Advice on latest blood results

[Thyroid16]

Hi all,

Could I have some advice on my latest blood tests results ahead of my doctors appointment next week. My symptoms have definitely improved. My levothyroxine is 75 mg (currently 50mg accord brand, 25 mg teva) was increased (on my request) from 50mg to 75 mg 7 weeks ago. My new blood results are:

TSH level 1.69 (range 0.55- 4.78 mU/L)

T4 13.5 (range 11.50-22.70 pmol/L)

My last results on 50 mg (September 23) were:

TSH 3.19 (range 0.55- 4.78 mU/L)

T4 13.5 (range 11.50-22.70 pmol/L)

My TSH looks healthier and hasn't been below 3 for years (for context it has taken me 7 years to get 'heard' by the doctors and it was only a antibody test (which I requested in August) that confirmed high antibodies of over 1300 m/ul (ref range lower than 60m/ul).

My T4 is still at the bottom of the range despite the much improved TSH. Does this suggest that I'm a poor convertor? Do I need to give it more time or ask for an increased dosage.

Many thanks, Emily

[Brightness14]

You require your FT3 results which is the important one.

[Lalatoot]

Your low ft4 and a tsh above 1 plus symptoms suggest that you could increase your levo by 25mcg daily. You may find it hard to convince the doctor as they will be happy with the TSH. Point out the low ft4. Tell the doctor that you wouldn't wear a normal size 4 shoe if your feet were normal 7s. Then add your normal ft4 result is too low for you and you need a higher normal result .

To know if you are a poor converter you need to have tsh, ft4 and ft3 done at the same blood draw and then look at the results. You can't tell by tsh and ft4 only.

[Thyroid16 in reply to Lalatoot]

Thanks both, I had my Ft 3 done in June 2023 and result was 5mol/L ref: 3.5 -6.50 pmol/L. I was on 25mg then and my Serum free T4 level as 13 pmol/L and TSH 4.58 MU/L. At the time the doctor told me that my Ft 3 showed I'm converting well - is this a correct interpretation? As you can see my TSH has come down a lot since June 23 but my T4 is still at the very low end of normal. So it's important to get Ft 3 done again at this stage?

[SlowDragon Administrator]

Request next 25mcg dose increase to 100mcg daily

FT4: 13.5 pmol/l (Range 11.5 - 22.7)

Ft3 only 17.86% through range

Also need vitamin levels tested as per previous post

healthunlocked.com/thyroidu...

Suggest you get FULL thyroid and vitamin testing privately if GP unhelpful

[Thyroid16 in reply to SlowDragon]

Thank you so much for the help Slow Dragon. On the levo increase, I just had my doctor's appointment which it turns out was actually about their letter to the endocrinologist sent 8 weeks ago (rather than my recent bloods)- who has said he wouldn't see me and suggested my dose is fine but suggested regular testing! It was another doctor today and she would not increase my dose to 100 mg on the basis that my TSH was well in range and that they would 'normally just measure TSH'. I pointed out the consistently low ft4 but said they use 'TSH as the basis for assessing dosage'.... Ahhhhh!

I was finally getting somewhere with the previous doctor (who has an under active thyroid herself and was very empathetic - even though I only saw her once) but I know her personally as our children go to the same school and I don't want her to feel compromised - nor do I expect special favours. I wonder if she asked the other doctor to deliver the news to me about the endocrinologist's response? possibly due to embarrassment or perhaps it just ended up in the other doctor's mailbox, who knows . Anyway I think 7 years is long enough to wait to feel better and the endocrinologist referral was on the basis of my high antibodies (greater that 1300) and the duration of time that I have been coping with symptoms ( 7 years). At this point, I'm going to seek a private endocrinologist as I've really had enough of not being listened to by GPs and nearly a decade of coping with symptoms that have reduced but aren't going away - I'm tired of the battle. I'm in South Wales area so will start a new thread and ask people to PM me

[SlowDragon Administrator in reply to Thyroid16]

Get vitamins tested and improved ideally BEFORE consultation

Obviously first thing you need is dose INCREASE in levothyroxine

List of thyroid specialists and NHS and private endocrinologists

Choosing an endocrinologist who’s both private and NHS

See privately initially and then transfer

healthunlocked.com/thyroidu...

[Thyroid16]

Thanks Slow Dragon, this time I had more ferriten tests done and they're all still crawling along the bottom with one abnormal result - this is actually why the GP has asked to see me next week.

I've been on (prescribed) liquid ferrous fumerate for 7 weeks now - two lots of 10mg per day (as obviously the tables weren't being absorbed) which I take at lunchtime and tea time - 7 hours after the levo. I am seeing a very slow increase in ferriten but actually still so low and feel quite worried about my absorption levels.

Current results are:

Serum iron tests (mc) Abnormal contact patient

serum iron level 10 umol/L (ref range 10.00 -30.00umol/L)

serum transferrin 2.3 g/L (ref range 2.00 -4.00 g/L)

! Transferrin saturation index 17.3% (ref range 20.00 -50.00%)

Serum ferritin (mc) normal no action 17 ug/L (ref range15.00 -300.00 ug/L)

I have sent off to Medichecks for Folate and Vit D.

[SlowDragon Administrator in reply to Thyroid16]

you need to click the blue reply otherwise other poster doesn’t get notified

I just happened to reread

Ferritin is still deficient

GP could prescribe 3 per day. Take with orange juice to improve absorption

any obvious reason for low ferritin apart from still being under medicated for thyroid

are you vegetarian or vegan

Or heavy periods

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

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

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...

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...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

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. ‘

[Bearo]

I suggest you don’t worry about how well you convert FT4 to F T3 until you have raised your dose of Levo to get FT4 up to a better level. Some will say you don’t have the full picture without FT3, but tbh it won’t tell you very much at the moment.

Every time you get a new blood test post the results here for comment.

Or if GP won’t raise any further, post here for comment.

There will come a time when someone will say: now we need to see where your FT3 is.

[Thyroid16 in reply to Bearo]

Thank you for the help Bearo. I just had my doctors appointment which it turns out was actually about their letter to the endocrinologist sent 8 weeks ago (rather than my recent bloods)- who has said he wouldn't see me and suggested my dose is fine but suggested regular testing! It was another doctor today and she would not increase my dose to 100 mg on the basis that my TSH was well in range and that they would 'normally just measure TSH'. I pointed out the consistently low ft4 but said they use 'TSH as the basis for assessing dosage'.... Ahhhhh!

I was finally getting somewhere with the previous doctor (who has an under active thyroid herself and was very empathetic) but I know her personally as our children go to the same school and I don't want her to feel compromised - nor do I expect special favours. I wonder if she asked the other doctor to deliver the news to me about the endocrinologist's response? possibly due to embarrassment or perhaps it just ended up in the other doctor's mailbox, who knows . Anyway I think 7 years is long enough to wait to get better and the endocrinologist referral was on the basis of my high antibodies (greater that 1300) and the duration of time that I have been coping with symptoms ( 7 years). At this point, I'm going to seek a private endocrinologist so will start a new thread

[Thyroid16]

Thank you