Test results need help

[shazthescot]

these are the results from Doctors i put in the calculor and looking for advice . I have underactive thyroid for 10 years . At present on 100 levo been feeling ill for few months tired all the time brain fog dry skin no energy.Doctor gave me 5mg of folic acid and review in 8 weeks refused to increase levo. In 10 years vitamins only tested twice and on no supplements.I Dont understand the results if anyone can help

[shazthescot]

TSH 4.99 mIU/L (0.27 - 4.2) 120.1%Free T4 (fT4) 14.6 pmol/L (10 - 22) 38.3%

Folate - Serum 3.2 ug/L (3.9 - 26.8) -3.1%

Vitamin B12 (active) 178 nmol/L (197 - 771) -3.3%

Ferritin 66 ug/L (30 - 400) 9.7%

[Jaydee1507 Administrator in reply to shazthescot]

For what reason did your doctor refuse a levo dose increase? It is clearly ABOVE the range.

B12 is also deficient. Are you vegan/vegetarian?

Ferritin should be 90-100 for our thyroid hormone to work at its best. Suggest increasing iron rich foods.

No D3 result.

[shazthescot in reply to Jaydee1507]

No not Vegan and he says no need to increase levo but gave me folic 5mg

[Jaydee1507 Administrator in reply to shazthescot]

I'd recommend making an appointment with a different, more helpful GP and taking these results along with you to show them.

Were these private blood tests as it's an active B12 result which NHS doesnt usually do.

You are deficient in B12 and your GP should be investigating if it is pernicious anaemia and offering you loading doses of B12.

When treated to remove symptoms people will usually feel well with a TSH of around 1 or just under. Yours is still above the reference range.

[SeasideSusie Remembering in reply to Jaydee1507]

Were these private blood tests as it's an active B12 result which NHS doesnt usually do.

It's not an Active B12 test that the OP has done, the reference range tells us it's a Total B12 test. The calculator is set by default to show "Active", it's just the way the member made the calculator, it's inaccurate, the word "Active" should be removed. I have contacted the member who made this calculator to ask if he will remove the word "Active" as it is causing confusion.

Calculator

[shazthescot in reply to Jaydee1507]

I had thyroids done 1st receptionist says retest 8 weeks i demanded to speak to doc and explained how ill i was feeling he then did the blood count says he wont increase levo as from results i just need folic

[SlowDragon Administrator in reply to shazthescot]

Make an appointment to See a different GP

On levothyroxine, TSH should be BELOW 2

ALWAYS test thyroid levels early morning and last dose levothyroxine 24 hours before test

Ft4 is far too low

Approx how much do you weight in kilo

Guidelines on dose levothyroxine by weight is approximately 1.6mcg per kilo per day

This can be helpful to get dose increase

Comprehensive list of references for needing LOW TSH on levothyroxine 

healthunlocked.com/thyroidu....

TSH should be under 2 as an absolute maximum when on levothyroxine 

gponline.com/endocrinology-...

NHS England Liothyronine guidelines July 2019

 

sps.nhs.uk/wp-content/uploa...

Page 9 

Test for Deficiency of any of the following: Vitamin B12, Folate,  Vitamin D, Iron

See page 13 

1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

[SlowDragon Administrator]

Folate - Serum 3.2 ug/L (3.9 - 26.8) -3.1%

Vitamin B12 (active) 178 nmol/L (197 - 771) -3.3%

Do NOT start folic acid yet

With BELOW RANGE B12 this MUST be addressed BEFORE starting folic acid

It is vital that if you need to supplement both B12 and folate that B12 daily supplement or injections started a week before the folate.

See different GP

Really need testing for testing for Pernicious Anaemia before starting B12 supplements, or quite likely need B12 injections

Do you have Low B12 symptoms 

b12deficiency.info/signs-an...

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

[SlowDragon Administrator]

Request/insist on vitamin D test and coeliac blood test too

[SlowDragon Administrator]

Looking at previous posts

You have high thyroid antibodies, this confirms autoimmune thyroid disease also called Hashimoto’s

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels 

Low vitamin levels affect Thyroid hormone working 

Poor gut function 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

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 and may slowly lower TPO antibodies 

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...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

Hashimoto’s and leaky gut often occur together

[SeasideSusie Remembering]

 shazthescot

Vitamin B12 (active) 178 nmol/L (197 - 771) -3.3%

That is not Active B12, that calculator has that wrong. Your reference range is telling us that your test was a Total B12 test. The Active B12 test has a much narrower range, eg. 37.5-188.

Your B12 is below range. Your GP should test you for B12 deficiency and pernicious anaemia.

Do you have any signs of B12 deficiency – check here:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency and it is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.

Doctor gave me 5mg of folic acid and review in 8 weeks

Quite simply, do not take this at this stage. See above - you need to have B12 tested and if you have B12 deficiency or Pernicious Anaemia then treatment for that should start before adding folic acid.

[shazthescot in reply to SeasideSusie]

The b12 was 178 range was 197- 771

[SeasideSusie Remembering in reply to shazthescot]

I know, I have quoted that. I copied and pasted into my reply what you had written originally and you can clearly see that your result is below range and indicative of B12 deficiency. One cause of B12 deficiency is pernicious anaemia. As I said above, check the links I have given you to see if you have any signs/symptoms of B12 deficiency and if so you need testing for B12 deficiency and pernicious anaemia before starting folic acid for the reasons I have mentioned above.

[helvella Administrator in reply to SeasideSusie]

Spot on.

[shazthescot]

I saw a doctor on Monday lovely guy just covering for 2 weeks.I had printed off a letter with all my symptoms and with all the great information from you guys could argue my point about my test results.

He had great knowledge about hypothyroidism

Increased my levothyroxine 3 injections b12 for 2 weeks then 2 for 2 weeks

He organised loads of blood tests full thyroid including t3 and antibodies .

Full blood count vit d test liver kidney funtion and parathyroid test igot that done yesterday .so waiting on results

Thanks for all the advice