My daughter is 24 and for several years she has had symptoms that tick all the boxes for overactive thyroid. She went to the doctors and asked as she has a needle phobia could she have blood test measuring her hormone levels, a thyroid function test, looking at levels of thyroid-stimulating hormone (TSH) ,TT4, T4 &TT3,T3 and thyroid antibody test, also any other bloods they think could be linked to my symptoms (B12, D, iron, cortisol,). Her symptoms are :
nervousness, anxiety and irritability
mood swings
difficulty sleeping
persistent tiredness and weakness
sensitivity to heat
swelling in your neck from an enlarged thyroid gland (goitre)
an irregular and/or unusually fast heart rate (palpitations)
twitching or trembling
Yesterday her blood results have come back and we asked for a copy which they gave us but didn't say if doctor had seen them. All looks normal and I am concerned as her problem with heat, excessive water drinking, tiredness and anxiety affects her daily life. Has anyone any ideas before she calls the doctors for an appointment.
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WendyW1964
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It looks like they didn't do all the thyroid tests you asked for which isn't surprising. TT4 and TT3 aren't useful tests (they measure the Total amount of hormone bound/unbound to proteins), it's the FT4 and FT3 that's needed (these are the Free/unbound hormones). FT3 is rarely done at GP level anyway.
The results of concern are:
Folate: 5.5 (3.90-20.00)
This is too low. Folate is recommended to be at least half way through range. This is not deficiency, just low. A B Complex will help raise her level BUT SEE BELOW.
B12: 301ng/L (197-771)
This is low. According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Many people with a level in the 300s have been found to need B12 injections.
Does she have any signs of B12 deficiency – check here:
If she does then list them to discuss with her 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.
Ferritin: 22: (15-150)
This is dire. She needs to speak to her doctor about this and point out
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
She also needs a full iron panel to test
Serum iron
Saturation percentage
Total Iron Binding Capacity
Ferritin
as this will show if she has iron deficiency or just low ferritin.
Can you post an image of the full blood count as this will show if she has anaemia. It's possible to have iron deficiency with or without anaemia.
Symptoms of low ferritin include:
◾Weakness
◾Fatigue
◾Difficulty concentrating
◾Poor work productivity
◾Cold hands and feet
◾Poor short-term memory
◾Difficulty remembering names
◾Dizziness
◾Pounding in the ears
◾Shortness of breath
◾Brittle nails
◾Headaches
◾Restless legs
Symptoms of iron deficiency:
Symptoms of iron deficiency can mirror or coincide with those in thyroid disease. They include:
◾Persistent fatigue
◾Pale skin
◾Shortness of breath
◾Headaches
◾Dizziness
◾Heart palpitations
◾Dry skin
◾Brittle hair and hair loss
◾Swelling or soreness of the tongue or mouth
◾Restless legs
◾Brittle or ridged nails
TSH: 3.07 (0.27-4.20)
FT4: 13.7 (11.3-21.6)
These results suggest that she may be on her way to hypothyroidism.
A normal healthy person with no thyroid condition would generally have TSH no higher than 2, often around 1, with FT4 around mid-range-ish.
It might be that optimising her key nutrients as above may help improve her thyroid levels, so working on those first and then retesting everything in about 3 months would be a good idea. Include Vit D when retesting as this is another important key nutrient.
As she has a goitre, ask for thyroid antibodies to be tested, she might have autoimmune thyroid disease.
Thank you for your reply. She doesn't take vitamin supplements. Do you know what high vitamin D could be caused by? She eats a well balanced diet (not veg or vegan) and makes all meals from scratch. How low is B12 and ferritin? could these be causing her symptoms?
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. ‘
Do NOT start any B12 or B complex until GP done test for Pernicious Anaemia
If GP won’t test
Or test is negative and not prescribed B12
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and after a week add a separate vitamin B Complex
Then once serum B12 is over 500 (or Active B12 level has reached 70), 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
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
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
Do you have Page 2 of the results? There might be some useful information in the Full Blood Count results.
Your daughter's low ferritin (iron stores) could be causing her palpitations and/or tachycardia (fast heart rate).
Untreated iron deficiency anaemia:
may increase your risk of developing complications that affect the heart or lungs – such as an abnormally fast heartbeat (tachycardia) or heart failure
This is a very long shot and unlikely to be relevant. Someone who drinks an excessive amount of water might have diabetes insipidus if the symptoms are a match :
Thank you for your reply. She was tested for diabetes and was negative. I was shocked that she had nothing back from doctors and told her to ask for a copy of the bloods, which they printed off but she had to approach them.
Diabetes Insipidus is a completely different condition to Diabetes Type 1 or Type 2, and getting tested for it would not be standard practice for GPs and most consultants since it is quite rare.
Hi there,Speaking only to the heat issue and water drinking, if she has dry feeling tongue, salt craving, thirst unrelieved by water she might as a minimum try electrolytes- oral rehydration salts. But not a long term solution. Might give a clue if it helps.
Look into adrenal testing? For low or high cortisol/adrenal issues.
But definitely speak to doctor.
If possible armed with list of symptoms and when they started.
It's going to need to detective work as her symptoms can relate to various conditions, thyroid, adrenals, vitamin and mineral levels being out of whack.
The Pernicious Anaemia Society health unlocked group is really helpful for b12, anemia, folate. Some people are members of both.
Haemoglobin is well within the reference range. This result is the one that doctors use to determine whether someone is anaemic or not. People can be iron deficient with or without anaemia, and the deficiency needs to be fixed in either case. Your daughter isn't anaemic.
The Mean Corpuscular Volume (MCV) tells you the average size of the red blood cells. A result low in range, or under range (like your daughter's) is an indication that her red blood cells are too small for good health. She is likely to become easily breathless and also likely to be exhausted easily because small red blood cells aren't good at carrying oxygen around. It is likely that serum iron and/or ferritin (iron stores) are low. And you've already listed her very low ferritin.
For future reference, if MCV is high in range or over the range it suggests that the patient has too little Vitamin B12 and/or too little folate. Large red blood cells are not good at carrying oxygen around the body either.
If someone has low serum iron and/or low ferritin AND low Vitamin B12 and/or low folate the result of MCV isn't reliable, and you would have to do proper testing of B12 / folate / iron / ferritin.
The results from Neutrophil count down to Basophil count tell you info about the white blood cells which will be affected if infection is present. Since all the results are well in range it suggests there is no infection present.
For more info on the above and for information on the things I haven't mentioned in the Full Blood Count, this link is a good one to look at :
There are more pages worth reading near the bottom of the above page in the section on Related Content.
Labtestsonline (the site where the previous link came from) is well worth keeping a link to when wanting to understand blood test results. Remember to click on the plus signs for more info.
...
Regarding the low iron, I would suggest asking your GP to get an iron panel done. The alternative is to pay for a finger-prick test :
It is worthwhile registering / opening an account with any testing company you come across that interests you. They will send you emails with special offers and discount codes for when they have sales.
If you get an iron panel done it is worth posting the results and reference ranges in a new post and ask for feedback.
Please note that iron supplements prescribed by doctors in the UK can be bought without prescription from UK pharmacies, but there are plenty of other iron supplements available that may suit your daughter that don't need a prescription either.
If the money is available and the iron deficiency test shows that serum iron, ferritin, and the transferrin saturation are all low then supplementing will be a good idea. (I think the low ferritin and the low MCV strongly supports this idea already.)
Mine wouldn't give me even a vitamins test. TSH and T4 look in range though. If overactive normally the TSH would be far far lower closer to 0 as in below number 1
That's a lot of numbers to look over but the GP needs to investigate more if she is having really bad symptoms, did they do any other hormone tests?
The trouble is if it comes back "in range" then the GP wont contact you for an appointment, it is classed as passing and no issues. It's only if out of range that they will contact you to make an appointment. You do have to advocate for yourself (or as in your daughter will have to advocate for herself) and go back to the GP if the symptoms are affecting her day to day life maybe they are missing something and it can take a long time to diagnose some things. Just hope they don't try to dish out anti depressants to her, or well maybe they have but I think it's best to talk talking methods first, what did they say about the neck swelling?
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