin is implicated in miscarriage

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 to miscarriage

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...

Here’s absolutely excellent reply by humanbean

on iron and ferritin panel test results for another member 

healthunlocked.com/thyroidu...

Good explanations of iron 

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

Helpful info on iron infusion and supplements 

healthunlocked.com/thyroidu...

Excellent reply by Blearyeyed about iron in this post

healthunlocked.com/thyroidu...

[Jazzw]

I’d be really surprised if 50mcg levo was enough for you. I’d definitely want to push for a raise to 75mcg in your shoes.

That ferritin is very low—have you ever had a full iron profile done?

[Chasing-rainbows]

I did have full iron panel done in March

Iron 23.6 (6.6-26)

TIBC 66 (41-77)

Transferrin Saturation 36% (20-55)

So it seems to just be the ferritin that is low despite good diet.

[SlowDragon Administrator in reply to Chasing-rainbows]

yes……will tag humanbean and SeasideSusie

They may have suggestions on how to improve low ferritin

Increase in levothyroxine likely to help

[SlowDragon Administrator]

Levothyroxine doesn’t top up failing thyroid, it replaces it

Dose levothyroxine is increased slowly upwards in 25mcg steps over 6-12 months until on full replacement dose …..usually approx 1.6mcg per kilo of your weight per day

Approx how much do you weigh in kilo

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.

[Chasing-rainbows in reply to SlowDragon]

Weight is about 50kg, waiting for consultant to review latest blood results so will see what they say about a possible increase.

Like I said, I had been feeling quite well up until the beginning of this month so wonder if it could be a blip at the moment?

[Chasing-rainbows]

Bumping this up in case there are any other thoughts/advice/opinions on whether I should be pushing for a dose increase or what further action I could be taking here?

My next plan is to start on Thorne B (didn't want to rock the boat over the summer when I was feeling so well for a change!)

Is it also worth getting another full set of bloods from medichecks as it has been 6 months now?