I've been treading a long road trying to get help for what I believe is a hypo issue since at least 2015. My T4 has been bottom of the range for most of that time. I had an annual health review in June and my T4 was 10.4 range 11-23. TSH was 2.01 range 0.35-5. I was flagged for a retest which I had today. Results (approx 10 weeks on) T4 12 and TSH 2.17. My TSH has climbed bit by bit, my last folate result done by Blue Horizon, was 18.50 range 8.83-60.8 and B12 271 range 145-569, both low but not flagged by NHS.
I'm just stumped that my T4 has gone up again even as my TSH has risen more. Any ideas, is this usual?
Blood taken at 08.30 prior to food and I don't take any biotin products
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Espeegee
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I don’t have any diagnosed thyroid problems according to the GP. I’ve had lots of private test via BH but never had any suggestion of Hashis, antibodies etc always fine.
I have had lots of private tests over the years using Blue Horizon. The last one was in March 2023, see above. It shows what it’s shown for the last couple of years, T4 at the bottom of the range, B12 insufficient, folate too low, Ferritin too high although this time it was much lower for some reason.
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
Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose
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
I am 72, not vegetarian or vegan, I haven’t taken any B supplements for a long time but have taken Thorn in the past and SuperIgennus B, folate goes up, B12 goes up a bit. Sister has PA, mother had PA and was hypo, doesn’t seem to make any difference to the GPs attitude, it’s a biggish practice where they all sing from the same hymn sheet.
I had an annual health review in June and my T4 was 10.4 range 11-23. TSH was 2.01 range 0.35-5. I was flagged for a retest which I had today. Results (approx 10 weeks on) T4 12 and TSH 2.17.
FT4: 12 pmol/l (Range 11 - 23)
Ft4 is only 8.33% through range
So clearly hypothyroid
Next steps
Improve low B vitamins and get full thyroid and vitamin testing
Before starting B12 supplementation has your GP done an Intrinsic factor test? As you have PA in your family very important. Though this test only picks up 50% of PA.
The current B12 assay is missing a lot of B12, deficiency. This is the case whether B12 active or standard b12 blood test. I attended a presentation (B12d. Org) recently where a Consultant was investigating this. He said labs are aware but dont know what to do. Due to new machinary brought in that enables them to do multiple tests at the same time.
Secondly if you've done b12 supplementation and it only raised your B12 level slightly then this sounds suspicious. In addition as we age we absorb less b12.
Your last option is to move onto B12 injections. My level was still in range at 235 but I was told by another Consultant that if I'm not vegetarian and eat meat then it's unlikely supplemention would improve things enough because my level was so low.
B12d. Org have a great assessment sheet that you can fill in. I was surprised by some of the symptoms listed which I had that I didn't realise was linked. Do you have symptoms?
Have you had your Homeostane level chscked. This is another indicator. It rises in B12 deficiency.
Given the factors above and your family history of PA your GP should be willing to trial b12 jabs. Mine couldn't to do this I had to be referred to neurology (took 6, months) so decided to self inject as had some serious symptoms such as weakness, blurred vision, numbness/, tingling, struggling to walk. Made a massive difference. Neurology supported me when I finally saw them..
Your GP should also check you for Coeliacs. You need to be eating gluten several times per days for several weeks before checking this.
Lastly your thyroid levels are bumping along the bottom as you say. These days they want the TSH to reach ridiculously high heights of over 10 before they will intervene.
I was very like you. I felt very, very ill. Eventually my TSH tipped over the top of the TSH range and GP treated. Sadly left me on a starter dose of levothyroxine for a whole year and didn't review (I didn't know he should) TSH shot up really high. I felt incredibly poorly. I tested negative for Hashi.
. It was a private doctor who got me sorted out. GP was useless tbh but did accept advice.
Thanks for the heads up in B12. Sadly familial PA doesn't seem too high on the GP radar. One GP asked for a haemochromatosis test, the lab refused with the not that as there wasn't a family history it wasn't necessary. I had a homocysteine test years and years ago and it was at optimal level but I doubt that it is now, it's a very expensive test so I'm not keen to have another done. There aren't any coeliac in the family so I'd wager they wouldn't test for that either. I'll go and do the questionnaire, I did the thyroid one on TUK and ticked a lot of boxes but when I gave it to the doctor at the hospital he dismissed it without looking along with the basal temp charts (I never reach "normal" ) and a research paper on Central Hyperthyroidism which was suggested to me by the good folks on here. Why are they so disinterested in expanding their knowledge base?
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
Yes, cholesterol was highest at 7.38 and is currently at 6.27, they just offer statins which I won't ever take. GFR, last tested in June 2023, ranges between 53-68 and is currently 52. I was diagnosed with CKD stage 3 a few years ago but reassured that it wasn't a big problem and related to age. I realise all these issues can be joined up and point at an under performing thyroid but it seems the NHS can't.
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