Abnormal ESR

[Mrs_Tumnus]

Hi,

I was looking for some advice.

My ESR was slightly elevated in 2020 -

Range - 2-16 - my reading 18

Yesterday

Range - 2-16 - my reading 24

I haven't had the ESR tested in between. I was diagnosed with hypothyroidism back in July and now have my TSH levels in the normal range. I have 50mcg thyroxin.

Could the elevated ESR be connected to my hypothyroidism? Could it be a sign of Hashimoto's?

[Jaydee1507 Administrator]

ESR is a non specific inflammatory marker so there are many causes of it. That said it can be linked to under treated hypothyroidism. It's not diagnostic of Hashimoto's, you would need thyroid antibody levels tested for that. Your GP can do those or one of the private blood test companies.

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

How do you feel? What were your latest blood results? Having a TSH within the normal range doesn't mean that we are on optimum treatment. You are still on a starter dose.

[SlowDragon Administrator]

Looking at previous posts it’s two months since dose levothyroxine was increased to 50mcg (standard starter dose)

Have you had bloods retested yet ?

You MUST have thyroid antibodies tested and vitamin D too

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

Likely to need several further increases in levothyroxine over coming months

Approx how much do you weigh in kilo

Ferritin was deficient at 22 last test

Have you had full iron panel test for anaemia yet

Likely to need iron supplements

On levothyroxine we need OPTIMAL vitamin levels

Ferritin at least half way through range

Presumably you are now taking daily vitamin B complex for low folate levels

[SlowDragon Administrator]

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.

Aiming for Ft4 and Ft3 at least 50-60% through range. Frequently TSH will be around or below one when adequately treated

All four vitamins need to be tested and optimal

Approx 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s

Highly likely you have Hashimoto’s you need coeliac blood test ….especially as you have close family members with hypothyroidism