I've finally had some blood test results back as I've still been feeling lousy (underactive thyroid symptoms) despite blood tests suggesting to the contrary.
My TSH came back: 0.07
T3: 5.10 (normal range quoted as 2.63 - 5.70)
T4: 15.40 (normal range 9.01 - 19.05)
The lab recommended lowering my thyroxine dose so I'll be doing that.
Vitamins wise:
B12 : 388 (normal range 187-883)
Folate: 3.7 (normal range 3.1 - 20.5)
From medichecks:
Iron: 10.4 (range 5.8 - 34.5)
I had one abnormal which was transferrin saturation: 18.5 (range 20- 50).
(The rest for my iron were pretty much at the mid to high range. )
My question is, even though these are in range, should I still be looking at taking supplements as they're on the low end?
Thank you!
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BluePumpkin
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The lab recommended lowering my thyroxine dose so I'll be doing that.
There is nothing in your results to suggest that your dose of Levo needs reducing. The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges. Your FT4 is 63.65% through range and your FT3 is 80.46% through range.
T4 and T3 are the thyroid hormones and tell us our thyroid status. TSH is a pituitary hormone and is basically useful for diagnosis but once on thyroid hormone replacement it's not much use, it's low because your pituitary detects you're taking thyroid hormone and is satisfied. We should not reduce our dose of Levo based on TSH, we should always look at FT4 and FT3 and take any symptoms into account. FT3 is the most important test and we are only overmedicated if FT3 is over range.
B12 : 388 (normal range 187-883)
Presumably the unit of measurement for your B12 test is pg/ml or ng/L? If so then your level is low. According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Do you have any signs of B12 deficiency – check here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.
If you don't then you could supplement with sublingual B12, along with a good quality B Complex (keeps all B vitamins balanced) until level reaches 500+, once this level is reached you could stop the B12 then just continue with the B Complex.
Suggestions for B12 supplements which include two forms of bioactive B12 - methylcobalamin and adenosylcobalamin which you might want to check out:
Note that the Nature Provides supplement contains a much higher dose than the Cytoplan one.
Folate: 3.7 (normal range 3.1 - 20.5)
This is very low, folate is recommended to be at least half way through range so around 12+ with that range. Supplementing with a B Complex will help raise your level.
I have used Thorne Basic B for a long time and always been happy.
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).
From medichecks:
Iron: 10.4 (range 5.8 - 34.5)
I had one abnormal which was transferrin saturation: 18.5 (range 20- 50).
When interpreting iron panel results we tend to refer to optimal levels as suggested by rt3-adrenals.org/Iron_test_... which are:
Serum iron
• 55 to 70% of the range
• higher end for men
Yours is 16.03% through range so it's low.
Saturation
• optimal is 35 to 45%
• higher end for men
Yours is 18.5% so is very low.
It would be helpful to see results for the following as the above two results suggest supplementing might be needed:
TIBC (total iron binding capacity) or Transferrin
• Low in range indicates lack of capacity for additional iron
• High in range indicates body's need for supplemental iron
Ferritin
• Low level virtually always indicates need for iron supplementation
• High level with low serum iron/low saturation indicates inflammation
or infection
• High level with high serum iron and low TIBC indicates excess iron
• Over range with saturation above 45% suggests hemochromatosis
Thank you! I've always just been going by what the doctor tells me - it seems that if it's all in range they basically tell me it's fine and that's it.
Yes the B12 was pg/ml. My GP was the one who said my folate and B12 are in range so nothing needs doing 😑. Is the test for pernicious anemia different from a regular B12?
I've been going back and forth with them about joint pain (I'm actually starting to lose feeling in my little and ring fingers in both hands) tiredness, memory issues etc. I've been referred to physio now and have an appointment in December.
I've always just been going by what the doctor tells me - it seems that if it's all in range they basically tell me it's fine and that's it.
Yes, unfortunately doctors seem to think that just anywhere in range is perfect, they don't appear to understand that it's where within the range that's important plus how the patient feels.
Is the test for pernicious anemia different from a regular B12?
Yes. Testing B12 tells you your B12 level and if it's low and you have symptoms it can be B12 deficiency. You can have B12 deficiency without Pernicious Anaemia.
Pernicious Anaemia is one cause of B12 deficiency, it's an autoimmune disease which means the body can't absorb enough B12. Tests for PA include MMA (methylmalonic acid), homocysteine and IF antibodies (intrinsic factor) I believe (but I'm not an expert on B12).
I've been going back and forth with them about joint pain (I'm actually starting to lose feeling in my little and ring fingers in both hands) tiredness, memory issues etc.
The joint pain could be low Vit D. Was this tested? Joint and muscle aches and pains are typical of low Vit D. Fatigue and memory issues could be undermedication of thyroid or low iron.
TIBC: 56.5 (45-81)
So this is low in range and suggests no capacity for supplementing iron. It's at odds with your serum iron and saturation percentage which both suggest you may benefit from more iron.
Ferritin: 141 (13-150)
This is surprisingly high. Ferritin can be elevated with inflammation. Was CRP also tested?
CRP hs was 4.27 ( given range <3) . My CRP whenever I've had it done has always been bouncing between just below range and just above range but they never said anything when it was above so I assumed it didn't matter.
My CRP whenever I've had it done has always been bouncing between just below range and just above range but they never said anything when it was above so I assumed it didn't matter.
CRP is an inflammation marker, so if that's high that would probably be why ferritin is high. Your CRP is a little above range so is showing some inflammation (the lower the better with CRP) so it could account for some elevation of ferritin level but it could be that you do have a decent ferritin level anyway. It's a difficult one because your serum iron and saturation are low.
Vit D isn't too bad, the Vit D Council, Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L with a recent blog post on Grassroots Health recommending at least 125nmol/L. As it's now winter and we can't make Vit D naturally during the winter months, you might want to check out a recent post that I wrote about Vit D and supplementing:
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 which is included in that post..
Thank you - I'll try adding in the supplements and see if that helps! It's been a nightmare. I keep going back and they're just going *shrug* your bloods are in range looks like you just have to live with it.
Getting vitamins optimal should help reduce symptoms
As you have autoimmune thyroid disease also called Hashimoto’s have you had coeliac blood test
Are you on, or tried strictly gluten free diet or dairy free diet
Poor gut function with Hashimoto’s 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
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
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
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.
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