Understandings Results: As recommended on this... - Thyroid UK

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Understandings Results

Jocat profile image
32 Replies

As recommended on this site, I under took a private blood test for thyroid. Please can someone help with the results and what they mean.

TSH 2.37

Free T3 4.31

Free Thyroxine 11.5

Please can someone advise me on my next steps and what these results actually mean.

Much appreciated.

Jo

32 Replies
greygoose profile image
greygoose

I'm afraid no-one can tell you what they mean without the ranges. Ranges vary from lab to lab, so we need those that came with your results - usually in brackets after the result. :)

SlowDragon profile image
SlowDragonAdministrator

please add ranges

Was test done early morning, ideally before 9am

Who did the test …..Medichecks or Blue horizon?

In Previous post I recommended you get full thyroid and vitamin testing done

healthunlocked.com/thyroidu...

Did you not get thyroid antibodies and vitamin levels tested as well?

what vitamin supplements are you currently taking, if any ?

Jocat profile image
Jocat in reply to SlowDragon

Hi Slow Dragon and Greygoose

I used Medichecks, advanced Thyroid Function Test. The first test they couldn’t read so sent me another which I did before 9am.

The results say, my free thyroxine is slightly low, however my thyroid stimulating hormone is normal. My thyroid peroxidase antibodies show no evidence of autoimmune thyroid disease.

It also showed CRP HS 5.92 (0-5) Inflammation

Vitamin B12 normal range, 79.9 (37.5-150)

Vitamin D normal range 66 (50-200)

Folate and Ferritin was sample error. They resent me another test but this also was sample error.

TSH 4.04 (0.27-4.2)

Free T3 3.89 (3.1-6.8)

Free Thyroxine 11.4 (12-22)

Hope this makes sense. Thank you so much for your help, I really appreciate it.

Jo.

SeasideSusie profile image
SeasideSusieAdministrator in reply to Jocat

Jocat

My thyroid peroxidase antibodies show no evidence of autoimmune thyroid disease.

What were the actual results for TPO and Tg antibodies?

CRP HS 5.92 (0-5)

This shows that you have inflammation somewhere but it can't tell you where.

Do you have any autoimmune diseases? Any medical condition that can cause inflammation?

TSH 4.04 (0.27-4.2)

Free T3 3.89 (3.1-6.8)

Free Thyroxine 11.4 (12-22)

These results clearly show that you are hypothyroid and you should discuss with your GP. As your FT4 is below range your GP should consider starting you on Levo. This might possibly be Central Hypothyroidism which is where the problem lies with the pituitary or the hypothalamus and is diagnosed when TSH is normal, low or minimally elevated with a low/below range FT4. Your results fit this criteria.

As Central Hypothyroidism isn't as common as Primary Hypothyroidism it's likely that your GP hasn't come across it before.

Your GP can look at BMJ Best Practice for information - here is something you can read without needing to be subscribed:

bestpractice.bmj.com/topics...

and another article which explains it:

ncbi.nlm.nih.gov/pmc/articl...

and another here:

endocrinologyadvisor.com/ho...

and another one:

academic.oup.com/jcem/artic...

A long read which you might find useful:

thyroidpatients.ca/2020/01/...

You could do some more research, print out anything that may help and show your GP.

You may need to be referred to an endocrinologist. If so then please make absolutely sure that it is a thyroid specialist that you see. Most endos are diabetes specialists and know little about the thyroid gland (they like to think they do and very often end up making us much more unwell that we were before seeing them). You can email ThyroidUK at

tukadmin@thyroiduk.org

for the list of thyroid friendly endos. Then ask on the forum for feedback on any that you can get to. Then if your GP refers you, make sure it is to one recommended here. It's no guarantee that they will understand Central Hypothyroidism but it's better than seeing a diabetes specialist. You could also ask on the forum if anyone has been successful in getting a diagnosis of Central Hypothyroidism, possibly in your area which you'll have to mention of course.

I am not diagnosing, just pointing out the possibility.

Vitamin B12 normal range, 79.9 (37.5-150)

Would be better over 100. Consider a good quality, bioavailable B Complex such as Thorne Basic B. 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).

See post below for Vit D.

SeasideSusie profile image
SeasideSusieAdministrator in reply to SeasideSusie

Vitamin D normal range 66 (50-200)

You might want to check out a recent post that I wrote about Vit D and supplementing:

healthunlocked.com/thyroidu...

and you can check out the link to how to work out the dose you need to increase your current level to the recommended level.

Your current level of 66nmol/L = 26.4ng/ml

On the Vit D Council's website

web.archive.org/web/2019070...

you would scroll down to the 3rd table

My level is between20-30 ng/ml

The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L (40-60ng/ml), with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L (50ng/ml).

So now you look at how much is needed to reach 50ng/ml and you'll see that they suggest 3,700iu per day. Nearest is 4,000iu but the cheapest way is to buy 5,000iu and take 5 days per week, say Monday - Friday.

Retest after 3 months.

Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.

For Vit K2-MK7 my suggestions are Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.

Vitabay and Vegavero are either tablets or capsules.

Vitabay does do an oil based liquid.

Vitamaze is an oil based liquid.

With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.

They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.

If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The K2-MK7 is the All-Trans form

natureprovides.com/products...

It may also be available on Amazon.

One member recently gave excellent feedback on this particular product here:

Here is what she said (also read the following replies):

healthunlocked.com/thyroidu...

Another important cofactor is Magnesium which helps the body convert D3 into it's usable form.

There are many types of magnesium so we have to check to see which one is most suitable for our own needs:

naturalnews.com/046401_magn...

explore.globalhealing.com/t...

and ignore the fact that this is a supplement company, the information is relevant:

swansonvitamins.com/blog/ar...

Magnesium should be taken 4 hours away from thyroid meds (if taken) and as it tends to be calming it's best taken in the evening. Vit D should also be taken 4 hours away from thyroid meds. Vit K2-MK7 should be taken 2 hours away from thyroid meds. Don't take D3 and K2 at the same time unless both are oil based supplements, they both are fat soluble vitamins which require their own fat to be absorbed otherwise they will compete for the fat.

Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.

Jocat profile image
Jocat in reply to SeasideSusie

Hi SeasideSusie,

Wow! This has blown my mind. Thank you so much, I look forward to reading the links.

Thank you so much for all your advice and time.

Jo

Jocat profile image
Jocat in reply to SeasideSusie

ahh, just found it! Thyroglobulin Antibodies 19 (<115)

Thyroid Peroxidase Antibodies 11 (<34)

SeasideSusie profile image
SeasideSusieAdministrator in reply to Jocat

OK, they're nice and low with this test so do not show autoimmune thyroid disease (Hashi's). However, one positive result confirms Hashi's but one negative doesn't rule it out, and it is possible to have Hashi's without raised antibodies (just to complicate things) but there is every possibility your CRP is raised for another reason.

Jocat profile image
Jocat in reply to SeasideSusie

*cold!

Jocat profile image
Jocat in reply to SeasideSusie

sorry, no I don’t have any autoimmune illnesses. I’m on Statins for high cholesterol and started HRT at Christmas. I have been feeling tired and lethargic for a very long time, I put it down to the menopause, but I’m soooo clod all the time. All my family have thyroid problems, but the GP just keeps saying the tests are normal. Many many thanks for your help. I truly do appreciate your time and advice.

Jo

SeasideSusie profile image
SeasideSusieAdministrator in reply to Jocat

Jocat

I’m on Statins for high cholesterol

Oh dear :(

Statins aren't recommended for females plus, and this is very important, check out the following and I think you should also discuss this with your GP:

From NHS website nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

I don't think there is any question that you have hypothyroidism, it's just a case of getting someone to appreciate your results and diagnose it. You should not be on statins.

Jocat profile image
Jocat in reply to SeasideSusie

Hi SeasideSusie,

My GP has replied to me stating that they don't accept any other bloodtest results other than NHS. I have a blood test tomorrow morning at 7.30am for Free T3, Lipid Profile, thyroid peroxidase, TRA (other reason), TSH.

Do I need to prepare or do anything before this blood test? Thank you so much for your help. Hope you're keeping well.

Jo

SeasideSusie profile image
SeasideSusieAdministrator in reply to Jocat

Jocat

Many doctors wont accept private tests, but at least your GP is doing his own.

Nothing except water before the test.

No biotin, B Complex or any supplement containing biotin for 3-7 days before the test. If you take any other supplement then take after the test.

Jocat profile image
Jocat in reply to SeasideSusie

Thank you so much for replying SeasideSusie. I'll let you know how I get on. Thank you again, I really appreciate all your advice and help.

Jo

Jocat profile image
Jocat in reply to Jocat

Hi Seaside Susie,

Results back today,

Serum TSH level (XaELV) 1.74 miu/L [0.35 - 4.94]

Serum thyroid peroxidase antibody concentration (XabCy) 1.58 kU/L [0 - 5.9]

Serum free triiodothyronine level (XaERq) 3.8 pmol/L [2.6 - 5.7]

Serum free triiodothyronine level;Serum thyroid peroxidase antibody concentration;Serum TSH level Report, Normal, No Further Action. Result reviewed by Dr...

LIPID PROFILE NON FASTING Report, Abnormal, but expected, No Further Action.

Serum cholesterol level (XE2eD) 5.28 mmol/L [2 - 5]

Serum HDL cholesterol level (44P5.) 1.16 mmol/L

Coded entry Calculated LDL cholesterol level (XaIp4) 3.45 mmol/L

Coded entry Serum cholesterol/HDL ratio (XaEUq) 4.6 mmol/mmol

Coded entry Serum triglyceride levels (XE2q9) 1.62 mmol/L [0.5 - 2.5]

Coded entry Serum non high density lipoprotein cholesterol level (XabE1) 4.12 mmol/L

Can you interpret these for me please? Any advice I would be very greatful. So confused.

Thank you so much

Joanne

Jocat profile image
Jocat in reply to SeasideSusie

Hi Seaside Susie/Slow Dragon/Grey Goose

Results back today,

Serum TSH level (XaELV) 1.74 miu/L [0.35 - 4.94]

Serum thyroid peroxidase antibody concentration (XabCy) 1.58 kU/L [0 - 5.9]

Serum free triiodothyronine level (XaERq) 3.8 pmol/L [2.6 - 5.7]

Serum free triiodothyronine level;Serum thyroid peroxidase antibody concentration;Serum TSH level Report, Normal, No Further Action. Result reviewed by Dr...

LIPID PROFILE NON FASTING Report, Abnormal, but expected, No Further Action.

Serum cholesterol level (XE2eD) 5.28 mmol/L [2 - 5]

Serum HDL cholesterol level (44P5.) 1.16 mmol/L

Calculated LDL cholesterol level (XaIp4) 3.45 mmol/L

Serum cholesterol/HDL ratio (XaEUq) 4.6 mmol/mmol

Serum triglyceride levels (XE2q9) 1.62 mmol/L [0.5 - 2.5]

Serum non high density lipoprotein cholesterol level (XabE1) 4.12 mmol/L

Can you interpret these for me please? Any advice I would be very greatful. So confused.

Thank you so much

Joanne

SeasideSusie profile image
SeasideSusieAdministrator in reply to Jocat

Jocat

Was there no FT4 test? We were talking about possible Central Hypothyroidism before and it's the FT4 test (not FT3) that they look at for CH. FT4 was below range with your Medichecks test so it's difficult to understand why FT4 wasn't included with your GP tests.

Your TSH is quite a lot lower than your Medichecks test, did you do the test as we advise and as mentioned above and no later than 9am:

Nothing except water before the test.

No biotin, B Complex or any supplement containing biotin for 3-7 days before the test.

Jocat profile image
Jocat in reply to SeasideSusie

Hi SeasideSusie,

Test was performed 7.30am, I had only had a glass of water and hadn't taken any biotin, B Complex or any supplement a week before.

This is what the doctor requested

Pathology Request (Request Sent):

Free T3 (Requested), Lipid Profile (Requested), Thyroid Peroxidase Abs (TPO) (Requested), TRA other reason (Requested), TSH - Thyroid Stimulating Hormone (Requested)

I have an appointment next Monday with a GP to go over the results.

Joanne

SeasideSusie profile image
SeasideSusieAdministrator in reply to Jocat

Jocat

I just wonder why FT4 wasn't included. It's not normal for FT3 to be tested unless TSH is below range and they're looking for overactive thyroid, or if the patient is on T3 medication. Very unusual for a lab to agree to FT3. It's scuppered your chances of getting a diagnosis of CH with no FT4 result. It might be worth ringing the surgery/GP and saying it's important to have FT4 and to check whether the lab still has your sample and if it's still viable and if so would they test FT4.

Jocat profile image
Jocat in reply to SeasideSusie

Thank you so much. I'll email the surgery now.

Many thanks for your help.

Joanne

Jocat profile image
Jocat in reply to SeasideSusie

Hi SeasideSusie,

Just received this from my GP. I'm so upset, they just don't understand. I'm guessing next steps for me is to get a private appointment?

"I requested everything allowed for your thyroid. As your TSH is normal this means the lab have not done a T4. The T3 is more sensitive and the antibodies are normal and there is no evidence of a thyroid problem in your results. I understand that there is the website that offers private tests who may disagree with this but the British Thyroid Association and NHS guidelines are what we work in. I am not able to add further tests to your sample and will leave you to discuss this further in your upcoming appointment. "

Thank you for all your help SeasideSusie.

Joanne

SeasideSusie profile image
SeasideSusieAdministrator in reply to Jocat

Jocat

Oh, they are so ignorant and their minds are closed.

Did you pass on the information about Central Hypothyroidism? I would just keep pushing this and hope you can get through to her. It's the squeaky wheel that gets the oil.

If you get nowhere then private is your next step, but you would need to make sure that whoever you see is au fait with Central Hypothyroidism, maybe re-read my post abouthtis above.

Also, maybe consider the ultrasound suggested by SlowDragon .

Jocat profile image
Jocat in reply to SeasideSusie

Evening SeasideSusie,

Thank you so much for replying. I have an appointment for Monday... But not sure where I'm going to go with it. Its with a different doctor, so fingers crossed. I'll keep you posted, you've been an absolute life saver. Enjoy your weekend and many thanks again.

Joanne

greygoose profile image
greygoose in reply to Jocat

TSH 4.04 (0.27-4.2)

Free T3 3.89 (3.1-6.8)

Free Thyroxine 11.4 (12-22)

Nothing about your results is 'normal'!

Your TSH is much too high. A 'normal' (euthyroid) TSH is around 1, never over 2, and at 3 you are technically hypo.

Your FT3 is right at the bottom of the range - euthyroid would be around mid-range.

Your FT4 is below range! How in the world can that be 'normal'?!? A euthyroid FT4 would be around mid-range, slightly higher through the range than the FT3.

When a doctor says 'normal', all he means is 'in-range' - although he probably needs new glasses because the FT4 isn't in-range! Well, any idiot can see the other two are in-range, but so what. It's where they fall within the range that is important, but doctors - funnily enough - aren't trained to interpret blood test results, so they believe that anything that is anywhere within the range just has to be fine. They are so wrong! And, you are hypo. :(

SlowDragon profile image
SlowDragonAdministrator

I see SeasideSusie has given full and detailed advice

You should be started on levothyroxine

Standard starter dose of levothyroxine is 50mcg …..bloods retested 6-8 weeks after each dose change or brand change in levothyroxine

dose is increased slowly upwards in 25mcg steps over 6-12 months

Typically eventual dose is approx 1.6mcg levothyroxine per kilo of your weight per day

Request ultrasound scan of thyroid via GP

20% of Hashimoto's patients never have raised antibodies 

healthunlocked.com/thyroidu...

 

Paul Robson on atrophied thyroid - especially if no TPO antibodies 

 paulrobinsonthyroid.com/cou...

Also request full iron panel test including ferritin via GP

Statins not recommended for anyone who’s hypothyroid. Your cholesterol levels will reduce as levothyroxine dose is increased

Don’t be surprised if GP unaware of the connection between hypothyroidism and high cholesterol

Jocat profile image
Jocat in reply to SlowDragon

Thank you SlowDragon, sadly, my surgery isn't very helpful, perhaps I should look at going private. I in West Sussex.

Many thanks for your advice and time. I really do appreciate it.

Many thanks,

Jo.

SlowDragon profile image
SlowDragonAdministrator in reply to Jocat

vast majority of endocrinologists are diabetes specialists and useless for thyroid

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors 

tukadmin@thyroiduk.org

Jocat profile image
Jocat in reply to SlowDragon

thank you so much.

SlowDragon profile image
SlowDragonAdministrator

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.

SlowDragon profile image
SlowDragonAdministrator

in opening post

TSH 2.37

Free T3 4.31

Free Thyroxine 11.5

In reply

TSH 4.04 (0.27-4.2)

Free T3 3.89 (3.1-6.8)

Free Thyroxine 11.4 (12-22)

Presumably both tests done early morning?

This large change in TSH suggests autoimmune thyroid disease also called Hashimoto’s

SlowDragon profile image
SlowDragonAdministrator

Has GP agreed to ultrasound scan of thyroid

If not get private ultrasound scan in London

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

Has GP done folate, B12 and full iron panel test for anaemia including ferritin?

If not suggest you book test at London blood test clinic same day as getting ultrasound scan done

bloodtestslondon.com/collec...

Jocat profile image
Jocat in reply to SlowDragon

Thank you so much SlowDragon,

No, she refuses to discuss it any further.

Thank you so much for your hhelp

Joanne

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