I suffered from subacute thyroditis in September 2022 which was also the beginning of my pregnancy. I was initially very hyper (treated by endo) but then became hypo and in the third trimester I was put on levo, first 25 mcg then 50 mcg by the consultant obstetrician. I gave birth 4 months ago and my gp has kept me on 50 mcg of levo, checking my tsh twice and my t4 once. I am not sure I am at the right dose and no one has told me if I should expect to be hypo for life now. I have decided to test all values via medicheck and my gp has agreed to speak with me tomorrow. My key symptom is extreme tiredness but of course this could just be due to having a baby. Test was done at 8:30 in the morning and I hadn’t taken levo for 24h. Please could someone help interpret my results and suggest what I should ask the gp ?
TSH 0.941 (0.27-4.2)
Free T3 4.5 (3.1 -6.8)
Free T4 14.7 (12-22)
CRP 4.56 (<3)
Ferritin 22.3 (30-150)
folate serum 7.8 (8.83-60.8)
b12 active 72.9 (37.5 -188)
vit D 56.4
thyroglobulin anitibodies 13.6 (0-115)
thyroide peroxidise antibodies <9 (0-34)
I am not vegetarian and I haven’t taken any vitamins/supplements since giving birth 4 months ago!
thanks in advance for any help
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Habibi87
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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
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
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.
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. ‘
Ok so I spoke with my gp today. He didn’t seem concerned about my thyroid (not a surprise), but wants to run a full iron panel, plus check again folate and vitamin D. He said that the range for ferritin and folate from medichecks were totally different from the ones they use and that my values for both ferritin and folate would be fine under the ranges of their lab. He agreed vitamin D was too low. I suggested a referral to an endo but he said we should wait for the new lab results first. I supposed it’s somr progress as he is at least running all the blood tests…
Hi SlowDragon, so these are the tests the gp has ordered: FBC & Diff, ESR, Thyroid Profile, Renal profile (Ns, K, Cr, GFR), CRP, Iron & Transferrin Saturation Levels, Ferritin, Serum Folate, Vitamin B13, 25 Hydroxy Vitamin D level. Do they make sense ?
Hi SlowDragon, I’m making no progress, the gp hasn’t even called me as all is in range…
For my thyroid they’ve only tested my tsh which came at 1.33 (0.35-4.94). I don’t know what use this is given that I have had below range ft4 with in range tsh. All I can see is that my tsh (with same nhs lab) has got higher higher since April.
serum iron 13.4 (9-30.4)
transferrin 2.6 (1.8-3.2)
transferrin saturation 19%
serum ferritin 24 (22-275)
serum total 25 OH vit D 73
serum folate 3.3 (3.1 - 20.5)
Serum vitamin b12 605 (187-883)
erythrocytes sedimentation rate 10 (0-12)
total white cell 7(4-11)
RBC 4.17 (3.95-5.15)
haemoglobin 126 (120-150)
Haematocrit 0.375 (0.360-0.47)
MCV 90 (80-100)
MCH 30.2 (27-32)
red blood cell distribution 13.2 (11-16)
platelet 194 (150-400)
Are these values actually Ok? I don’t really know what to do with the gp who hasn’t even written a referral for my work insurance to see an endocrinologist. My period has also returned post pregnancy 4 days ago and it’s never been so so heavy ( having to use post partum pads ). Feeling a bit helpless
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
Thank you, I will self supplement, no point in battling this with gp. I am not on B12 so will take that too. Yes, I do have the MTHFR mutation on both genes ( found out during IVF)
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
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
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.
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.
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