need help understanding my results pls!

[Luna777]

Hi everyone! I have been reading posts on here for a few weeks now and got to know so much information that I didn’t know before, but still confused and quite worried about my blood test results. I would really appreciate your help in understanding them and what should I do, or what should I say to my GP going forward.

I have been diagnosed with hypothyroidism around October 2022, only because after having covid (end of September) my thyroid gland has inflamed and I felt great discomfort in swallowing, it felt like I have got something stuck in my throat. I have also given birth in June, and during pregnancy level of antibodies were quite high, but not dangerous to the point of me taking meds, according to GP.

So, my 1st blood results were following:

• ESR - 29mm ( range 1-12mm)

• Thyroid Stimulating Immunoglobulins- <0.10 iu/L (range <0.56iu/L)

• Free T4 - 3.2pmol/L (range 10.5 -21 pmol/L)

•Thyroid Peroxide Antibody- 428 iu/ml (range 0-60 iu/ml)

• TSH - >150 mu/L ( range 0.35 -5.40 mu/L)

Then I have been prescribed levothyroxine (Teva) 50mcg and 2nd round of bloods was done after 2 weeks of me being on thyroxine.

2nd blood results :

• Free T4 - 8.3 pmol/L (range 10.5 -21 pmol/L)

• ESR - 29mm ( range 1-12mm)

• TSH - >150 mu/L ( range 0.35 -5.40 mu/L)

After this, it has been decided by both my doctor and me that he should increase the dose, as he said that 50 is not working.

So, since beginning of December I have been taking 100mcg of levothyroxine (Aristo). About 10 days after taking a new dose I have done bloods again, don’t remember why I have done them, but they were :

• Thyroid Stimulating Immunoglobulins- <0.10 iu/L (range 0-60 iu/ml)

• Free T4 - 14.8 pmol/L (range 10.5 -21 pmol/L)

• TSH - 29.95 mU/L ( range 0.35 -5.40 mu/L)

• Thyroid Peroxide Antibody- 421 iu/ml (range 0-60 iu/ml)

So, my last blood results were:

• Ferritin - 11.2 ug/L ( range 10.0 -291.0)

• TPO - 355 iu/ml (range 0-60 iu/ml)

• TSH - 12.62 mu/L ( range 0.35 -5.40 mu/L)

• Free T4 - 14.8 pmol/L (range 10.5 -21 pmol/L)

• Free T3 - 5.3 pmol/L (range 3.5 - 6.5 pmol/L)

I feel fairly all right, though I am overweight as I weigh 109kg now. My cholesterol levels are high too, and I am pretty sure it’s due to hypothyroidism.

I didn’t know that you should take your bloods before 9am, which I intend to do going forward, but I have been taking them between 10am and 12pm. And, I will be asking for B12, Vit D and folate tests next time round.

My worries, after reading posts here, that my TSH and TPO levels are still too high. Does it mean that my current dosage is not working for me and I have to ask my dr to increase it? I have been on 100mcg for almost 2 months now.

My ferritin levels have been always low as I have chronic anemia and I usually take ferrous fumarate 305mcg, but can’t do it at the moment, as my baby gets very constipated. And because I am breastfeeding, I can’t take vitamins (mentioned here for optimal thyroxine effect) other than D3, as far as I am aware. Also, I have been, I’d say, 95% gluten free for the past few weeks, after reading advices here.

Could you please help me to interpret my results? Are they too bad? Do you think I should request to increase my dosage after next blood tests or wait for another month, no matter what the results will be? If to increase, what impact higher dosage can have on my baby? As it’ll be quite high due to my weight, at least 150mcg.

[GlowCoach Administrator]

Taking thyroid hormones such as Levo is just a replacement for your own natural hormones so is safe in pregnancy and breast feeding. At lower doses the Levo was working for you, just you needed a higher dose.

You should get bloods done after 6-8 weeks on a stable dose so at 2 months you are due new bloods and a dose review. 10 days is too soon after a dose increase to test.

You haven't given reference ranges (numbers in brackets after your number) which vary from lab to lab so its important to quote them. I can see your TSH at 12.62 is way above any reference range so yes it's too high and you need a dose increase.

For ferritin, concentrate on iron rich foods such as chicken livers or pate a few times a week.

Levo dose won't necessarily affect TPO antibodies. These will fluctuate naturally although a completely gluten free diet may help to reduce them over time.

You shouldn't start supplementing before doing bloods for vitamin levels otherwise you don't know what or how much you need. As far as I am aware it is safe to supplement whilst breastfeeding.

[Luna777 in reply to GlowCoach]

Thanks for the info. I have added missing references in my post.

My bloods are due next week, so will be calling and asking for vitamins levels as well.

[tattybogle]

yes , you should get retested by GP now , . inform your GP of that TSH 12 result and book a new blood test with them ( they should be doing one of their own round about now anyway )

2 months is long enough on 100mcg to see the effect of that dose on T4 and TSH levels ,,and the TSH of 12 is clearly saying that 100mcg is not enough . (the aim is for TSH to be around 1 or 2 see this list of recommendations for GP's to keep TSH under 2/2.5 in patients on levo healthunlocked.com/thyroidu... )

(* TSH should usually respond within 6-8 weeks to the new level of T4 , but it can take a while longer than usual to come down when it's been as high as your was ... so sometimes you can't trust TSH be giving a completely true picture of your T4 hormone level at the time ... and so it is equally important to look at the fT4 level .. but we can't see how good your fT4 level is without knowing the lab ranges for those fT4 tests )

Levo can be increased by 12.5mcg /25mcg increments as well as 50mcg .. so your next dose is not necessarily going to be 150mcg straight away ..it would be more usual to increase to 125mcg at this point rather than 150mcg .. they increased you straight up from 50 to 100mcg without waiting more than 2 weeks for the blood test because you were extremely low on T4 at diagnosis ..and those low levels needed increasing without delay ,..... but usually you need to wait 6-8 weeks to get a true reading of new TSH and T4 levels after any dose change ... and once the dose is something like expected ( *or when we don't trust the TSH to be truthful yet_ it is good practice to go up in smaller increments to avoid ending up taking more T4 than is necessary ( which can make you feel worse than 'not enough' did )

[Luna777 in reply to tattybogle]

Thank you so much for your reply and explanation🙏🏼I have already called GP and booked my bloods for next week. Have not managed to book to test vitamin levels, but will call tomorrow morning to speak to the dr and request it.

[tattybogle in reply to Luna777]

good luck with that lol~ you may have to push quite hard as unless you've got a golopping case of scurvy or rickets , some GP's don't seem to know what relevance 'a vitamin' is to anything..

[Luna777 in reply to tattybogle]

🫤I’ll try my best, if not, will go privately.

Is there any studies that mention correlation between hypothyroidism and vitamins deficiency?

[tattybogle in reply to Luna777]

are there any studies that mention correlation between hypothyroidism and vitamins deficiency?

yes probably , but i don't have any links to hand SlowDragon do you have any links to support request for GP's to test vit b12/vit D/ folate/ ferritin ?

[helvella in reply to tattybogle]

How about:

The Relationship between Gastrointestinal Health, Micronutrient Concentrations, and Autoimmunity: A Focus on the Thyroid

europepmc.org/article/MED/3...

[tattybogle in reply to helvella]

Thankyou muchly x

[Luna777 in reply to tattybogle]

thank you 🙂

[Luna777 in reply to helvella]

thank you🙂

[SlowDragon Administrator]

Your high thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

When hypothyroid we frequently develop LOW stomach acid, this leads to poor nutrient absorption and low vitamin levels as direct result

Guidelines say hypothyroid patients should have vitamin D, folate, ferritin and B12 levels tested

ALWAYS get actual results and ranges

pubmed.ncbi.nlm.nih.gov/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

pubmed.ncbi.nlm.nih.gov/273...

Vitamin D insufficiency was associated with AITD and HT, especially overt hypothyroidism. Low serum vitamin D levels were independently associated with high serum TSH levels.

pubmed.ncbi.nlm.nih.gov/300...

The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.

ncbi.nlm.nih.gov/pmc/articl...

Our results indicated that patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia that is significantly associated with the degree and severity of the hypothyroidism. That encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency and serum calcium levels for all hypothyroid patients.

Same applies to low B12 - extremely common in hypothyroid patients 

All patients who are hypothyroid should have B12 tested 

ncbi.nlm.nih.gov/pubmed/186...

There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,

ncbi.nlm.nih.gov/pubmed/169...

Patients with AITD have a high prevalence of B12 deficiency and particularly of pernicious anemia. The evaluation of B12 deficiency can be simplified by measuring fasting serum gastrin and, if elevated, referring the patient for gastroscopy.

Folate supplements can help lower homocysteine 

ncbi.nlm.nih.gov/pmc/articl...

Levothyroxine can decrease serum homocysteine level partly; still its combination with folic acid empowers the effect. Combination therapy declines serum homocysteine level more successfully.

Low ferritin frequent in hypothyroidism 

endocrineweb.com/profession...

[Luna777 in reply to SlowDragon]

oh wow, thank you ever so much SlowDragon for all this information🙏🏼🙂really appreciate it. I feel like I now have some evidence to present to my dr and ask to test my vitamin levels.