help with recent blood tests?

[G172125]

Tests

[G172125]

Iron

J

[G172125]

Vit d

Bloods

[G172125 in reply to G172125]

Vit b12

Tests

[G172125 in reply to G172125]

Tsh

Trs

[G172125 in reply to G172125]

T4

T4

[PurpleNails Administrator]

You currently take PTU - how much? Has doctor suggested Increase?

Serum TSH level Result < 0.01 miu/L Normal range (0.49 - 5.23)

FT4 13.3 pmol/L Normal range (11.5 - 22.7) 

FT3 level 7.6 pmol/L (3.5 - 6.5) 

Frees are lower than previous results & so going in right direction. 

 Your results are showing high FT3 / low in range FT4. So FT3 dominant, you might find FT4 falls too low before FT3 is in range.  Some can function ok with low FT4 provided FT3 is good but some need both balance.

TSH can take long time to recover focus on FT4 & FT3.  

Discuss option of block & replace.  

Iron results - 

Serum iron level 21.8 umol/L Normal range (9.0 - 30.4)

Serum transferrin  2.26 g/L (2.50 - 3.80) LOW

Unsat iron binding capacity 57 umol/L (45 - 81) 

Transferrin saturation index 38 % (15 - 40) 

Someone knowledgeable will hopefully be along soon.  

Vitamin D  61 nmol/L (50 - 250).  Not optimal, raise to 80nmol. 

B12 247 ng/L (211 - 911) Very low in range.   Needs to be 50% =561

[G172125 in reply to PurpleNails]

I’m on 50mg per day of PTU, Dr said to stay on that for now. What causes serum transferrin to be low?

[PurpleNails Administrator in reply to G172125]

the serum TSH?

The TSH “thyroid stimulating hormone” is a pituitary hormones which signal thyroid to produce.  

TSH doesn’t cause symptoms it part of the thyroid function system -  the thyroid hormones causes the symptoms. 

If thyroid hormones are too low is rises in an attempt to get the thyroid to work harder & make more hormone. 

When thyroid hormones are high it reduces as a signal to lower production. 

 With Graves the thyroid is being stimulated out side of this feedback process. 

The TSH  can take time to recover even in Healthy individual and therefore is not a reliable measure.  

There are also cases if you’ve been hyper for a prolonged time the TSH remains down regulated & does not recover & function as a  accurate reflection of ft4 & ft3.  

 This is what happened to me my hyper was missed for nearly 5 years, I’ve been on carbimazole 4 year with euthyroid level but TSH has remained undetectable.  

dr likely hoping FT4 & FT3 balance out. Do you have another test schedule. Eg in 6 weeks. If levels remain similar you need to push for block & replace as it likely they will stay disproportionate.

[PurpleNails Administrator in reply to PurpleNails]

edit. I see you asked about serum transferrin. Not TSH. - I’m unsure about iron panel results. Possibility do new post about iron results. It will be notice by knowledgable members.

[G172125 in reply to PurpleNails]

No I’ve not got anything scheduled. I’ve only seen the endocrinologist once and I’ve got to chase my Gp just to even get my prescription I feel like I’ve just been told I have graves and left to it. I’ve not got anymore scheduled blood tests or appointments I just keep asking the receptionist to add thyroid tests on the blood form everytime I go for a full blood count because I keep getting mouth sores

[PurpleNails Administrator in reply to G172125]

This is terrible.  You should be having 6 weekly test until stable + you are not stable until FT4 & FT3 in range.  

GP probably leaving to endocrinology.  No reason why endocrinologist team can’t arrange blood test & telephone to discuss results & adjust PTU dose accordingly.  Many hospital do telephone clinic between in person appointments.  

Can you contact endo & leave message.  Are they aware of this low FT4 & high FT3?  PTU 50mg is 1 pill? & equivalent to 5mg carbimazole so you have been given low dose.  

Many doctors would increase as TSH low. Likely left as is because FT4 low.  Seems doctors not accounted for high FT3.

[G172125 in reply to PurpleNails]

yes one 50mg pill a day. I’ve left a message with the endocrinologist secretary to hopefully get a telephone appointment lol

[SlowDragon Administrator]

also need folate tested and ferritin

What vitamin supplements are you currently taking

You will need daily vitamin D, separate B12 and a vitamin B complex

Have you had coeliac blood test

Are you on, or tried strictly gluten free diet

[G172125 in reply to SlowDragon]

Not currently taking any vitamins. Not had coeliac blood test. I’m going to try gluten free diet . My ferritin was 16ug/L range 10-291. Don’t think my folate was tested

[SlowDragon Administrator in reply to G172125]

Get coeliac blood test done FIRST

Poor gut function with Graves’ disease or 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. 

 A trial of strictly gluten free diet is always worth doing

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

Hashimoto’s and leaky gut often occur together

Both dairy and gluten are inflammatory foods

A strictly gluten free diet helps or is essential due to 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

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...

[SlowDragon Administrator in reply to G172125]

Vitamin levels most likely low because of low Ft4

Ferritin is deficient

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 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-...

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. ‘

[pennyannie in reply to G172125]

This ferritin result alone should be ringing an ' alarm bell " - and likely causing your mouth issues - is there another doctor you can see at this surgery as this is simply not acceptable.

B12 also needs attention and needs to be 500 ++ with folate at around 20 :

Vitamin D needs to be around 100 and ferritin at around 100:

[G172125 in reply to pennyannie]

The drs receptionist said no appointment was necessary because all my levels was within the normal ranges . The last appointment I had with the Gp was as two weeks ago about my mouth problems and she said it was caused by my thyroid levels and it will settle eventually. I pushed for her to test my iron and vitamin levels. Any symptoms I have just seem to be brushed off as caused by my thyroid. My folate was tested but it just says n/a . The only abnormal result in my iron studies was the transferrin ?

[pennyannie in reply to G172125]

So what is she proposing to be about this 1 abnormal result ?

Wait to collect a few more " abnormal " results and claim the jackpot ??

Doesn't allowing this happen to a patient question her medical knowledge and competence ?

Ferritin is already much too low - mine was at 22 and flagged as needing investigation, and I had to have an endoscopy and colonoscopy because of my age - I was then late 60's ) :

Your ferritin is not going to get any better by ignoring it :

Show her the guidelines she is meant to be following as detailed by SDragon.

Whether it's got anything to do with your thyroid or not - your ferritin and B12 are much too low and need some medical intervention - your vitamin D and folate = can't see a reading though - can probably be supplemented by yourself.

It seems that doctors are not taught about vitamins and minerals and some of guidelines for ranges are too wide to even be sensible and why we must be proactive in this area ourselves and rather than be on the back foot with deficiencies as the NHS would leave us - do this bit of the job for ourselves.

Is there another doctor there - sorry I'm getting angry for you :

[G172125 in reply to pennyannie]

can ferritin be bought over the counter? Looking through my medical record it has always been on the low side especially when I was pregnant.

The only result I can see for folate was from 2018 and that was 2.4 range>5.4. I wasn’t given anything then either.

It really is frustrating. I just feel as though the Gp Is fed up of me mithering them .

I’ve phoned my endocrinologist and she said she will pass a message on to try get a telephone appointment but I’m not sure if they will help with vitamins and iron

[pennyannie in reply to G172125]

OK - so you do have an endocrinologist who is responsible for this current phase of ill health - some endo's do understand better the vitamins and minerals - bit it does seem to be more a case of pot luck.

The thyroid is a major gland and responsible for full body synchronisation which includes your metabolism.

Too fast a metabolism as in ' hyperthyroidism - and you body struggles to extract key nutrients through your food and your vitamins and minerals can nose dive through the ranges :

Too slow a metabolism as in ' hypothyroidism ' and the same situation happens :

Metabolism has to be optimal - and when on an AT drug it needs regular monitoring every 6-8 weeks with a TSH, Free3 and a Free T4 reading and regular AT dose adjustments so your levels of T3 and T4 do not fall too far through the ranges and you suffer the equally disabling symptoms of hypothyroidism.

So yes - these vitamin and mineral results are possibly thyroid related - but this shouldn't stop the doctor shoring up these core strength vitamins and minerals as when these are low in range your health issues are further compounded - which seems to be where you currently find yourself.

P.S. I ended up supplementing all 4 myself and stayed away from the doctor as i was so angry with how i had been treated post RAI thyroid ablation - and having been refused any treatment other than T4 Levothyroxine started self medicating and buying my own thyroid hormone replacement.

You are in a very different place to me - you are in the NHS system and the NHS have a duty of care and responsible to run the appropriate tests and medicate you accordingly.