Hello, I'm a women in my mid 30s and have recently been informed by my GP that I have 'subclinical hypothyroidism' after a blood test showed my TSH level was 9.7 mIU/L [range: 0.27 - 4.2].
My GP said she wouldn't usually prescribe Levo in my case, but because I am trying to conceive she did and is aiming to get my TSH to or below 2.5 mIU/L. She has prescribed 25 micrograms of Levothyroxine daily and will test my TSH level again in 2 week's time (6 weeks after I started to first take Levo). I've been feel tired and having low energy for some years on and off and have suffered with very cold feet for as long as I can remember so not sure if that's linked to this?
I read a lot of helpful information from this forum which prompted me to get a private advanced thyroid test with Medichecks. I'd really appreciate any help understanding my results and next steps please?:
(I had this blood test done in the morning, my last Levo dose was 24 hours before the test, I don't take any Biotin supplements and I was fasted. I'd been taking 25 micrograms of Levo for about 2 weeks at this point.):
I'm assuming I don't have Hashimoto's as my antibodies are low in range, so I guess there must be another reason for my thyroid issues?
The Medicare doctor suggested I now have a serum Methylmalonic Acid (MMA) blood test to see if I have an underlying B12 deficiency as my Vitamin B12 is a 'normal' level but low in range. My serum vitamin B12 level was tested as part of a different test about a year ago and was well above range (at 1067 ng/L [Range: 197.0 - 771.0] )but the doctor at the time said that was nothing to be concerned about. Do you think it's worth me getting this MMA test and if so, do you think the NHS would do this or I'd need to pay for it privately?
Any other pointers on what I should do next or what my test results mean would be really appreciated as I'm not too sure.
Thanks!
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Junebuggg
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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.
- Free T3 4.1 pmol/L (3.1 - 6.8)27% through the range
- Free Thyroxine T4 13.4 (12 -22) 14% through range
Testing just two weeks after a change of dose won't really tell you anything very reliable about your TSH (which is a pituitary hormone not a thyroid hormone, but doctors just love it to tell them everything they think they need to know about thyroid function), and your TSH won't have settled down to a realistic level for your current dose. We normally suggest waiting 6 - 8 weeks before testing.
Your Free T4 and Free T3 are both low in range as would be expected in hypothyroidism. We usually suggest that hypothyroid people feel best with Free T4 around 60% to 80% through the range, and Free T3 around 50% to 70% through the range. But these suggested levels are very flexible and shouldn't be taken as being absolutely ideal for everyone.
Your thyroid antibodies are not currently showing evidence of Hashimoto's Thyroiditis (also known as autoimmune thyroid disease). But antibodies do fluctuate a lot.
CRP HS 0.43 (< 3)
CRP is a measure of inflammation. Your result is very low, and a result < 1 is optimal, suggesting that you aren't suffering from significant inflammation.
- Ferritin 63 ug/L (30 - 150)
- Folate - Serum 39.4 nmol/L (8.83 - 60.8)
- Vitamin B12 - Active 51 pmol/L (37.5 - 188)
- Vitamin D 90 nmol/L (50 - 250)
For people with thyroid disease optimal for ferritin is often quoted as 90 - 110 ug/L, so yours is a little bit low, although not dramatically so. Ideally you would have an iron panel done before considering supplements. An iron panel includes Serum Iron, Transferrin Saturation Percentage, Total Iron Binding Capacity (TIBC), Ferritin, and CRP.
The problem with iron and ferritin is that they often appear to be independent of each other, although they obviously can't be. So, depending on your various health issues and genetics, iron might be low while ferritin is high, iron might be high while ferritin is low, or other combinations. What you should avoid is supplementing iron to raise ferritin (for example) and being unaware that serum iron is rocketing upwards at enormous speed while ferritin hardly changes. The reverse could happen too. High iron or ferritin is dangerous because the excess could deposit itself in various organs. The body has no normal means of getting rid of excess iron/ferritin except by bleeding e.g. menstruation, and everyone loses a tiny amount in faeces.
Another option for raising iron/ferritin is to include more iron in your diet. If you eat meat then eating a portion of liver once every 7 - 10 days might help.
Folate - Optimal is upper half of the range, so yours is optimal already, which is good.
Vitamin B12 - Your level is rather low. Minimum for Active B12 is 70, optimal is 100+. You might need testing for B12 deficiency or Pernicious Anaemia.
SeasideSusie has info on what to do about this. Hopefully she'll give you some links on the subject.
Vitamin D - Optimal is 100 - 150 nmol/L. Yours is very close to that, so I wouldn't worry about it.
I could be wrong, but I think your reference to Medicare is a mistake and you really mean Medichecks?
When I answered you earlier I was working on the assumption for a few minutes that you were from the USA, but the tests and reference ranges were not ones I'd ever seen from the USA before.
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