Help with blood results

[Lordy40]

I have been feeling breathless lately more than normal so my doctor did some blood tests.My thyroid function test came back as abnormal and I am booked into to see GP 10th January.

My latest results are

TSH- 8.19 (0.27-4.2)

T4- 16.1 (12.0-22.0)

Serum ferritin 50ng/ml(13-150)

Serum B12 level 828pg/ml (197.0-771.0) above high reference limit

Serum folate level 12.1ug/l

My last blood results for thyroid were within normal range March 2022 TSH was 1.42 (0.27-4.2) T4 was 16.8 (12.0-22.0)

I've been put on a different blood pressure tablet raporsin XL prolonged release tablets 8mg a day which I take at least 3 hours after thyroxine and I'm also on HRT but it's estrogel which I put on at night and reading up about it shouldn't affect my thyroid function. I've been on that a year since hysterectomy so don't think it's that.

I have had trouble lowering my blood pressure all year and tried lots of tablets this one seems to be lowering it.

Any advice gratefully received as it's affecting me being able to exercise and even just getting up the stairs.

Thanks for your time.

[SlowDragon Administrator]

Well you are now extremely under medicated

How much levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

You need full iron panel test for anaemia including ferritin

Breathlessness is frequently low iron

Was CRP tested (test for inflammation)

What vitamin supplements are you currently taking

You need to test vitamin D and folate too

[Lordy40 in reply to SlowDragon]

I take 150mcg a day I’m always given the same brand of levothyroxine, they did a full blood count too which came back normal, I’ll look and see if they did a CRP test. I take vit b complex, vit b12, vit D and magnesium. My vit D result in September was within range. I use to be on ferritin but after the hysterectomy they took me off it and said I didn’t need it any more.

[SlowDragon Administrator in reply to Lordy40]

I use to be on ferritin but after the hysterectomy they took me off it and said I didn’t need it any more.

Highly likely your iron levels have dropped then

So what are your most recent thyroid results

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

Just testing TSH is completely inadequate

You need TSH, Ft4 and Ft3 tested

previous post shows 150mcg wasn’t high enough dose

You were going to try 150mcg and175mcg alternate days

HRT invariably results in needing increase in levothyroxine

What was vitamin D result

Within range is not necessarily optimal

[Lordy40 in reply to SlowDragon]

I was tested at 7.10am no thyroxine since morning before. I was doing alternate days of 150 then 175 but it came back as abnormal that was earlier in the year. I didn’t think the HRT gel only would affect the thyroid and I’ve been on it a year now and results changed since last bloods in September which makes me think it could be the blood pressure tablet. As I’ve only been on this one for a couple of months. I will attach my vit D and other results too.

[SlowDragon Administrator]

previous post from year ago

healthunlocked.com/thyroidu...

Have you had coeliac blood test done

Are you now on gluten free diet

[Lordy40 in reply to SlowDragon]

the doctors won’t do a coeliac blood test and I’m not on a gluten free diet.

[SlowDragon Administrator in reply to Lordy40]

so you can buy one privately

But GP should test as you have Hashimoto’s

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.

Only 5% of Hashimoto’s patients test positive for coeliac disease, but a further 80% find strictly gluten free diet helps or is essential

[SlowDragon Administrator]

Levothyroxine can not work correctly unless all four vitamins are OPTIMAL

Vitamin D at least over 80nmol…..and between 100-125nmol may be better

Serum B12 at least over 500

Folate and ferritin at least half way through range

NHS only tests and treats vitamin deficiencies

On levothyroxine we need OPTIMAL vitamin levels

If you have inflammation (common with Hashimoto’s) ferritin can be falsely high ……and iron low

Ferritin is “an acute phase reactant” and rises with inflammation

Ferritin over 100 to alleviate symptoms 

healthunlocked.com/thyroidu...

Low Iron implicated in hypothyroidism 

healthunlocked.com/thyroidu...

are you vegetarian or vegan?

List of iron rich foods

dailyiron.net

Links about iron and ferritin

An article that explains why Low ferritin and low thyroid levels are often linked 

preventmiscarriage.com/iron...

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin 

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin 

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron 

Medichecks iron panel test 

medichecks.com/products/iro...

Iron and thyroid link

healthunlocked.com/thyroidu...

Excellent article on iron and thyroid 

cambridge.org/core/journals...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron 

healthline.com/nutrition/he...

Heme iron v non heme

hsph.harvard.edu/nutritions...

[Lordy40 in reply to SlowDragon]

thank you for all info and advice . I will look into private testing and see what GP says when I go.

[SlowDragon Administrator in reply to Lordy40]

on levothyroxine TSH should always be below 2

ESSENTIAL to test TSH, Ft4 and Ft3 together early morning and last dose levothyroxine 24 hours before test

Most important results are always Ft3 followed by Ft4

Ft3 at least 50-70% through range if not higher

TSH will frequently be below range or suppressed

Maintain optimal vitamin levels at all times

Frequently gluten free diet/dairy free diet necessary