thyroid function satisfactory but iron low - Thyroid UK

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thyroid function satisfactory but iron low

jeffbird profile image
24 Replies

Hi there, Ive been taking levothyroxine for hypothyroidism for 6 months now.

I previously was anaemic but that had resolved after iron supplementation also around 6 months ago. I just rang for update on levels and was told thyroid satisfactory but cholesterol high and iron and haemoglobin low.

I was told to ring the GP for an appointment tomorrow.

I know that there are specific ranges I should have and to ask for those values but can't remember what they are. I am not even sure what was tested. Could anyone point me to reference values?

thanks

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24 Replies
TiggerMe profile image
TiggerMeAmbassador

I would register for patient access, then you can get to your full test results 🤗

RedApple profile image
RedAppleAdministrator in reply toTiggerMe

Access to such things isn't guaranteed everywhere in the UK. I don't think it's widely available in Wales, Scotland or N.Ireland.

jeffbird profile image
jeffbird in reply toRedApple

yes you're right, I'm in NI and we don't have access here. thanks for answering

SlowDragon profile image
SlowDragonAdministrator in reply tojeffbird

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

 

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

How much levothyroxine are you currently taking

How long at this dose

What vitamin supplements are you currently taking

Low vitamin levels linked to not being on high enough dose levothyroxine

High cholesterol is almost certainly linked to not being on high enough dose levothyroxine too

DJR1 May be able to help re online access in NI

Recent post discussing access issues

healthunlocked.com/thyroidu....

SlowDragon profile image
SlowDragonAdministrator in reply tojeffbird

Have you had thyroid antibodies tested

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

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...

If you can get GP to test vitamins then 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 

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

TiggerMe profile image
TiggerMeAmbassador in reply toRedApple

Ah... even before this new access I could access test results... chatting up the lovely receptionists is next best then for some hard copies

jeffbird profile image
jeffbird in reply toTiggerMe

I’m pretty sure if I get the nice GP she will print them off for me, if not I’ll as the receptionist, thanks

humanbean profile image
humanbean in reply tojeffbird

I really think you should ask the receptionists for a printout of results. Yes, the receptionists need permission from the doctor to do so, but at worst it will mean you have to go back the next day to pick them up. Doctors would consider a request that they print out results as a waste of their time or a waste of an appointment.

jeffbird profile image
jeffbird in reply tohumanbean

Thanks for your reply, the printoff was ready this afternoon but the receptionist wouldn’t let my husband have it 👍 GP also forgot to print off the prescription so long story short Ill get the results and tablets tomorrow

rustyempire profile image
rustyempire

your levels need to be optimal. Demand your results in hand and post here. Optimal levels are required for thyroid, not “normal” levels. And your iron levels are not resolved if it’s still low!

Are your thyroid levels Optimal?
jeffbird profile image
jeffbird

thanks everyone,

to be fair to my gp if I ask they will tell me the results - I'm not upset that the receptionist doesn't have the ability to do that for me. Ive a lot of ongoing issues since having covid in 2020 and they all seem to be connected.

I had antibodies tested me when I was diagnosed in May - Im not sure that they were checked this time. When I get the results I will post on here.

thanks again

SlowDragon profile image
SlowDragonAdministrator in reply tojeffbird

NHS only tests antibodies once

If TPO antibodies are negative they won’t test TG antibodies

Significant minority of Hashimoto’s patients only have high TG antibodies and therefore struggle to get diagnosed

20% of Hashimoto’s patients never have high thyroid antibodies

Increasingly rare to get anything other than TSH tested…..which is completely useless

How much levothyroxine are you currently taking

Which brand

Was test done in morning and last dose levothyroxine 24 hours before test

Are you currently taking any vitamin supplements

If yes, what exactly

greygoose profile image
greygoose

If your cholesterol is high it's very doubtful that your 'thyroid function' is satisfactory. And, after six months on levo, it's doubtful your thyroid is functioning at all. High cholesterol is a hypo symptom, due to low T3. Does your doctor even test for FT3?

Are you sure that the receptionist can't print out your results for you? They usually do it. I don't suppose your doctor will. He might tell you verbally that your TSH is xyz, but probably won't give the ranges, which are essential. You need a printed copy so there's no danger of mistakes creeping in.

jeffbird profile image
jeffbird

Thyroid auto antibodies 260 something- high in May

currently on 50 microg levothyroxine

test was done in morning and last dose 24 hours before test

SlowDragon profile image
SlowDragonAdministrator in reply tojeffbird

You need to click on reply button otherwise other poster isn’t alerted

50mcg is only the standard STARTER dose

Bloods should be retested 6-8 weeks after each dose increase

Dose levothyroxine is increased slowly upwards in 25mcg steps over 6-12 months approx….until on approx full replacement dose

Levothyroxine doesn’t “top up” failing thyroid…..because of feed back mechanism, almost everyone, will likely eventually be on what is approx full replacement dose. This is usually around 1.6mcg per kilo of your weight per day

Unless extremely petite likely to need to be on at least 100mcg levothyroxine per day

But we have to increase SLOWLY, especially if you have been left far too long on too small a dose levothyroxine

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

Recommended not to change brand when increasing dose, otherwise you can’t tell if it’s brand change or dose causing any issues

Teva is the only brand that makes 75mcg tablets

If avoiding Teva …..request 50mcg and 25mcg tablets

If taking Accord (also boxed as Almus via Boots or Northstar via Lloyds) Accord brand don’t make 25mcg. Request extra 50mcg tablets and cut in half to get 25mcg dose extra per day

Cut with pill cutter or sharp craft scalpel

Use weekly pill dispenser for remaining half. Only cut as required….don’t cut several at once

Bloods should be retested 6-8 weeks after being on 75mcg everyday

Likely to have low vitamin levels as been left too long on too low a dose levothyroxine

SlowDragon profile image
SlowDragonAdministrator in reply tojeffbird

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Has GP done coeliac blood test, if not request testing BEFORE considering trial on strictly gluten free diet…..perhaps in New Year

nice.org.uk/guidance/ng20/c...

1.1 Recognition of coeliac disease 

1.1.1 Offer serological testing for coeliac disease to:people with any of the following: 

persistent unexplained abdominal or gastrointestinal symptoms 

faltering growth

prolonged fatigue 

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes,

at diagnosis autoimmune thyroid disease,

at diagnosis irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease.

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels 

Low vitamin levels affect Thyroid hormone working 

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common. 

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link) 

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies 

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first 

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

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.

Comprehensive list of references for needing LOW TSH on levothyroxine 

healthunlocked.com/thyroidu....

TSH should be under 2 as an absolute maximum when on levothyroxine 

gponline.com/endocrinology-...

NHS England Liothyronine guidelines July 2019

 

sps.nhs.uk/wp-content/uploa...

Page 9 

Test for Deficiency of any of the following: Vitamin B12, Folate,  Vitamin D, Iron

See page 13 

1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)

Graph showing median TSH in healthy population is 1-1.5

On levothyroxine we frequently end up with TSH below one

web.archive.org/web/2004060...

jeffbird profile image
jeffbird in reply toSlowDragon

Thanks for your super detailed response!

I was tested for Coeliac before (negative) because of anaemia

I’m taking accord brand (first 2 months were TEVA and made me feel much worse)

Looking at those dose/weight guideline suggests 75mg would be more appropriate dose but I suppose can’t tell that until I see the actual test values at the gp tomorrow

I’ll print off your replies and show to the gp.

Thanks again I really appreciate it

SlowDragon profile image
SlowDragonAdministrator in reply tojeffbird

definitely never mention an Internet forum to a GP ….red rag to a bull

You could print off official links I gave you on dose levothyroxine

Most important results are always Ft3, followed by Ft4

Assuming you are in need of next dose increase in levothyroxine…....ask for extra 50mcg tablets and cut in half to get 25mcg

Negative coeliac test doesn’t rule out gluten intolerance

Always worth trying strictly gluten free diet

Only make one change at a time or add one new supplement at a time

Link from U.K. government in support of thyroid patients being prescribed unchanging brand levothyroxine if necessary

(because patients were being persistently ignored by medics re different brands levothyroxine not being interchangeable)

gov.uk/drug-safety-update/l...

a small proportion of patients treated with levothyroxine report symptoms, often consistent with thyroid dysfunction, when their levothyroxine tablets are changed to a different product – these cases are noted in UK professional guidelines

if a patient reports symptoms after changing their levothyroxine product, consider testing thyroid function

If a patient is persistently symptomatic after switching levothyroxine products, whether they are biochemically euthyroid or have evidence of abnormal thyroid function, consider consistently prescribing a specific levothyroxine product known to be well tolerated by the patient

jeffbird profile image
jeffbird

I have some results but not many, spoke to a different GP to previously who was rather vague. Am going to call back to get a print off of the full set as I need to collect a prescription for iron tablets

thyroid was 13.1

iron stores were low (guessing she meant ferritin here)

cholesterol was 7.3 which is similar to previous values (I'm slightly under average weight, eat healthily and prior to all this used to run a lot and am building back up distances slowly e.g. 5k on weekend)

Hb was 112

she was clearly in a bit of a rush. said she couldn't find my coeliac screen results either so I will ask receptionist about that too. pretty disappointing call to be honest.

SlowDragon profile image
SlowDragonAdministrator in reply tojeffbird

thyroid was 13.1

This is likely Ft4 result…..need range

Typically range is 12-22 …but not all labs have same ranges

Aiming for Ft4 at least 60-70% through range

Come back with new post once you get printed copies of results

SlowDragon profile image
SlowDragonAdministrator in reply tojeffbird

high cholesterol linked to being hypothyroid and under medicated

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.

Similarly low vitamin levels linked to being hypothyroid

humanbean profile image
humanbean in reply tojeffbird

I need to collect a prescription for iron tablets

I don't know if you know this but iron tablets can be bought from pharmacies in the UK without a prescription.

I wrote a reply to another member about many of the iron supplements available in the UK :

healthunlocked.com/thyroidu...

.

When a doctor or receptionist tells you that your iron is low, it is most likely they have tested only ferritin (iron stores). Your serum iron and saturation will rarely have been tested.

The most informative kind of iron testing is an iron panel. This link is for a private finger-prick iron panel.

medichecks.com/products/iro...

Discounts may be found here :

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

jeffbird profile image
jeffbird in reply tohumanbean

Yes depending on the results *when I eventually get them :) * I might go for a medicheck as they have a partner clinic in Belfast. Thanks again. Btw prescriptions are free in NI but I will check that other post too. Thanks again for taking the time to reply

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