Help needed interpreting advanced thyroid blood test 🙏

[J972]

Hi, I’m new here and looking for help interpreting recent blood tests. At the bottom of this rather lengthy post are the results of tests I just had done via the testing company Monitor My Health. I paid for the advanced thyroid panel of testing and it’s the first time I’ve had FT4 & antibodies tested.

The results came with an explanation that I probably have hypothyroidism, albeit sub clinically. If I’ve understood correctly, the elevated antibodies means that I could have/go on to develop Hashimotos.

I am 50, menopausal (on HRT) and have been back and forth to my GP complaining of feeling disproportionately tired/thinning hair for upwards of 10 years now. In 2021 my TSH was 5.08. Since then it has hovered around the 3 mark (although I now know about timing/fasting before testing, so this may be a factor). I have the following symptoms: fatigue, extreme hunger particularly after exertions (walking to work, for example), cold hands & feet, palpitations, irritability, puffy eyelids, my voice is becoming hoarse, joint and muscle pain, breathlessness (other possible causes of which have all been ruled out) and hair loss. I understand that menopausal symptoms can be conflated with thyroid symptoms but I feel confident that I’ve been on HRT long enough now (3+ years) to appreciate the ways in which it has had a positive effect. The fatigue persists, despite sleeping well. Before I finish I’d just like to add that I generally feel very unwell, everyday. I no longer drink any alcohol because I routinely wake feeling something akin to hungover. I am grateful for any insight or advice you can provide. Thank you.

TSH: 4.74 mu/L TSH levels high (normal range 0.27 - 4.2 mU/L)

FT4: 13.9 pmol/L FT4 levels normal (normal range 12 - 22 pmol/L)

FT3: 3.7 pmol/L FT3 levels normal (normal range 3.1 - 6.8 pmol/L)

TPO antibodies: 35 IU/mLYou have raised levels of TPO antibodies

[tattybogle]

Hi J972, Since your latest TSH is just over range . book an appointment with GP , and show the these results .. they will probably have to do their 'own' NHS tests to confirm these results even though Monitor My Health is an NHS lab , (so make SURE you get an early am test , they will not accept that thyroid needs an early morning slot , so i suggest you be "unable to attend appointment later than 9am due to work commitments" even if this means waiting 5 weeks to get one) .

Assuming their TSH Test is also over range , they will then have to wait 3 months to repeat the TSH test to rule out a transient rise ....... but if TSH is over range on both their tests and since you do (just) have positive TPOab they could then 'consider' starting you on Levothyroxine ,, (*note~ 'could consider ', not 'must' .. it's rather dependant on the feelings of the individual GP).

NHS guidelines for diagnosing and treating subclinical hypothyroidism below . (* note 'subclinical' means 'TSH over the lab range while fT4 is still within range' )

nice.org.uk/guidance/ng145

1.5 Managing and monitoring subclinical hypothyroidism

Tests for people with confirmed subclinical hypothyroidism

Adults

1.5.1Consider measuring TPOAbs for adults with TSH levels above the reference range, but do not repeat TPOAbs testing.

Treating subclinical hypothyroidism

1.5.2When discussing whether or not to start treatment for subclinical hypothyroidism, take into account features that might suggest underlying thyroid disease, such as symptoms of hypothyroidism, previous radioactive iodine treatment or thyroid surgery, or raised levels of thyroid autoantibodies.

Adults

1.5.3Consider levothyroxine for adults with subclinical hypothyroidism who have a TSH of 10 mlU/litre or higher on 2 separate occasions 3 months apart. Follow the recommendations in section 1.4 on follow-up and monitoring of hypothyroidism.

1.5.4Consider a 6-month trial of levothyroxine for adults under 65 with subclinical hypothyroidism who have:

a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions 3 months apart, and

symptoms of hypothyroidism.

If symptoms do not improve after starting levothyroxine, re-measure TSH and if the level remains raised, adjust the dose. If symptoms persist when serum TSH is within the reference range, consider stopping levothyroxine and follow the recommendations on monitoring untreated subclinical hypothyroidism and monitoring after stopping treatment."

[Jaydee1507 Administrator]

Welcome to the group.

So raised antibodies mean you have Hashimoto's disease, an autoimmune condition. Very slowly, over years your thyroid gets attacked and it's output of thyroid hormone diminishes. You are at the early stages of that and have symptoms as a result of your thyroid struggling.

In the UK hypothyroidism is diagnosed & treated after 2 successive NHS tests showing TSH at 5 or over. It would be good to take these results to your GP who will likely want to run their own tests. Book the test for 9am and do it fasting. 9am is when TSH is at it's highest, it varies throughout the day. See if your GP will monitor you and do regular tests every 3-4 months.

Hypothyroid people get low vitamin levels due to low stomach acid. Get your GP to also test ferritin, folate, B12 and D3. In the mean time you can be supplementing these to optimal levels which might help you. Post the results here when you have them

[SlowDragon Administrator]

Welcome to the forum

ESSENTIAL to test vitamin D, folate, ferritin and B12

Low vitamin levels extremely common when hypothyroid

Low iron/ferritin often linked to hairloss and breathlessness

Joint pain low vitamin D

ALWAYS get actual results and ranges

Low vitamin levels tend to lower TSH

Being hypothyroid frequently causes low stomach acid, this leads to poor nutrient absorption and low vitamin levels as direct result

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 BOTH thyroid antibodies and all four vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.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...

[J972 in reply to SlowDragon]

thanks ever so much to you all for your prompt and helpful responses. I have access to my medical records and will post details of my vitamin results. Interestingly, my ferritin levels have been consistently low for years (we’re talking 22-24 where the range is 23-300) and numerous GPs and nurse practitioners have insisted that they’re unproblematic because they’re within range.

[SlowDragon Administrator in reply to J972]

Any obvious reason for low iron /ferritin

Are you vegetarian or vegan

Heavy periods?

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...

Look at increasing iron rich foods in diet 

Eating iron rich foods like liver or liver pate once a week plus red meat daily, 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.

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. ‘

[SlowDragon Administrator in reply to J972]

What are B12, folate and vitamin D results and ranges ?

[J972 in reply to SlowDragon]

Good evening,

most recent tests carried out in June 2022, results as follows:

Serum vitamin B12 level 328 ng/L [187.0 - 883.0]

Serum folate level 11.5 ug/L [2.7 - 15.0]

Serum total 25-hydroxy vitamin D level 120 nmol/L [50.0 - 120.0]

Soon after these results I had my active B12 tested privately with Forth. Result as follows:

79.6 pmol/L (range unclear but result was described as ‘normal’).

🙏

[SlowDragon Administrator in reply to J972]

With such low Serum B12 it would be good idea to supplement

perhaps get retested first see where levels are now

Low B12 symptoms 

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins)

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 drops 

healthunlocked.com/thyroidu...

B12 sublingual lozenges 

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

After 2 weeks add a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20 

If you want to try a different brand in the meantime, one with virtually identical doses of the ingredients, and bioavailable too, then take a look at Vitablossom Liposomal B Complex. Amazon sometimes has it branded Vitablossom but it's also available there branded as Yipmai, it's the same supplement

amazon.co.uk/Yipmai-Liposom...

or available as Vitablossom brand here

hempoutlet.co.uk/vitablosso... &description=true

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12

[J972 in reply to SlowDragon]

your help and advice is humbling….thank you. I’m perplexed as to why the NHS considers my ferritin and b12 levels to be within normal range. I mean, what exactly is that all about? Is it purely about cost? If so, where’s the care?

[SlowDragon Administrator in reply to J972]

Yes cost and lack of understanding on relevance of good vitamin levels (no money in this for pharmaceutical companies)

NHS only test and treats vitamin deficiencies

Unfortunately they don’t explain that to patients…..who if they knew that vitamin levels were inadequate could take action themselves to improve the situation