Help with blood test results please

[Jellybabyhead]

Hello

I have a phone appointment on Monday to discuss these results with my GP, but in order to arm myself with the right info, can anyone help me to interpret the attached please?

Background: I am 44 years old and started HRT about 5 months ago, having had symptoms for the last few years. I am on the mini pill (Detrogel) and at the time of blood draw (Wed) I had 4 pills left in a 4 week packet. I am also on Evorel Sequi twice weekly patches, and currently coming to the end of a box, so currently using the Evorel Conti section of patches and have 1 left in the box.

I went to see my GP because I am losing scary amounts of hair, am very low on energy and experiencing a lot of anxiety, rage and very low mood. I’ve got low vit D, and I am also on levothyroxine (50mcg a day) after having half my thyroid removed. This time, my TSH came back at 2.59 (range 0.55-4.78) and they didn’t test for T3 or T4, but whenever I have had these tested privately they always come back in normal range.

Thanks in advance!

[greygoose]

Just being 'in normal range' is not good enough. It's where the results fall within the range that counts. You can have FT3 in-range and still be hypo. And, your TSH is saying that you are under-medicated. Which wouldn't be surprising on only 50 mcg even if you do still have half a thyroid left. Because thyroid hormone replacement (levo, etc.) doesn't just top up what your thyroid is making, it shuts down the thyroid and replaces it. So, you have to take enough to replace it, and then some.

A euthyroid TSH (i.e. in someone with no thyroid problems) is around 1. But those on thyroid hormone replacement usually need it lower than that because they need more thyroid hormone when taking it exogenously than someone who's thyroid is working perfectly. So, you desperately need an increase in dose.

Your ferritin is really low and your doctor needs to do a full iron panel to find out why. That is probably why you are losing so much high - that and your low thyroid hormone levels.

Your B12 is much too low - should be at least over 550 - and puts you at risk of irreversable neurological damage. Your folate is also low, should be at least double figures. But, I doubt your doctor will do anything about those because they are both within the ranges. So, I would suggest you buy yourself some sublingual methylcobalamin (B12) 1000 mcg and take them along with a B complex containing at least 400 mcg methylfolate. When the sublingual B12 is all gone, continue with the B complex as a maintenance dose.

[Jellybabyhead in reply to greygoose]

Thank you greygoose that is very interesting and a lot of food for thought. I am actually on iron tablets for unexplained low iron so I’d expected my ferritin to be a lot better than it is. I also need to remind them that the reason for my low iron still needs investigating.

So I guess the question is how to convince the doctor to increase my levo, along with the B12, although it sounds like I can source that myself.

[greygoose in reply to Jellybabyhead]

The reason for your low ferritin is quite possibly the same as the reason for your low B12/folate: you're hypo. When we are hypo, we usually have low stomach acid which makes digesting food and absorbing nutrients. And, to make things worse, low B12 makes your stomach acid even lower! So, you really do need to get that up for all sorts of reasons.

But, don't rely on your doctor to prescribe anything because they will always prescribe the cheapest and least bioavailable form, and they know nothing about the need to take a B complex with it to balance the Bs, which all work together. You can buy that OTC or online.

The problem with convincing your doctor to increase your levo is something else. As it's still in-range, he thinks it has to be ok, he doesn't know enough about thyroid - or about interpreting blood test results - to know better. But, you could try telling him that a euthyroid TSH is around 1, never over 2, and at 3 you are technically hypo. However, once you are on thyroid hormone replacement, getting enough hormone into your cells would probably require a TSH lower than 1.

A blood test only tells you what is in the blood, it does not tell you how much is getting into the cells. The pituitary has no idea how much is getting into the cells, either. It just goes by what is in the blood. But, imagine you're taking 50 mcg levo:

- you're not going to absorb 50 mcg through the gut into the blood. Can't remember how much goes through, and it varies from person to person, but it doesn't all get through.

- lets say, for the sake of argument, that 45 mcg gets through. It doesn't do anything in the blood, it has to get into the cells. Not all of it is going to do that. How much gets into the cells depends on the person.

- also, T4 is a storage hormone which doesn't do much until it is converted into T3, the active hormone. Even if you were a perfect converter, you would only convert 30% of your T4 into T3. And not many hypos are perfect converters. Some are really bad at it. So, they need more T4 in their system than someone with a healthy thyroid. They might also need more T3 because they need to saturate the T3 receptors in order to get enough in to make them healthy. So, if you need, and if you have, more thyroid hormone than a euthyroid person, your TSH is going to be lower than a euthyroid TSH.

I don't know how much of that he'll take on board, but it's worth a try.

[Jellybabyhead in reply to greygoose]

This is all totally fascinating. There is so much to it, it’s no wonder GPs can’t know it all. Interesting what you say about low stomach acid - I’ve been having terrible stomach aches for over a year now and was prescribed esomeprazole for a short while to see if it helped. It has, but I’m still on it and symptoms persist (although not as bad). I did wonder if it was stomach ulcers as that might explain the low ferritin too.

I wonder if the best approach with the GP might be to just plead to try a higher dose of levo for a while as I’m very clearly symptomatic, and see how I get on. Retest in a few months. Maybe.

[greygoose in reply to Jellybabyhead]

Well, you could try begging, if reasoning doesn't get you what you want. lol But it does depend what sort of a person your doctor is. They're not all made in the same mould anymore than patients are.

The PPI (esomeprazole) really isn't a good idea because it's lowering your already low acid. Doctors don't understand that you can have low stomach acid and ascribe all stomach problems to high acid levels - hence the PPIs. What would probably do you more good is something to raise your acid level, not lower it - HCL and pepsin, or Apple Cider Vinager - or even just largish doses of vit C before meals.

Of course, you could have a stomach ulcer because they are basically caused by low stomach acid - it's a virus, but if the stomach acid was normal it would kill the virus.