Hello , Thank you in advance for any one who takes time to look at this post and advise me
So as you know I am newly diagnosed Hashimotos. This weeks test results: obviously Ferritin is low and has been for some time although has improved and is now seen as satisfactory by GP. Not sure how to interpret the white blood differentials low lymphocytes?
9.05.2023 after 7 weeks 50mcg levothyroxine.
TSH: 1.80. T4: 12.8. T3 Not done .
Serum B12: 602ng/l
Serum folate: 15.9
Serum Ferritin: 24ug*/L
Vit D: not done ( although it was discussed with GP who said it was a good idea!)
Haemaglobin 139g/l, Total white blood cells: 4.5. Red blood cell count: 4.33. haematocrit: 0.419
TSH 11.77*. T4: 9.8. T3 [not done] Liver function serum total bilirubin 30umol* diagnosed with Gilberts Syndrome 2000. so elevation not unusual. Lymphocytes: 1.7
September 2022:
TSH: 4.57. T4: 10.00.
Ferritin 13*. ug/l Lymphocytes 1.4.
June 2022. presented at Gp with long history extremely heavy periods and extreme exhaustion.
TSH: 7.65* T4: 9.8. T3: not done. Ferritin 7.ug/* prescribed Ferrous fumarate 210mg (2 a day) adverse reaction with IBS so only took for a month. Lymphocytes 1.5.
Was taking Feel Multivitamins until a month ago. Currently taking Milk Thistle 4000mg daily Selenium 200ug daily Vitamin D 1000iu daily.
Advise on ferritin and other supplements gratefully received. 😀
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.
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
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
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.
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. ‘
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
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
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
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
Thank you , so much information, I'm speed reading so forgive me if I'm not quite making sense ...Please add ranges on Ft4 results, I've added the screenshot.
Was test done early morning, ideally 9am and last dose levothyroxine 24 hours before test.
Yes 8am , definitely 24 hour since last dose of levothyroxine. .
Which brand of levothyroxine are you currently taking. Mercury
Vitamin D advice noted will chase .
I'm currently week five of the autoimmune protocol diet and have not had any gluten or dairy products in five week , and intend to not reinstate gluten ...ever . No tests done or offered from GP ..re coeliac status. Ferritin advice noted and will chase GP on that score ..not sure why GP said it was a satisfactory result when clearly it isn't. Lots more reading thank for all the links they're incredibly helpful.
No I'm not vegetarian or vegan but have had a meat 'light'diet for a few years ..the heavy periods have been immensely difficult for years and so the blood results are not surprising. Not tolerating the ferrous fumarate hasn't helped. Levels are picking up bit no where near appropriate.. explains symptoms. 🤨
Thank you, I'm very confused by the percentage ranges ? What is the ideal percentage? Is there any literature on this method of calculating, the link took me to the calculation but no explanation..
Most people when adequately treated will have Ft3 (active hormone) at least 50-60% through range and usually Ft4 (levothyroxine) will be a little higher at least 70% through range
Testing with last dose levothyroxine 24 hours before test
Thank you , where can i find the background information to support the use of this percentage range ? I've had a look through this forum and a bit of google, the link just gives me the calculator no information ..i need to understand the rationale and evidence to support it before i attempt to discuss with my GP , it doesn't appear on NHS radar ? I have booked a telephone consultation with a GP tomorrow to discuss my low ferritin, lack of Vit D test and the over all management of my Hashimotos and its relationship with Iron deficiency. To be honest anxiety is escalating as this proactive stance in feeling like confrontation ( recovering people pleaser ) lots of deep breathes !!!
Hi, the percentage calculator is really helpful when different labs use different ranges but also when the NHS has a wide range of 'normal' so you can work out if you are right at the lower end of 'Normal' or top end... 1% can mean just before becoming 'deficient' on their scale though well below optimal and becoming a much bigger issue... we try to aim for optimal, which for most things is somewhere above 50% 🤗
Don't fear showing some knowledge, many are quite happy to be guided by the patient , you often don't get much help unless you request tests which they like to refer too 😉
They mightn't act on them but you can at least see what over the counter supplements will help you
Thank you for your reassurance To be honest I don't want to take Ferrous Fumerate as it played havoc with my stomach last time and GP knows this , so I do know having a complete blood profile for the Iron deficiency will lead to that prescription and the ensuing discussion with GP!! The cause is clear years of incredibly heavy periods and a Haem Iron light diet/not quite vegetarian and actually possible Coeliac [all the symptoms no diagnosis] I'm not going down the diagnosis route with GP I would prefer to continue the elimination and work with that , I've been 6 weeks without gluten [so wouldn't be able to have that test] and have seen some good changes, long way to go with stomach, digestion and absorption ..I have just sent off a sample of stool for analysis of gut bacteria and am hopeful I can get some idea of how my gut is performing to add into the information. I have noticed a kinder Haem iron supplement in one of the links in here and will be looking further into that to support my Iron. I feel so sad that the GP practice is so reactive and minimalist in providing support rather than a proactive stance which would probably save the NHS a significant amount in time and money. I worked for ten years as a Nurse and once upon a time wouldn't have blinked at asking and discussing with doctors regarding my health or a patients health. I have lost my confidence and am now feeling vulnerable and anxious . I dare say I'm not alone with that, and really appreciate the support of this group
It is a real shock when you realise that making you well isn't really the remit and they just want you in the 'normal' range 😕
I'm one of a growing bunch that have done well with the Three Arrows Heme and no upset tum or awkward timing😅(terrible website but excellent product and service!)
I had terrible stomach issues which improved greatly once I got my fT3 level up, I still avoid dairy, nightshades and high histamine foods.
Your fT4 is still at the bottom end of range so though an increase would help without optimal levels of B12, Vit D, Folate and Iron your body won't be able to make the most of it to convert it into the active fT3
p.s. Hypo and Meno steal your confidence, once you are optimal the old you will resurface 🤗 are you using HRT?
😁I think I have quite a way to go before I'm firing on all cylinders again!! Big girl pants on to navigate GP and ermmm no HRT long story re Mirena progesterone coil, it went in November via a Gynecology consultant to help with excessive bleeding I asked it to be removed March, very disgruntled GP reluctantly removed it ..I wanted to feel/read my body and know which part of me was doing what ... it has given me a clearer picture of gastric issue and the gyne picture and thyroid and ferritin deficiency. all symptoms Menopause, HypoThyroid, Iron Deficiency are the same so unpicking needed a clean slate ...not sure if any of that made sense but im perfectly happy for now dealing with the issues i have
I did just the same with regards to my last replacement Mirena to regain some control, but be aware hypo and meno symptoms crossover and low thyroid hormones often leads to low sex hormones… I now supplement all of them as they all hit rock bottom 🙄
When on levothyroxine we need high enough levels ……not just within range
Levothyroxine doesn’t top up failing thyroid…..it replaces it
Even if we frequently have to start slowly and can’t tolerate starting on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Comprehensive list of references for needing LOW TSH on levothyroxine
The link between TSH, FT4 and FT3 in hyperthyroidism is very different from taking thyroid hormone (T4) in therapy. In hyperthyroidism, FT4 and FT3 are usually well above range and TSH is very low or undetectable. In therapy, FT4 can be high-normal or just above normal, TSH can be suppressed but FT3 (the important hormone that controls your health) will usually be in the normal range. FT4 and TSH are of little use in controlling therapy and FT3 is the defining measure. A recent paper has shown this graphically:
Heterogenous Biochemical Expression of Hormone Activity in Subclinical/Overt Hyperthyroidism and Exogenous Thyrotoxicosis
February 2020 Journal of Clinical and Translational Endocrinology 19:100219
DOI: 10.1016/j.jcte.2020.100219
LicenseCC BY-NC-ND 4.0
Rudolf Hoermann, John Edward M Midgley, Rolf Larisch, Johannes W. Dietrich
Thank you, yes I think I found that research and I've stopped taking milk thistle. Funnily enough lemon balm causes issue too for hypothyroidism, and is a common ingredient in calming teas and tinctures so I've had to filter out that as well ...am now taking, iron bisglycinate 40mg magnesium bisglycinate 400mg sélénium 200mcg and vit d 4000iu ... hopefully my ferritin will respond..if it doesn't I'm looking at heam iron supplements
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Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
To be honest I don't want to take Ferrous Fumerate as it played havoc with my stomach last time and GP knows this , so I do know having a complete blood profile for the Iron deficiency will lead to that prescription and the ensuing discussion with GP!! The cause is clear years of incredibly heavy periods and a Haem Iron light diet/not quite vegetarian and actually possible Coeliac [all the symptoms no diagnosis] I'm not going down the diagnosis route with GP I would prefer to continue the elimination and work with that , I've been 6 weeks without gluten [so wouldn't be able to have that test] and have seen some good changes, long way to go with stomach, digestion and absorption ..I have just sent off a sample of stool for analysis of gut bacteria and am hopeful I can get some idea of how my gut is performing to add into the information. I have noticed a kinder Haem iron supplement in one of the links in here and will be looking further into that to support my Iron. I feel so sad that the GP practice is so reactive and minimalist in providing support rather than a proactive stance which would probably save the NHS a significant amount in time and money. I worked for ten years as a Nurse and once upon a time wouldn't have blinked at asking and discussing with doctors regarding my health or a patients health. I have lost my confidence and am now feeling vulnerable and anxious . I dare say I'm not alone with that, and really appreciate the support of this group 
Help with recent test results - low TSH but feel fine
please see my latest test results 
Low but in range test results?
Low ferritin 
Very low ferritin level
