Blood tests

[Squiggles4]

hi can anyone help with my results from recent bloods pls.

[SlowDragon Administrator]

Welcome to the forum

TSH over 10 confirms you are hypothyroid and GP should be starting you on levothyroxine immediately

What symptoms do you have

Symptoms of hypothyroidism

thyroiduk.org/wp-content/up...

Approximately how old are you and are you male or female

GP needs to also test thyroid antibodies to see if cause of your hypothyroidism is autoimmune

TPO and TG thyroid antibodies tested at least once

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Standard starter dose levothyroxine is at least 50mcg daily (unless you’re over 65 then start on 25mcg)

Dose levothyroxine is increased slowly upwards overcoming 6-18 months until on full replacement dose

Bloods should be retested 6-8 weeks after any dose change in levothyroxine

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Aim is to be on high enough dose levothyroxine so that TSH is always below 2

Most people will have TSH around 1 or less when adequately treated

Most important result is always Ft3 (rarely tested on NHS) and to maintain OPTIMAL vitamin levels

[Squiggles4 in reply to SlowDragon]

Hi, ty for reply, I am currently on 100 mg levo thyroxine , I’m 51 and female.

[SlowDragon Administrator in reply to Squiggles4]

Well then you need to make an appointment with GP

Get TSH, Ft4 and Ft3 tested together

See if it’s just TSH that’s high or wether Ft4 and Ft3 are low

Which brand of levothyroxine are you taking

Do you always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after

No mediations or vitamin supplements within 2 hours

Some like magnesium, calcium, iron, vitamin D, HRT or PPI at least 4 hours away

it’s possible (but rare ) to have high TSH and normal/good Ft4 and Ft3 due to test interfering by (believe it or not) mouse 🐁 antibodies!

ncbi.nlm.nih.gov/pmc/articl....

So if you don’t feel hypothyroid get further testing BEFORE considering increase in dose levothyroxine

[SlowDragon Administrator in reply to Squiggles4]

please very helpful if you add background information on your profile page

[SlowDragon Administrator in reply to Squiggles4]

Are you pre or post menopause

Taking HRT?

If yes is that patches or tablets

HRT frequently results in needing dose increase in levothyroxine

How much do you weigh in kilo

You may simply need dose increase in levothyroxine

guidelines on dose levothyroxine by weight

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Squiggles4]

hi here are the results of the bloods I had taken ,ty

Print

[Gingernut44 in reply to Squiggles4]

When you reply to a member, remember to tap the reply button at the bottom of their response. I will tag SlowDragon for you as she will not have been notified of your answer

[Squiggles4 in reply to Gingernut44]

ok tyvm.

[SlowDragon Administrator in reply to Squiggles4]

No Ft4 or Ft3

Request GP retest thyroid including Ft4 and Ft3 now

Ferritin seriously deficient as well below 30

You need full iron panel test for anaemia

Any obvious reason for being anaemic (apart from being hypothyroid)

Heavy periods?

Vegan or vegetarian?

Folate and B12 also slightly low

No vitamin D

High cholesterol…..typical when hypothyroid

nhs.uk/conditions/statins/c...

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.

[Squiggles4 in reply to SlowDragon]

Hi ty for reply, doctors have told me all tests are fine apart from the one which was flagged , I’m booked in for a call from

Chemist regarding my dosage on 18th September, periods havent changed have always been heavy , will discuss with chemist when they ring me and ty again.

[SlowDragon Administrator in reply to Squiggles4]

print out guidelines that clearly show ferritin below 30 is deficient

GP MUST do full iron panel test for anaemia

TSH over 2 shows you are on inadequate dose levothyroxine

Ideally you would test TSH, Ft4 and Ft3 together BEFORE increasing dose levothyroxine

But if GP won’t then just accept 25mcg dose increase in levothyroxine to 125mcg

Which brand of levothyroxine is your 100mcg tablets

Ideally always get same brand of levothyroxine

Retest thyroid in 6-8 weeks

Just TSH, Ft4 and Ft3 test - £32

monitormyhealth.org.uk/thyr...

10% off code here

thyroiduk.org/getting-a-dia...

How much do you weigh in kilo?

[SlowDragon Administrator]

Ferritin

cks.nice.org.uk/topics/anae...

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

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

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

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

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.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Excellent article on iron and thyroid

cambridge.org/core/journals...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Ferritin range on Medichecks

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

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. ‘