My daughter's test results are "normal". I am w... - Thyroid UK

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My daughter's test results are "normal". I am worried she is being ignored. Looking for your expert help as usual.

Mugs19 profile image
11 Replies

TPO Abs 70 iu/mL (<35.00iu/mL)

IRON

Serum Iron Level 19.8umol/L (9 - 30umol/L)

Serum Transferrin 3.44g/L (2.5 - 3.8g/L)

Serum Iron binding capac 23% (15 - 45%)

Serom Ferritin 11ug/L (10 - 291ug/L)

Serum Folate (red blood cell) 5ug/L >4ug/L

Serum Vit B12 801ng/L (211 - 911)

Vit D 63nmol/L (50 - 125nmol/L)

THROID function test:

Serum TSH 0,79mU/L (0.35 - 5.0 U/L)

I am so annoyed that TSH is supposed to be enough evidence of thyroid function and that a ferritin level of 11 is normal. A nurse did these tests so she probably isn't allowed to test even T4. I am advising her to self medicate with iron supplement and vitamin D but I am worried that I am missing something and hoping that your sharp eyes will notice. The low TSH level in particular.

She has Hashimotos which was discovered during surgery for Hyper-Parathyroidism. Her results have always been within normal range but she has symptoms such as exhaustion, inabllity to lose baby weight, PMS monthly. Her TPO antibodies were very high after her last pregnancy which is not unusual, but after coming down they have risen again. Baby is now 2 yrs 6 months old.Is she having a Hashi's flare? That is something I don't know about.

I am struggling to type as I need a shoulder op, so if I don't reply immediately it will be because I am struggling but all opinions are very welcome.

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Mugs19
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SeasideSusie profile image
SeasideSusieRemembering

Mugs19

Is your daughter on any Levo for her Hashi's?

Impossible to know full thyroid status when testing just TSH. She needs a full test - TSH, FT4 and FT3. If GP wont do it then she can get this done with MonitorMyHealth fingerprick test for £26.10 which I would strongly advise. Details and code for that price here:

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

Serum Iron Level 19.8umol/L (9 - 30umol/L)

Serum Transferrin 3.44g/L (2.5 - 3.8g/L)

Serum Iron binding capac 23% (15 - 45%)

Serom Ferritin 11ug/L (10 - 291ug/L)

I am advising her to self medicate with iron supplement

She needs to be careful. In fact with that ferritin level I would suggest that she insists on speaking to the doctor and presenting the evidence that NICE say this confirms iron deficiency - see here:

From: 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.

and the GP should prescribe anything necessary and reguarly monitor her levels.

In fact her other iron panel results don't show iron deficiency. When discussing iron results we usually refer to optimal levels shown here:

rt3-adrenals.org/Iron_test_...

Serum iron: 55 to 70% of the range, higher end for men - hers is 51.54%

Saturation: optimal is 35 to 45%, higher end for men - hers is 23% assuming same test

Transferrin: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - hers is at the higher end of range

Ferritin: Low level virtually always indicates need for iron supplementation

So although her serum iron is pretty good and saturation a bit low, it probably wouldn't be classed as iron deficiency but her Transferrin and Ferritin results suggest she needs iron supplementation. Because a keen eye needs to be kept on serum iron and saturation levels this this is best overseen by her GP with regular monitoring.

How much D3 have you suggested she takes, and have you mentioned D3's important cofactors - Vit K2-MK7 and magnesium?

Mugs19 profile image
Mugs19 in reply to SeasideSusie

My daughter is not taking levothyroxine or any other thyroid meds. She was worried when she became pregnant with her second child and the received wisdom of those treating her was a low dose of thyroxine. This made her feel much worse( probably because it wasn't enough) so she stopped taking it. Fortunately baby was born healthy. She has been reluctant to try it again expecially as doctors don't think she needs it as her test results have always been within range. I haven't spoken to her about what dose of vitamins to take - must do that , but when she last took Vit D she used the Better You spray and stopped because it mad her mouth sore. Thankyou for this very informative reply

SeasideSusie profile image
SeasideSusieRemembering in reply to Mugs19

Mugs19

when she last took Vit D she used the Better You spray and stopped because it mad her mouth sore.

I've never liked the sprays because of the excipients. She could have a look at Doctor's Best D3 softgels, good clean supplement with no excipienets, just D3 and extra virgin olive oil.

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. She'd be look at supplementing with 4,000iu D3 during the winter months then retest around end of March and dose may need adjusting for the summer.

Vit K2-MK7 is needed because taking D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from soft tissues and arteries where it can be deposited and cause problems like kidney stones, calcification of arteries, etc.

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. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.

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 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.

Mugs19 profile image
Mugs19 in reply to SeasideSusie

Thankyou so much for all this info. Splendid service as always

SlowDragon profile image
SlowDragonAdministrator

Serum Iron Level 19.8umol/L (9 - 30umol/L)

Serum Transferrin 3.44g/L (2.5 - 3.8g/L)

Serum Iron binding capac 23% (15 - 45%)

Serom Ferritin 11ug/L (10 - 291ug/L)

Will flag up for humanbean or SeasideSusie to comment on iron and ferritin levels

Ferritin is deficient

Look at increasing iron rich foods in diet

Is your daughter vegetarian or vegan

Folate is too low

B12 - is she on B12 supplements or injections

Vitamin D too low

Obviously she needs TSH, Ft4 and Ft3 tested together

test thyroid levels early morning before 9am and last dose levothyroxine 24 hours before test

cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Only do private testing early Monday or Tuesday morning.

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

SlowDragon profile image
SlowDragonAdministrator

is she currently on levothyroxine or can’t get prescribed?

Low vitamin D

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

greygoose profile image
greygoose

Her TSH is not low. It's 'normal' - euthyroid - so don't worry about that. :)

Her TPO antibodies were very high after her last pregnancy which is not unusual, but after coming down they have risen again.

Antibodies fluctuate all the time. It doesn't mean anything. It's not a measure of severity of the disease, it's just what antibodies do.

Is she having a Hashi's flare? That is something I don't know about.

No. If she were, her TSH would be suppressed.

I don't like talking about 'Hashi's flare's' because the name is confusing. I prefer to call it a Hashi's 'hyper' swing, because that's exactly what it is. When the thyroid is under attack from the immune system, the dying cells deposite their stock of hormone into the blood, causing the FT4/3 to rise sharply, and the TSH to drop, making the patient temporarily 'hyper'. With time, though, these excess hormones will be used up/excreted, and she will become hypo again.

:)

Mugs19 profile image
Mugs19 in reply to greygoose

thankyou for this information . I am so touched by all of your immediate responses.

greygoose profile image
greygoose in reply to Mugs19

You're welcome. :)

SlowDragon profile image
SlowDragonAdministrator

Very low folate

Serum Folate (red blood cell) 5ug/L >4ug/L

Vit B12 801ng/L (211 - 911)

assuming she is supplementing B12

With B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

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

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

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, she might want to consider taking a separate methyl folate supplement

Mugs19 profile image
Mugs19

I can let her have some folate . As I said she isn't taking B12.Thankyou for all the information, it is much appreciated.

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