Hi everyone, I'd really appreciate some help interpeting blood results and advice on what to discuss with my GP at my next appointment.
Serum TSH levels:
Aug 23 - 7.02
May 23 - 5.64
June 19 - 2.3
Free T4:
Aug 23 - 11.3
May 23 - 11.7
June 19 - 10.6
BACKGROUND:
I visited the GP back in May feeling exhausted and concerned with hair thinning and some loss over the past year, worsening Raynauds (poor circulation to hands and feet, numbness), always cold and low mood. I'm a vegetarian and I actually thought I was anaemic so I asked for blood tests. My iron and b12 results however came back within normal. It was my TSH levels that were a concern to me. The Dr didn't speak with me, I was just called by reception and told they were booking another blood test in 8 weeks. They didn't even say what for.
I've had a stressful couple of years with a long-term relationship breakdown and subsequent house sale / purchase (still ongoing), financial worries, the illness and then death in January of my dad and a full-time job as a high school teacher in a deprived inner city area. I'm also mum to a daughter at Uni and a 17 year old son.
I was diagnosed with adult ADHD a year ago. This was after my daughter's diagnosis. I take the stimulant medication Elvanse for this. It has been a godsend with regards to helping me stay focused and get things done without succumbing to overwhelm.
ADVICE
I know different people have different experience / areas of knowledge but if you could help that would be great.
1. Do my symptoms and blood results warrant medication for hypothyroidism? Will the GP be reluctant to prescribe? I've actually suffered with fatigue for a long time but the 2019 results would suggest no problems with the thyroid then?
2. Can I take ADHD medication and meds for hypothyroidism? I've heard there is a contraindication.
3. Has anyone heard of ADHD meds causing hypothyroidism? Is that something the GP may be concerned about?
4. Has anyone with Raynauds experienced worsening symptoms and is it likely to resolve with medication?
5. Is it true that stress can bring on thyroid issues?
6. Is there anything in particular I should be asking the GP for - eg further tests, other conditions, referral to endocrinologist?
Thank you!
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Millfin
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For proper interpretation of your results please add reference ranges, these vary from lab to lab so it's essential that we have the ranges that come with your results. Also please add results and ranges for Ferritin and B12, just saying "normal" doesn't mean anything except that they fall within the reference range but that doesn't man they're at optimal levels.
However, what we can deduce from the results you've posted is that your TSH for July and August is that they are over range (range tends go no higher than 5 for TSH) and the level is increasing. This looks very like hypothyroidism.
NICE guidelines say that TSH over range plus symptoms is subclinical hypothyroidism, 2 x over range TSH results plus symptoms can initiate a prescription for Levo - see:
1.5.4 Consider a 6-month trial of levothyroxine for adults under 65 with subclinical hypothyroidism who have:
a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions 3 months apart, and
symptoms of hypothyroidism.
Also, 2 x over range TSH results plus positive antibodies should give a diagnosis of autoimmune thyroid disease and a prescription for Levo.
I was just called by reception and told they were booking another blood test in 8 weeks. They didn't even say what for.
This is normal. They can't act on 1 x over range TSH because it could be elevated due to non thyroidal illness so they will always do a second test after a couple of months. It would have been helpful if they'd told you though.
1. Do my symptoms and blood results warrant medication for hypothyroidism? Will the GP be reluctant to prescribe? I've actually suffered with fatigue for a long time but the 2019 results would suggest no problems with the thyroid then?
See NICE guideline above and if necessary show GP and request a trial of Levo. 2019 results aren't important now other than it shows the trend of your TSH rising, it's the current results that are.
2. Can I take ADHD medication and meds for hypothyroidism? I've heard there is a contraindication.
Check with GP and/or pharmacist.
3. Has anyone heard of ADHD meds causing hypothyroidism? Is that something the GP may be concerned about?
Probably needs some research, there seems to be conflicting information (as is often the case).
4. Has anyone with Raynauds experienced worsening symptoms and is it likely to resolve with medication?
Don't know.
5. Is it true that stress can bring on thyroid issues?
I've seen articles that say it doesn't cause thyroid disorders but can make them worse.
6. Is there anything in particular I should be asking the GP for - eg further tests, other conditions, referral to endocrinologist?
Thyroid antibodies. Only Thyroid Peroxidase (TPO) antibodies can be done with GP, an endo would be needed to test Thyroglobulin (Tg) antibodies.
Key nutrients - Vit D, Folate as well as B12 and Ferritin.
Referral to endo wouldn't normally be made as it's judged that GPs can deal with hypothyroidism. If GP wont follow guidelines I've mentioned above then ask for a referral.
Thank you ! That's really useful to know about the NICE guidelines and further testing. I'm dreading feeling this shattered again back at work and with a house move so it would be good to see if meds could help. Results as follows with ranges:
TSH Normal Range 0.27-4.20mU/
Aug 23 - 7.08 - test at 10.30am - fasting
May 23 - 5.64 - test at 9.30am - had breakfast
Jun 19 - 2.3 - not sure time
T4 Normal Range 11.3 - 21.6 mmol/L
Aug 23 - 11.3
May 23 - 11.7
Jun 19 - 10.6
B12 NR 197-771 ng/L
May 23 - 434
Jun 22 - 434
Folate NR 3.9-20 ug/L
May 23 - 12.0
Ferritin NR 15-150 ug/L
May 23 - 47
Jun 22 - 46
Vitamin D - no normal range given
Serum Total 25-OH Vit D level -
May 23 - 40.3 nmol/L
May 23 - 0 nmol/L
Serum 25-HO Vit D3 level-
May 23 - 40.3 nmol/L
Serum 25-HO Vit D2 level
May 23 - 5.0 nmol/L
I take no supplements,.occasionally magnisium biglycinate for sleep, but I do eat a good varied diet although my appetite is low and I have lost weight - 8st3 and 5'5". This is at least partly due to ADHD meds.
Considering that your FT3 is currently on the bottom level of range, I think that any doctor with half a brain should have seen where this was going and been prompted to start you on Levo.
B12: 434 (197-771) ng/L - ng/L is the same as pg/ml mentioned below
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."
Consider supplementing with sublingual B12 methylcobalamin to give your level a boost. When supplementing with B12 we should also take a B Complex to keep all the B vitamins balanced.
Folate: 12 (3.9-20) ug/L
Folate is recommended to be at least half way through range (12 plus with that range) so there is room to increase this. The B Complex mentioned above will help there.
One bottle should be enough then stop the B12 but continue with the B Complex to maintain level.
B Complex: the following are popular with members
Thorne Basic B - can be hard to find and can get expensive
Vitablossom Liposomal B Complex - from hempoutlet.co.uk
Yipmai Liposomal B Complex - this is Vitablossom just showing as this brand on Amazon
Pink Tribe Liposomal B Complex - from Amazon
Vitamin D: 40.3nmol/L = 16.12ng/ml
The Vit D Society,m Vit D Council and Grassroots Health all recommend a level of 100-150nmol/L (40-60ng/ml) with a recent blog post on Grassroots Health recommending at least 125nmol/L (50ng/ml).
Check out the Vit D Council website where you will find recommendations for the dose needed to bring your level up to the recommended level. You will see that they recommend 4,900iu D3 daily, nearest to buy is 5,000iu. Retest after 3 months.
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Important cofactors are needed when taking D3 - magnesium and Vit K2-M K7.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
Magnesium which helps the body convert D3 into it's usable form.
There are many types of magnesium so we have to check to see which one is most suitable for our own needs:
Magnesium should be taken 4 hours away from thyroid meds and as it tends to be calming it's best taken in the evening. Vit D should also be taken 4 hours away from thyroid meds. Vit K2-MK7 should be taken 2 hours away from thyroid meds. Don't take D3 and K2 at the same time unless both are oil based supplements, they both are fat soluble vitamins which require their own fat to be absorbed otherwise they will compete for the fat.
Suggestions for supplements:
D3 - Doctor's Best oil based softgels - best price is usually dolphinfitness.co.uk
Vit K2-MK7: Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
Vitabay and Vegavero are either tablets or capsules.
Vitabay does do an oil based liquid.
Vitamaze is an oil based liquid.
With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.
They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.
Another "all trans" one worth considering if the others aren't availaable:
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Ferritin: 47 (15-150) ug/L
This is low. Some experts say the optimal ferritin level for thyroid function is 90-110ug/L. Before considering self supplementing with iron you should do a full iron panel to include serum iron, saturation percentage, total iron binding capacity plus ferritin. If you already have good iron and saturation levels then you wouldn't want to take iron supplements as this could take them too high and lead to iron overload/toxicity. Instead you would try to raise ferritin level through diet by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
I know nothing about that supplement but if I were you I'd get your diagnosis and prescription for Levo and see how you go, don't start introducing any thyroid stimulating supplements which could muddy the water.
It comes in two forms D and L. The letters D and L indicate that in one form it is right handed (Dextro) in the other it is left-handed (Laevo or Levo).
DL means it is a mixture of the two forms.
L-Phenylalanine is far better known as aspartame - the artificial sweetener.
Products which contain aspartame must be labelled ‘Contains a source of phenylalanine’. Those who suffer phenylketonuria must avoid consuming phenylalanine.
The reason it is considered in thyroid issues is that it can act as a source of another amino acid - tyrosine - which is a fundamental "ingredient" for the thyroid gland to make thyroid hormone.
But most of us already have decent supply of tyrosine.
And if we do not have a working thyroid, tyrosine isn't needed for that purpose!
As you are vegetarian suggest you get full iron panel test for anaemia via GP or privately
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
My Raynauds did not alter at all, but I had had it since childhood and was only diagnosed with thyroid problems in my 50's. I hope you feel better soon.
Sending hugs - Life sounds really tough at the moment !
Just to be aware…if you do start treatment, it’s not uncommon to feel worse before you start to feel better, as the dose is usually lower than you eventually need so your body gets used to it. Just keep posting your progress here!
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