What next?: Hello Have had some blood tests done... - Thyroid UK

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What next?

Amtired profile image
12 Replies

Hello

Have had some blood tests done and awaiting results on others, including FT3.

TSH - 5.10 (0.27 - 4.2)

Vit D - 103 (50 - 174)

Serum B12 - 242 (180 - 999)

Serum Ferritin - 28 (30 - 400)

Unable to find a folate result.

I have been using a Vit D3/K2 spray.

I still have the same symptoms, tiredness, cold intolerance etc that I started with. I am not taking thyroxine etc.

I have another GP phone call booked to discuss my results. What should I expect/ask for? and is there anything I can do in the meantime?

Again, thank you so much for sharing your vast knowledge 💐

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Amtired profile image
Amtired
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SovietSong profile image
SovietSong

Someone better clued up than myself will hopefully be on soon to give advice however as far as I'm aware most people need the tsh nearer 1 or under 2 at least to feel at best.Im sure the others on here will tell you to get results/ranges for t3 and t4 to give a better idea of where to go next.

SlowDragon profile image
SlowDragonAdministrator

Previous posts show you have high thyroid antibodies which confirms autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Vitamin levels

Vitamin D is good

Are you also taking a daily magnesium supplement?

Especially important on gluten free diet

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...

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...

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...

Amtired profile image
Amtired in reply toSlowDragon

Am using the vitamin D spray by Better you. Am not taking a magnesium supplement or been prescribed levothyroxine (yet)! Is there a magnesium supplement you would suggest?

Am managing well on a gluten free diet so far.

SlowDragon profile image
SlowDragonAdministrator in reply toAmtired

If you tend to suffer constipation, calm vitality magnesium powder is cheap and easy to use.

If don’t want something that affects bowels, Thorne citramate is good option. It’s a large capsule, but can open and tip powder into small cup water to drink.

SlowDragon profile image
SlowDragonAdministrator

Serum B12 - 242 (180 - 999)

B12 is too low

But GP might not agree as NHS generally only tests and treats vitamin deficiencies

Low B12 symptoms

b12deficiency.info/signs-an...

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

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and add a separate vitamin B Complex after a week

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

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

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...

Folate

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

healthline.com/nutrition/fo...

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-£25. iherb.com often have in stock. Or try ebay

Other options

healthunlocked.com/thyroidu....

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 folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

SlowDragon profile image
SlowDragonAdministrator

Request GP retest thyroid again in another 6-8 weeks

Make sure you test early morning, before 9am, and only drink water between waking and blood test

Meanwhile working on improving low vitamin levels essential

Serum Ferritin - 28 (30 - 400)

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.

Request GP do full iron panel test for anaemia

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...

Are you vegetarian or vegan?

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

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...

Posts discussing Three Arrows as very effective supplement

healthunlocked.com/thyroidu...

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...

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...

Good iron but low ferritin

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...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Ferritin range on Medichecks

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. ‘

Amtired profile image
Amtired in reply toSlowDragon

Did ask GP for iron panel test, not sure what results I should be looking for and am still waiting for some. Am vegetarian and have increased the amount of pumpkin seeds etc I eat!

SlowDragon profile image
SlowDragonAdministrator in reply toAmtired

As a vegetarian it’s likely you will need to take iron supplements

Plant based iron is all non heme and harder to absorb

SlowDragon profile image
SlowDragonAdministrator

Starting levothyroxine - flow chart

With 2 tests with TSH over 5, high thyroid antibodies and symptoms you should be started on levothyroxine

gps.northcentrallondonccg.n...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

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.

Amtired profile image
Amtired in reply toSlowDragon

the flow chart is interesting, although I really don’t want to wait few weeks for another blood test 🙄. About 10 years ago I did have 2 blood tests over 5 & was told it was nothing to worry about………I know more now!!!

Amtired profile image
Amtired

Meant to also ask about total white cell count, test results are

4.1 (4-11)

could there be any reason for this low level and anyway to increase it?

Many thanks

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