help with blood tests

[Sparkie1986]

hi all- could someone help me with the below blood test results. I was tested for auto immune disorder last month and that came back clear. Is there a test I should suggest next? My iron and saturation levels have come back low also. I take 50mg of levothyroxine. I originally developed hypothyroidism post natally over 2 years ago. Thanks

[SarahJane1471]

Hi, those levels look good to me. Others with greater knowledge will come along soon to give more detailed advice. How do you feel? If you feel good then don’t change anything but if you still feel unwell there is room for a 25mcgs increase.

[SlowDragon Administrator]

Was test done early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

How do you feel

High Thyroglobulin antibodies confirms autoimmune disease.

50mcg levothyroxine is only the standard starter dose. Your results suggest you might need next dose increase up to 75mcg

FT4: 17.4 pmol/l (Range 11.9 - 21.6) = only 56.70% through range

Most people when adequately treated will have Ft4 at least 70% through range

ESSENTIAL to test vitamin D, folate and B12 levels too

What were iron and ferritin results

Low vitamin levels are direct result of being left on inadequate dose of levothyroxine

Low vitamin levels tend to lower TSH (and TSH is all many GP’s look at)

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we MUST have good vitamin levels

[Sparkie1986 in reply to SlowDragon]

test was done at 1pm- fasted and with dosage of 50mg intake

Results

[Sparkie1986]

thanks both. I have joint pain but have put that down to exercising etc. but feel very crampy a lot of time and cycles are irregular. Not sure if that affects things. Below is snapshot of rest of results.

Result

[SlowDragon Administrator in reply to Sparkie1986]

See GP

Your iron and ferritin are extremely deficient

You will need iron supplements for many months or possibly an iron infusion

Any obvious reason for such low levels

Eg

Are you vegetarian or vegan ?

Heavy periods?

Low iron/ferritin extremely common when hypothyroid

You almost certainly need dose increase in levothyroxine

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

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...

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. ‘

Here’s absolutely excellent reply by @humanbean

on iron and ferritin panel test results for another member 

healthunlocked.com/thyroidu...

Good explanations of iron 

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

Helpful info on iron infusion and supplements 

healthunlocked.com/thyroidu...

[Sparkie1986]

Bit d results below and b12

Blood results

[SlowDragon Administrator in reply to Sparkie1986]

These look good

Do you supplement B12 or vitamin D?

No folate result?

[Sparkie1986 in reply to SlowDragon]

I supplement vitamin d and k2 (it’s a combined supplement) and take cucumin supplement daily. I eat a very balanced diet lots of fruit and veg.

I had my first cycle post pregnancy in January and it lasted almost 4 weeks. It was a heavy cycle - would this lower iron suddenly or is it more likely to be something longer term than that.

The thyroglobulin results- is it certain given the level of those it’s some sort of autoimmune disorder? Given my go just tested for that a few weeks ago should I request a repeat?

I had the results I posted today carried out privately.

[Sparkie1986 in reply to SlowDragon]

no folate just folic acid which was 9.1

[SlowDragon Administrator in reply to Sparkie1986]

Folic acid is folate

What was the range ?

How long after giving birth was this test done?

TSH would have been higher probably at least over 2 if tested at 9am

Make an appointment with GP.

Before appointment post or email in those results

GP will almost certainly want to retest on NHS before treatment

Make sure you book 9am appointment

NHS only tests Thyroglobulin antibodies if TPO antibodies are high. NHS frequently won’t currently diagnose autoimmune thyroid disease on just high TG antibodies

pubmed.ncbi.nlm.nih.gov/303...

Elevated TgAb levels are associated with symptom burden in HT patients, suggesting a role of thyroid autoimmunity in clinical manifestations of HT. Based on these results, we recommend screening for TgAb antibodies in HT patients with symptom burden.

[Sparkie1986 in reply to SlowDragon]

range was 3.8-26.8.

Tests were done 6 months PP.

My GP is so adverse to requests for blood tests hence why I went private for the above results. So apologies if I’m asking you to repeat yourself but is there a specific antibodies test I should request?

Thanks so much for all the information- it’s refreshing to the usual block wall I’m met with at my clinic.

[SlowDragon Administrator in reply to Sparkie1986]

Just give copy of these results to GP and copy of the research on Thyroglobulin antibodies

But because TPO antibodies are negative GP may not agree that high Thyroglobulin antibodies shows autoimmune thyroid disease

Iron and ferritin need improvement

Levothyroxine dose may need increase to 75mcg daily