Shot in the Dark: Can anyone advise what these... - Thyroid UK

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Shot in the Dark

marillo profile image
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Can anyone advise what these results mean please?

I am not on Thyroid meds but feel something is very off, I’m in perimenopause also. These results were 7 months ago. I’m losing hair, shaking inside, cold all the time, weight loss. I’m on HRT. I had iron deficient anaemia in 2020. Feel like I’m going mad!

Serum TSH 1.3 mu/L 0.27-4.20mu/L

Serum Free T4 17.5 pmol/L 12.00-22.00 pmol/L

Serum iron 13.5

Serum Ferritin 50ug/L 13.00-150 ug/L

Serum Transferrin 2.6g/L. 2.00-3.60/L

Any advice appreciated before I speak to GP

Thank you in advance.

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marillo
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PurpleNails profile image
PurpleNailsAdministrator

Welcome to forum

Your thyroid biomarkers tested (TSH & FT4) appear good, but it is only part of the thyroid picture.

When these results are in range it’s very unlikely you have a thyroid issue & further tests are deemed unnecessary but to completely rule out thyroid issues you need FT3 & Thyroid antibodies (TPO & TG) tested.

Is there a particular symptom causing you to think of thyroid issue, or any family history?

The weight loss & would make iron deficiency anaemia recurrence possible.

Ferritin is in range but over 80 is nearer optimal.

Is there a range for serum iron?

Has haemoglobin been tested?

Many make faster progress having a complete test arranged privately. Order a kit online and sample can be taken by fingerprick test, sample posted back & results available online often very quickly.

Sample recommended to be taken at 09.00 fast overnight, avoid biotin 3 days before test.

See link for private companies with discounts with many packages & options.

thyroiduk.org/testing/priva...

“Monitor my health” offers a combined test profile including :

* Diabetes 

* Vitamin D

* Total Cholesterol

* Thyroid

* TPO Antibodies

* Anaemia

Which would give you FT3, haemoglobin, other key nutrients & TPO antibodies (not TG ab)

The other option is separate tests for thyroid & complete iron profile from other (possible separate) - companies.

marillo profile image
marillo in reply toPurpleNails

Thank you Purple nails, really helpful. My haemoblobin was 132 g/l, my serum iron was 13.5, both in April 2023, I noticed in my records my serum iron was 26.5, November 22, is it usual to differ so much? I couldn’t see a record of my Ferritin in November 22. The reason I am delving, I’m having such a terrible time with perimenopause/menopause and HRT, migraines in the mix, I take beta blockers 3 times a day for prevention. It’s mainly the feeling cold and inner trembling for the past 12 months, racing heart at certain times of the day, nobody seems to be able to give me an answer, it’s very frustrating and driving severe anxiety. I give a Thyriod nodule which I’ve had for years, checked about 18 months ago, they said it shouldn’t be causing a problem. Thank you for listening, Karen

PurpleNails profile image
PurpleNailsAdministrator in reply tomarillo

Lab ranges vary but I think that haemoglobin is low. or it might be it’s just within range & so hasn’t been flagged as issue by dr.

Iron levels will change but by what degree is “normal” I’m not sure. Dr will be focusing for out of range results.

Do you take propranolol? Or another beta blockers?

I was given high dose propranolol when diagnosed hyperthyroid with fast heart rate. Is was then stopped abruptly (which should not be done) & I had terrible migraines. I resumed it & reduced it to a lower dose slowly but remain on it for migraines prevention.

Propranolol specifically can lower magnesium levels & this can worsen migraine & headaches, I’m my case low levels caused twitching around my eyes, It can also can affect FT3 levels & parathyroid.

This a a good article about the best forms of magnesium.

naturalnews.com/046401_magn...

I do well with powdered citrate as I take it in a drink before sleep.

You might find glycinate a good form which I took initially, however the brand I had were 3 large pills a day & I find the powdered more convenient.

Magnesium is a mineral which can usually be taken safely at over the counter doses, without testing first, blood tests tend not to be reliable as body is good a regulating blood levels, but there no test for magnesium in other cells. Excess will be safely excreted.

Always worth obtaining previous ultrasound? or any scan reports. Sometimes includes details about thyroid health which aren’t fully explained.

Ultrasounds can’t determine the function throughout thyroid, drs rely on thyroid function results to decide if there is a function problem. Scans look for potential physical issues.

I have hyper nodule which was cleared after scan but months later found to be hyper functioning, the blood tests weren’t processed.

Non functioning nodules are more common & the thyroid can compensate for the non functioning area & rarely an issues.

marillo profile image
marillo

Thank you, I take propranolol, 40mg 3 times a day. I did wonder if there is some kind of conflict going on? I take Estradiol patch and Utrogestan progesterone. I understand the thyroid can be affected, not sure how etc.. I take Magnesium Glycinate also. The Hrt has helped massively with migraine, I am questioning whether I need the propranolol 3 times a day now, been on it for 17 years, I’m 54. It’s difficult getting a GP to look at all this. I think I’ll ask for iron studies and Thyroid again, B12 etc. maybe then get some private testing, Thanks so much.

Lovecake profile image
Lovecake

I wonder if the propranolol is lowering your blood pressure or heart rate too much which is making you feel cold? I would speak to a GP about possibly lowering the dose a tiny bit. But I have no medical reason for saying this, it’s just my thought after reading your post. I am lucky though, my current GP is good and does listen - even though she doesn’t always have the answers, but at least she admits it and is nice.

marillo profile image
marillo in reply toLovecake

Thank you Lovecake, I had thoughts of this myself. I’ve been like this for 12 months now and just need some answers.

Lovecake profile image
Lovecake

I feel for you, as do many people on here. Our bodies are so complicated, I hope you find your answers and if you do, please give us an update ☺️🧁

marillo profile image
marillo in reply toLovecake

Thank you! I will x

Regenallotment profile image
RegenallotmentAmbassador

your ferritin would make me feel awful, achey and my thyroid conversion would be poor. Highly recommend Three Arrows Heme Irop Repair. Order from US and wait weeks for it to come but it does what other iron supplements don’t do 🌱

marillo profile image
marillo

Thank you that’s interesting, I will get some upto date tests done first, but Thanks for the recommendation.

marillo profile image
marillo

Hi, just an update. I asked my GP to look at my iron, he also did my Thyroid, Vitamin D, B12 and Folate, I have some results. The blood was taken at 9.30am, that’s the earliest I could get, I had fasted since 7 the previous evening, the GP did not tell me to do this, I listened to your advice re Thyroid results. Is it possible for anyone to comment on the results? My serum Ferretin looks low but not out of range yet? Thank you in advance.

B12 and Folate
marillo profile image
marillo in reply tomarillo

Thyroid results

Thyroid
marillo profile image
marillo in reply tomarillo

Serum Ferretin

S Ferretin
marillo profile image
marillo in reply tomarillo

iron

Iron
marillo profile image
marillo in reply tomarillo

iron

Iron
marillo profile image
marillo in reply tomarillo

Vit D

Vit D
SlowDragon profile image
SlowDragonAdministrator in reply tomarillo

Your ferritin is virtually deficient

% saturation Transferrin high to try to rectify this

urmc.rochester.edu/encyclop....

Are you vegetarian or vegan?

Look at increasing iron rich foods in diet

Eating iron rich foods, red meat daily and liver or liver pate once a week, 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-...

healthunlocked.com/thyroidu...

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...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40 30 to 180

Females 40 ≤ age < 50 30 to 207

Females 50 ≤ age < 60 30 to 264

Females Age ≥ 60 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

marillo profile image
marillo in reply toSlowDragon

Thanks SlowDragon for all your information, very helpful. I’m not vegetarian or Vegan, I don’t eat a lot of red meat though, I’m trying to eat more.I’ve made an appt with the GP to discuss the results and my propranolol. All the tests have been marked as normal no action, but clearly my symptoms are telling me otherwise. You suggested a new post for more comments, I’ll do this also. If my Ferretin gets lower does this mean I will have iron deficient anemia? Are the Thyroid levels a bit useless because of my Propranolol.

Forgot to add my haemoglobin.

Thanks so much, Karen

haemoglobin
SlowDragon profile image
SlowDragonAdministrator in reply tomarillo

Are the Thyroid levels a bit useless because of my Propranolol.

Yes …..because propranolol will stop thyroid hormones being used/processed in the cells…..just sitting in the blood

As discussed here

rejuvagencenter.com/hypothy...

Propranolol increases reverse T3 (rT3). Possibly by increasing the conversion of T4 to rT3, and by reducing it’s metabolism and clearance from the body.

What is interesting is that T4 will often rise, and TSH does not appear to be influenced by Propranolol. So consider you are put on a beta blocker. After a period of time you start to have low thyroid symptoms; tired, fatigue, weight gain, edema, dry skin, etc. You see your primary who runs a TSH with fT4 reflex panel.

Since the beta blocker does not influence TSH it may look normal. If it is high and fT4 is run, it to will be normal or possibly high because beta blockers raise T4 levels.

You will be told you don’t have a thyroid problem because these two labs are normal. If however a comprehensive thyroid panel was run to include T3 and rT3, we would be able to see that the beta blocker is inducing a cellular hypothyroid state.

This is a case of Drug Induced Hypothyroidism. The beta blocker induces the hypothyroid state as well as hide the impact because limited thyroid panels are often performed.

Ween off propranolol VERY SLOWLY over 6-12 months…..and wait at least 3-6 months for thyroid levels to recover

I was stuck on 40mg propranolol 20 years and already diagnosed as hypothyroid due to autoimmune thyroid disease …..caused no end of issues….more on my profile

marillo profile image
marillo in reply toSlowDragon

Thank you SlowDragon, really helpful, I will discuss with the GP. I’ve managed to get a face to face appt, hopefully I can get somewhere with all this. Thanks again.

SlowDragon profile image
SlowDragonAdministrator in reply tomarillo

Your GP highly unlikely to know that propranolol affects thyroid or that it lowers magnesium levels

marillo profile image
marillo in reply toSlowDragon

I agree, but as I’m on 40mg 3 times a day, I’ll need some further advice re migraines, Thank you.

SlowDragon profile image
SlowDragonAdministrator in reply tomarillo

Migraine are a hypothyroid symptom…..chicken and egg

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Also always worth trying strictly gluten free diet

But get coeliac blood test BEFORE trialing gluten free diet

healthline.com/health/migra...

marillo profile image
marillo in reply toSlowDragon

Thank you, I only started with migraine after my first child was born, I was referred to an endocrinologist because of changes to my Thyroid levels I think, they discovered 2 nodules, apparently harmless. No medication ever given, 27 years ago now. I’ve just had cealiac test, it was negative. Thanks again.

SlowDragon profile image
SlowDragonAdministrator in reply tomarillo

I only started with migraine after my first child was born, I was referred to an endocrinologist because of changes to my Thyroid levels I think, they discovered 2 nodules, apparently harmless. No medication ever given, 27 years ago now.

So you need new ultrasound scan

thyroiduk.org/testing/other...

and test BOTH TPO And TG antibodies

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

marillo profile image
marillo in reply toSlowDragon

Thank you for the information, you have been very helpful.

SlowDragon profile image
SlowDragonAdministrator in reply tomarillo

Thyroid results are extremely unreliable on propranolol

SlowDragon profile image
SlowDragonAdministrator in reply tomarillo

only start one vitamin supplement at a time …..then wait 20-14 days to assess before adding another

B12 and folate both very low

Low B12 symptoms

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and a week or so later add a separate vitamin B Complex 

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

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

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

Post discussing different B complex

healthunlocked.com/thyroidu...

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

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 until over 500

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

SlowDragon profile image
SlowDragonAdministrator in reply tomarillo

Propranolol

pubmed.ncbi.nlm.nih.gov/168...

rejuvagencenter.com/hypothy...

escardio.org/Journals/E-Jou...

labtestsonline.org.uk/tests...

Drugs that may decrease PTH include cimetidine and propranolol.

SlowDragon profile image
SlowDragonAdministrator

You would get more replies if you write a new post

Propranolol significantly affects thyroid levels

If you decide to experiment with reducing dosage it must be done EXTREMELY SLOWLY

Likely to take at least 6-9 months to very slowly reduce dose …you might be able to reduce by 10mg…..wait 6 weeks…..reduce again

Or you might have to reduce by 5mg

Propranolol also lowers magnesium

What vitamin supplements are you taking

Vitamin D

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

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