8Advice: Tsh 1.42 range 0.27 to 4.2 FT4 is 21.... - Thyroid UK

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Pen1966 profile image
50 Replies

Tsh 1.42 range 0.27 to 4.2

FT4 is 21.5 rsnge 12 to 22

Ft3 is 3.9 range 3.1 to 6.8

Have been told my Vitamin d is too high at 120nmol calcuim is 2.26 ps not supplementing atm either also have no thyroid cfs and fibromyalgia and Gerd and sinutitis29/12/2022

You have a low level of haemoglobin which is also known as anaemia. Your results indicate that this is unlikely to be related to low levels of iron, vitamin B12 or folate. The best course of action is to discuss these results with your doctor. Please check test-specific details below as there may be important additional information.

HB

29/12/2022

107 g/L

You have low levels of haemoglobin. The best course of action is to see a doctor as soon as possible.

FERRITIN

29/12/2022

34 ug/L

Normal

TSAT

29/12/2022

28 %

Normal

ACTIVE B12

29/12/2022

132 pmol/L

Normal

FOLATE

29/12/2022

>20.0 iu/L

Normal

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Pen1966
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Jaydee1507 profile image
Jaydee1507Administrator

If you could edit your post and add ranges that would help anyone trying to advise. Ranges vary from lab to lab.

What dose levo are you on and what were your latest results please?

Your ferritin is only 4 off a complete deficiency. Would recommend adding chicken liver or pate to your diet a few times a week.

Pen1966 profile image
Pen1966 in reply toJaydee1507

Sorry Medichecks didn't give ranges on test results have added update thyroid ones

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

Look at your results tab on the Medichecks site. The range is right next to the number results or you can see from the result 'meter'.

Medichecks result range
Pen1966 profile image
Pen1966 in reply toJaydee1507

Wilk do later head not working

Pen1966 profile image
Pen1966 in reply toPen1966

Sorry was monitor my health mo medichecks no ranges on results

Example
SeasideSusie profile image
SeasideSusieRemembering in reply toPen1966

pen1966

MonitorMyHealth do give ranges. The normal range is the green band on the graphic and you will see the lower/upper limits there. You will see for your haemoglobin test the low limit of the normal range is 126 (the upper limit isn't showing in your image).

Also my MMH results have ranges as shown in the box below the graphic:

Result/range
Pen1966 profile image
Pen1966 in reply toSeasideSusie

Thank you will look later fibro ME and FND head not good today

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

I'm not surprised your head isn't working, your FT3 is only at 21% of it's range. It needs to be 60-70%. Really you need a 25mcgs dose increase but you might also want to think about adding some T3.

Pen1966 profile image
Pen1966 in reply toJaydee1507

That will elevate my t4 further won't it?

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

Just checking. How long before that test did you take your Levo?

Pen1966 profile image
Pen1966 in reply toJaydee1507

24 hours before I've had no thyroid for over 33 years now

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

OK, then yes it would raise your FT4 over range, you're a poor converter. Time to start trying to get some T3 then.

Also to work on low ferritin with chicken livers or pate which would help conversion somewhat.

SeasideSusie Is the person to ask about Vit D.

Pen1966 profile image
Pen1966 in reply toJaydee1507

Ok my Haemoglobin is low too

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

Probably best to take those results to GP and get them to do full blood count and full iron panel. Your ferritin (iron storage) is all but off the bottom of range so would be interesting to see where the rest of your iron is at.

Pen1966 profile image
Pen1966 in reply toJaydee1507

When I showed gp she said haemoglobin was low and that was it and she will retest in March

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

Try a different GP, emphasis your symptoms of fatigue etc and get the iron panel done.

Pen1966 profile image
Pen1966 in reply toJaydee1507

Cannot change gps only one I can register with in my area

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

I mean a different GP in the same practice. I see you've had more advice on the iron etc Would be good to follow that, also perhaps push for an iron infusion.

You really do need some added T3 though. How might you do that?

Pen1966 profile image
Pen1966 in reply toJaydee1507

I have some tiromel from a friend butscared of trying it 25mg pills

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

Perhaps start a new thread to ask about that specifically.

I've been fighting symptons for 3 years with thyroid anemia etc then diagnosed with fibro ME and FND last July August time

Obviously it's your choice, but just to share a bit about myself, I've been hypo 30 odd years, on Levo only for the majority of that and have ended up virtually housebound for the past 9 years with multiple diagnoses. Now just adding some T3 via a private Endo, it's early days still but I do feel different and also very positive about what I'm doing. The risk is in not adding T3 and staying as I was and getting worse!

Pen1966 profile image
Pen1966 in reply toJaydee1507

I need guidance on how much to start with etc 😕

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

Most people need to drop around 25mcgs levo for a week and then add the smallest amount possible of T3. You have 25mcg tablets, so cut into quarters with a pill cutter and take 6.25 in the morning. Also be sure you can source more Tiromel.

Pen1966 profile image
Pen1966 in reply toJaydee1507

I can source privately

Jaydee1507 profile image
Jaydee1507Administrator in reply toPen1966

Best to delete that, but anyway get bloods done in 6-8 weeks after getting onto the Tiromel.

Pen1966 profile image
Pen1966 in reply toJaydee1507

Will do

SlowDragon profile image
SlowDragonAdministrator in reply toPen1966

Words fail me

SeasideSusie

humanbean

Pen1966 profile image
Pen1966 in reply toSlowDragon

I've been fighting symptons for 3 years with thyroid anemia etc then diagnosed with fibro ME and FND last July August time

SlowDragon profile image
SlowDragonAdministrator

FT4: 21.5 pmol/l (Range 12 - 22)

Ft4 is 95.00% through range

FT3: 3.9 pmol/l (Range 3.1 - 6.8)

Ft3 is only 21.62% through range

your conversion rate of Ft4 to Ft3 is terrible

Most people when adequately treated will have Ft4 and Ft3 approx 70% through range

Low ferritin definitely not helping conversion

Looking at your age are you pre or post menopause?

What’s your diet like

Pen1966 profile image
Pen1966 in reply toSlowDragon

56 no periods for over 15 years diet not great have been on ferrous fumerate 210 mgs for 6 months and 5mg folic acid

SlowDragon profile image
SlowDragonAdministrator in reply toPen1966

Are you vegetarian or vegan

What’s reason for your hypothyroidism?

Have you ever had coeliac blood test done?

Low iron can be due to undiagnosed gluten intolerance

Clearly your current iron supplements are totally inadequate

Suggest you read the many posts and replies by humanbean on improving iron and ferritin

Pen1966 profile image
Pen1966 in reply toSlowDragon

No thyroid and had all bloods done last year hence diagnosis of Fibro FND and ME

SlowDragon profile image
SlowDragonAdministrator

Your ferritin shows your anaemic

What’s GP doing about this?

Anaemia causes fatigue

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

Also See page 7 on here 

rcn.org.uk/-/media/royal-co...

Has GP done full iron panel test for anaemia?

Look at increasing iron rich foods in diet 

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

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.

healthunlocked.com/thyroidu...

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...

Ferritin over 100 to alleviate symptoms 

healthunlocked.com/thyroidu...

Low Iron implicated in hypothyroidism 

healthunlocked.com/thyroidu...

Ferritin range on Medichecks 

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes: 

Males 16-60: 30-400 ug/L

Female's: 16-60: 30-150

Both >60: 30-650 

The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘

Pen1966 profile image
Pen1966 in reply toSlowDragon

Gp prescribed ferrous fumerate and folic acid

SlowDragon profile image
SlowDragonAdministrator in reply toPen1966

Folic acid if for low folate which is now at good level

More on low iron

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

Helpful info on iron infusion and supplements 

healthunlocked.com/thyroidu...

Excellent reply by Blearyeyed about iron in this post

healthunlocked.com/thyroidu...

Pen1966 profile image
Pen1966 in reply toSlowDragon

Thank you will have a read through when brain working

SlowDragon profile image
SlowDragonAdministrator in reply toPen1966

So how many iron tablets have you been taking per day

Do you take iron with vitamin C or orange juice to improve absorption and at least four hours away from levothyroxine and 2 hours away from other vitamin supplements

Unless you were already on 3 tablets per day GP could/should have increased dose of iron

There’s loads of other/better/different iron supplements that you can self supplement

healthunlocked.com/thyroidu...

Pen1966 profile image
Pen1966 in reply toSlowDragon

Just one ferrous fumerate tab a day and take with vitamin c

SlowDragon profile image
SlowDragonAdministrator in reply toPen1966

Suggest you self source your own iron supplements

It’s chicken and egg….having such terrible iron levels results in low Ft3

Low Ft3 results in terrible iron levels

Could you afford to see thyroid specialist to get T3 prescribed and oversee you starting on it ?

Roughly where in U.K. are you

Email Thyroid U.K. for list of thyroid specialist endocrinologists and doctors who will prescribe T3 if clinically appropriate 

tukadmin@thyroiduk.org

Private consultation is approx £250 including prescription

Thybon Henning 20mcg tablets on private prescription are approx 50-60p per tablet

Typical eventual dose T3 is 1/4 tablet twice or three times per day

With such high Ft4 result, you would reduce levothyroxine by 25mcg per day

Wait 5-7 days

Then add just 1/4 tablet T3 in morning

Assuming that’s ok, wait at least another 2 weeks before adding 2nd 1/4 tablet mid-late afternoon

Retest thyroid levels in 6-8 weeks

Pen1966 profile image
Pen1966 in reply toSlowDragon

In Dorset

SlowDragon profile image
SlowDragonAdministrator in reply toPen1966

Some on the list in near by counties

SlowDragon profile image
SlowDragonAdministrator in reply toPen1966

GP could easily have doubled iron supplements

Suggest you do you own reading on other options from these links

Ferrous fumerate is the cheapest, and often most difficult to absorb

SeasideSusie profile image
SeasideSusieRemembering

Pen1966

Have been told my Vitamin d is too high at 120nmol

Who told you that? According to the Vit D Council, Vit D Society and Grassroots Health it's just about perfect. They recommend a level of 100-150nmol/L with a recent blog post on Grassroots Health recommending at least 125nmol/L. If you are achieving 120nmol/L naturally then that is good.

The attached image is a sample results sheet from the NHS lab in Birmingham which offers Vit D testing to the general public, you can see that a Vit D level of over 220nmol/L is considered high and increases the risk of Vit D toxicity. So according to the NHS your level of 120nmol/L is nothing to worry about.

Vit D
Pen1966 profile image
Pen1966 in reply toSeasideSusie

Monitor my health did

SeasideSusie profile image
SeasideSusieRemembering in reply toPen1966

Well MMH are an NHS lab too, shame they don't all sing from the same hymn sheet.

Personally I would ignore what MMH says and go by the dedicated Vit D websites and follow their recommendations. In their, and my, opinion there is nothing wrong with your Vit D level, it is just about perfect.

Pen1966 profile image
Pen1966 in reply toSeasideSusie

Thank you for the reassurance 🙏 😊

humanbean profile image
humanbean

29/12/2022

FERRITIN 34 ug/L

TSAT 28 %

HB 107 g/L

ACTIVE B12 132 pmol/L

FOLATE >20.0 iu/L

When I showed gp she said haemoglobin was low and that was it and she will retest in March

have been on ferrous fumerate 210 mgs for 6 months and 5mg folic acid

.

Your ferritin and Transferrin Saturation (TSAT) are both low and your haemoglobin shows that you are anaemic. It would be very helpful if you could find the ranges for your results.

The optimal levels for you iron-related results are given in this link :

rt3-adrenals.org/Iron_test_...

I've used the following ranges. They came from my last Medichecks test in summer 2022 - doing this is not valid, but I don't have a choice without the MMH ranges.

Ferritin 13 - 150 ug/L

TSAT 20 - 50%

Haemoglobin 120 - 160 g/L

Active B12 37.5 - 150 pmol/L

Folate > 3.89 ug/L

Ferritin - Your ferritin (iron stores) is much too low. Ferritin would be expected to be low in someone who is anaemic. According to the NICE Guidelines a level below 30 is an indication of iron deficiency. On this forum we suggest an optimal level of ferritin of at least mid-range, or with a range of 13 - 150 a result of around 90 - 110 is good.

Transferrin Saturation - Your TSAT is also low. Optimal according to the link in bold above is 35% - 45%, higher end of that for men.

Haemoglobin - Yours is under range showing that you are anaemic.

Active B12 - Optimal is 100 pmol/L and upwards. So your result is fine.

Folate - Optimal is either in double figures or upper half of range if the range has an upper limit. Yours is fine.

Please read these links on the subject of folate and folic acid :

takecareof.com/articles/ben...

chriskresser.com/folate-vs-...

Since your folate result is quite high I would suggest that you don't need it any more. And if you need it in future you should buy a methylfolate supplement. If you need to supplement B12 in future please take a methylcobalamin supplement. Both these suggested supplements are available on Amazon and other sites selling supplements.

For future reference you might find this link of interest on the subject of anaemia :

irondisorders.org/wp-conten...

There are lots of possible causes for anaemia, not just low iron. It's a pity you don't have a full iron panel - something like this :

medichecks.com/products/iro...

On that link under "What's Included", click on "Iron Status" and "Inflammation". It lists the full test as including :

CRP - hs

Iron

Tibc (Total Iron Binding Capacity

Transferrin saturation

Ferritin

Your doctor has obviously assumed that your prescriptions for ferrous fumarate will fix your anaemia. But since you have been on it for six months already and your haemoglobin is still very low I think you need to ask for further testing and a referral to a haematologist or a gastroenterologist.

How many ferrous fumarate 210mg have you been taking per day? And how many days a week?

Have you ever checked your poo for blood? It would be a good idea - and do the check several times because some conditions that cause GI bleeds e.g. polyps can bleed intermittently. Bright red blood usually comes from piles, dark red blood or anything that looks like black coffee grounds could be coming from bleeding polyps, bleeding ulcers or probably many other conditions I don't know about. The higher up the gut the blood comes from the darker it will be, as a result of it being digested. You could ask your doctor to test your poo for blood (a faecal occult blood test) . Be aware that they are not very reliable tests.

How to reduce the risk of false positives or false negatives :

healthunlocked.com/thyroidu....

Good luck. :)

Pen1966 profile image
Pen1966 in reply tohumanbean

Thank you I have done a fit test which has come back positive so have to have camera up bottom in next 2 weeks

humanbean profile image
humanbean in reply toPen1966

Ask if they can give you an iron transfusion or a blood transfusion after they have found the source of your bleeding. Otherwise you could be struggling to get your iron and haemoglobin levels back to normal for a long time. I don't know what the response will be.

You could ask them to do a full iron panel and a Full Blood Count after your problem is found and fixed, and you should do them every few months until your levels are good, you feel at your best, and your haemoglobin is back to being 120+ i.e. you are no longer anaemic.

Pen1966 profile image
Pen1966 in reply tohumanbean

Will try xx

Pen1966 profile image
Pen1966

Thank you i have been referred fir camera up bottom xc

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