Blood tests.

[moljanie]

Hi could anyone have any knowledge on blood results . Have been off carbumazole for 8 years and no problems . Prior diagnosis of graves which has been fine. Started hrt 1 month ago and am extremely fatigued and very stiff and painful joints so booked a blood test . Not sure what bloods mean but definitely not experiencing hyper symptoms . Could it be hypo symptoms as I feel OK one day then ill the next . Any ideas anyone please .

[tattybogle]

related post with TSH FT4 fT3 results here healthunlocked.com/thyroidu...

Hi moljanie,,,you can add that other image in a reply to this post , otherwise it will get confusing having two posts going at once , then delete the other post.

[tattybogle]

TSH 4.93 [2.7-4.2] this is over range which does indicate your thyroid may be struggling to make enough T4/T3 for you . which could explain feeling some hypothyroid symptoms

The fT4 and fT3 are currently still in range

fT4 15.9 [12-22]

fT3 4.8 [3.1 -6.8]

the raised TPOab and TGab could either indicate hashimoto's (autoimmune hypothyroidism) .where the immune system very slowly destroys the thyroid ...or they could just be raised because you have had Graves in the past) but i think graves can eventually end up with hypothyroidism

The antibodies which cause Graves (TRab / TSI) have not been tested .

I'm not so good at answering questions about "Graves and what happens next" , so i'll leave that to others who know more , they will no doubt be along shortly .

[moljanie in reply to tattybogle]

Thank you. I was thinking that maybe thyroid is slowly being destroyed by anti bodies .

[tattybogle in reply to moljanie]

*note moljanie.

It is not the Thyroid Peroxidase antibodies that damage / destroy the thyroid in hashimoto's disease .

They are used to confirm the diagnosis of "autoimmune damage" , but they do not cause it .

They are part of the clean up process after some damage has been done.

The immune system does the damage ( lymphocytes infiltrate the thyroid and cause fibrosis in bits of the thyroid , so it can't make so much T4 anymore , the fT4 in the blood goes bit lower and the TSH level goes up a bit in response .. until eventually , (if enough damage is done) , it cant make enough T4 at all , the fT4 level in the blood goes below range . and the TSH goes even higher .

Thyroid Peroxidase is contained inside the thyroid gland .. when the thyroid is damaged , some Thyroid Peroxidase leaks out (...sort of , not a totally scientific explanation )

The Thyroid Peroxidase antibodies attach to the spilled Thyroid Peroxidase , like a label saying " somebody clean this up , it shouldn't be here"

because this autoimmune process is so complex to explain (and not 100% understood yet anyway ) , you will read many articles, even science papers, that say "antibodies damage the thyroid" ....this is sometimes a form of shorthand (to avoid having to go into loads of detail about an extremely complex bit of the immune system ,when that was not what the paper is looking at ) . or sometimes it is just that the writer has seen it written so often somewhere else and copied it without question.

it is only in papers that are specifically looking at the autoimmune process /antibodies in detail that you will find the more accurate description of 'what does what' .. but nobody reads them because they are so complicated they give everyone a headache lol.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The antibodies that cause the high levels of T4 and T3 in Graves disease, work differently .

They are called TRab (Thyroid Stimulating Hormone Receptor antibodies )

They are the same 'shape' as TSH ( Thyroid Stimulating Hormone) and so they fit into TSH receptors on the thyroid, and 'ask' it to make more T4 / T3 (just the same as 'real' TSH does) so you get too much T4/T3 while the TRab are present .

If the levels of TRab go down .. then the thyroid stops making too much T4/T3 and you are in remission .

So TRab are used to confirm a diagnosis of Graves Disease, and once on carbimazole (if they go back down and stay down) , they can indicate remission is likely ......so eg. they can be used as a guide to whether to try coming off carbimazole, or to wait longer.

(and just to make life complicated ~ there are different sorts of TRab .. one is 'stimulating' (acts like real TSH on the thyroid ) ..... and one is 'blocking' (blocks real TSH from getting into the thyroid)

[SlowDragon Administrator]

Was test done early morning

Take/post/email these results to GP

Request repeat test in 6-8 weeks and ultra sound scan of thyroid

Meanwhile request testing of vitamin D, folate, B12 and ferritin plus coeliac blood test

[moljanie in reply to SlowDragon]

Thank you. All vitamin results are in range . Vit d was 49. Which doc said was slightly low and to a supplement. What would optimum vit d level be please.

[SlowDragon Administrator in reply to moljanie]

please add actual results and ranges for folate, B12 and ferritin

Within range is not the same as “good” levels

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[moljanie in reply to SlowDragon]

Vitamin level

Tests

[SlowDragon Administrator in reply to moljanie]

no ferritin result

Iron is only mid range

B12 and folate too low

B12 is very low

Do you have Low B12 symptoms 

If you do firmly request GP test for Pernicious Anaemia before starting any B vitamins

b12deficiency.info/signs-an...

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

GP may prescribe B12 injections or daily supplements

If not you likely benefit from self supplementing

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement initially for first week before adding a separate Vitamin B complex

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week 

B12 drops 

healthunlocked.com/thyroidu...

or

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...

supplementing 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-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

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 - might find online at iHerb

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

[moljanie in reply to SlowDragon]

Ferritin

Ferritin

[SlowDragon Administrator in reply to moljanie]

So ferritin is slightly too low as well

Aiming to keep over 70 minimum and around 100 better

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

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...

[moljanie in reply to SlowDragon]

Hi after looking at b12 I think that's my starting point as symptoms are there. You have been most help ful. I was thinking maybe to book a b12 jab privately as I'm so desperate to feel better . Would you think that would be OK to do . Just to boost me as I cannot cope with symptoms for weeks on end .

[moljanie in reply to SlowDragon]

Thank you I will try these supplements I'm so tired of feeling so out of whack . Hopefully I shall improve. Gp doesn't seem bothered by results . Going to have to treat myself . God bless you for your help.

[moljanie]

Bloods

Results

[pennyannie]

Hello Moljanie :

Well your Graves could have burnt it self out but it does appear that you are dealing with high over range antibodies that are generally associated with Hashimoto's auto immune disease.

Do you have previous readings on these antibodies - have they been there since your diagnosis of Graves or a new development - have you started experiencing ' swings ' in symptoms or just plodding along and more ' hypo ' than anything else ?

Graves will have left your body exhausted and it's important to ensure your core strength vitamins and minerals - especially those of ferritin, folate, B12 and vitamin D are up and maintained at optimal levels to support your overall health and well being.

The good news your TSH has moved and not stuck down in the low/suppressed area of the range giving the impression that you could be over medicated - as with Graves the TSH is the last reading to recover, if it ever does, mine hasn't though I'm post RAI in 2005.

Your current symptoms sound as though you could be slipping into hypothyroidism and it is said that a TSH reading over 3 suggests hypothyroidism though the current guidelines are suggesting ones TSH has to rise to over 10 before thyroid hormone replacement treatment can be considered.

I have read on here that some forum members find they need to increase their thyroid hormone replacement after introducing HRT - I have no experience of HRT.

You might like to read around Graves, it is an auto immune disease and ' for life ' and the most well rounded of all I read is that of Elaine Moore - elaine-moore.com

[moljanie in reply to pennyannie]

Hi thankyou for your response I've never had any antibodies results before as NHS never ever tested. Tft was all that was ever on my blood forms . Endo only ever gave me tsh level. He over medicated me for a while there. When I stopped carbimaxole I settled for 5 years + . No thyroid Meds at all but joint pain has been a problem which I thought was declining estrogen. I think my b12 is the problem after some advice given on here. I've got all the symptom so going to start on that I think. Thank god for this forum . Gp just not knowing much at all really .

[pennyannie in reply to moljanie]

Well there should have been an antibody blood test run from your very first blood test when you first went to the doctor asking for help !

Do you have that original blood test reading and range somewhere as that could give us a clue ?

The Carbimazole should only be prescribed when there is the medial evidence and proof of over range and positive antibodies unique to Graves Disease which are generally expressed and as either a TR ab - a thyroid receptor blocking or a TSI - a thyroid stimulating immunoglobulin.

The reason for this is because both Graves and Hashimoto's start off with similar symptoms and the only way to tell these 2 AI diseases apart is through which antibodies were positive in your blood.

Hashimoto's AI thyroid disease s not treated with an AT drug - like Carbimazole.

For Hashimoto's = thyroidpharmacist.com