Elderly mum's blood test results (part 2)

[Pinkpetite]

Hello, I posted about a month ago regarding my mum's blood results and I have put her on vitamin D to try and get her level up. She had to have another blood test so I couldn't put her on the B vitamins as I know these interfere with the test.

She has a GP appt tomorrow and I wanted to see what I could ask the GP for.

As I said in my initial post about her she is very very tired and seems quite oedematous, noticeable from last year.

Her TSH on 1st June this year was 2.9( 0.3 - 5.6) but on 29th June was 0.43 (0.3 - 5.6) - does this make sense to anyone? She was taking vitamin D but not regularly as she kept forgetting it.

Her T3 on 1st June was 3.2 (3.1 - 6.8). She is clearly suffering but do I just initially try and get all her vitamin levels up and then see where we are? She is nearly 87 and it's hard seeing her so exhausted - she can hardly walk any distance now and her weight gain is huge.

I am going to start her on the vitamin B complex shortly.

Could I insist they try vitamin B12 injections?

What can I ask them to do about her raised ferritin (from previous results in initial post) - was 192 (13 - 150)? On the very recent blood test they did an iron studies test and FBC but found nothing.

I didn't ask for the pernicious anaemia test - would it be a good idea to do this tomorrow?

My mum does have slow onset dementia too so all this is very hard for her.

There is a some diabetes in the family and her HbA1c was 39 (25 - 41) - is there any other test I can ask them to do regarding this?

Lastly, would it be worth seeing a private endo now or are we better waiting to get the vitamin levels up? Just wondered if some T3 may help her in this very latter part of her life.

Many thanks.

[SlowDragon Administrator]

Serum folate 2.8 (2.1 - 26.8)

Serum B12 266 (197 - 771)

I would imagine she has some Low B12 symptoms

b12deficiency.info/signs-an...

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

Request testing for Pernicious Anaemia

Particularly apt post 2 days ago from helvella

healthunlocked.com/thyroidu...

Common symptoms include fatigue, confusion, blurry vision and mental health problems such as anxiety and depression, which can make the deficiency hard to diagnose.

[Pinkpetite in reply to SlowDragon]

Thank you, she does have some low B12 symptoms but not the weight loss. Will testing for pernicious anaemia then make them treat the low B12? Possibly with injections? Do I start her on the B12 immediately and then take her off it a week before the pernicious anaemia test? The next blood test appointment will probably be another month away!

[SlowDragon Administrator in reply to Pinkpetite]

Do NOT start any B12 or vitamin B complex or folate or folic acid until had further tests via GP

Can you get her an appointment sooner

Retest TSH, Ft4 and Ft3 privately now if possible

[Pinkpetite in reply to SlowDragon]

The appointment with the GP is tomorrow, it may be possible to get a blood test appt sooner, if he agrees to have it done, as it doesn't need to be early morning. Re the thyroid tests, the TSH and T3 was on 1st June and as they'd missed out the T4 they redid the TSH and added the T4 in the blood test on 29th June.

I will try and get a private test for her and do it when I am next down seeing her. Are you thinking the bloods need repeated due to the TSH being so different a month later?

[SlowDragon Administrator in reply to Pinkpetite]

Low B12 extremely common in elderly people

If he won’t test for PA you will just have to start self supplementing

TSH and added the T4 in the blood test on 29th June.

What was Ft4 result

Was test done early morning

[Pinkpetite in reply to SlowDragon]

Yes it was done early morning.

T4 21 (10 - 22)

[SlowDragon Administrator in reply to Pinkpetite]

Had she taken her levothyroxine that morning, before the test…..if yes Ft4 is false high result

[Pinkpetite in reply to SlowDragon]

No, I'd instructed her not to, and no food or drink either. In May 2021 her T4 was 19 (10 - 22) and her TSH 0.88 (0.3 - 5.5) and in February 2021 her T3 was just 25% in the range. So really is it a conversion issue?

[SlowDragon Administrator in reply to Pinkpetite]

Definitely looks like it

First step is to get all four vitamins at OPTIMAL Levels

This will improve conversion rate

They are very unlikely to agree to adding T3 on prescription

[Pinkpetite in reply to SlowDragon]

Yes, thanks, I will sort her vitamin levels out first of all.

I do actually have some T3 here, may be slightly out of date, but I suppose not worth trying until her vitamin levels are up?

[SlowDragon Administrator in reply to Pinkpetite]

no

And would it even be possible to ensure she took same dose every day

Do you currently oversee her existing medication

[Pinkpetite in reply to SlowDragon]

No, my dad is her carer but she puts her thyroxine into a dosette box herself but I must get her one for all the vitamins to ensure she takes them all at the right times - and instruct my dad!

And do you know if sublingual B12 would be good at a 1mg dose each day?

[SlowDragon Administrator]

Higher ferritin levels over 60 years old is normal

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. ‘

[SlowDragon Administrator]

Request thyroid levels retested

TSH, Ft4 and Ft3

Test early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

If GP can’t/won’t

Retest privately…….Wait until 6-8 weeks after starting separate B12 and separate vitamin B complex (week after starting B12)