Advice on ‘normal’ test results : Hi I’ve... - Thyroid UK

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Advice on ‘normal’ test results

Bubblesgirl78 profile image
11 Replies

Hi I’ve recently joined and wanted some guidance on blood tests that my doctors are saying need no action. I went struggling with neck pain and neurological symptoms and they ordered full bloods. In the last two years I’ve gained a huge amount of weight, my face is puffy, and I’ve struggled with running due to joint pain, constantly exhausted and dry skin, thinning hair and weak nails (amongst other symptoms)

key blood results are as follows:

Thyroid function test

Serum TSH level 4.61 mU/L [0.3 - 5.0]

Serum free T4 level 7.2 pmol/L [7.9 - 16.0]; Below low reference limit (no further action needed)

Serum vitamin B12 level 121 ng/L [120.0 - 900.0]; B12 low normal/borderline (No further action needed)

Serum total 25-hydroxy vitamin D level 47 nmol/L [75.0 - 250.0]; Between 25 and 50 nmol/L: Vitamin D insufficiency (Told to take supplements)

Also got a text message to lower my cholesterol

Do the thyroid results in particular need no action given T4 is below normal range? My sister also has an under active thyroid and is a nurse and she has told me to query these (I do have private insurance too). Would appreciate any advice thanks

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Bubblesgirl78
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11 Replies
jimh111 profile image
jimh111

This is secondary hypothyroidism cks.nice.org.uk/topics/hypo.... Your GP should refer you to an endocrinologist.

SlowDragon profile image
SlowDragonAdministrator

obviously you are clearly hypothyroid

Was this test done early morning for highest TSH

B12 is deficient

Are you vegetarian or vegan?

Insist on test for Pernicious Anaemia before starting any B12

Quite likely to need B12 injections

Have you got folate or ferritin results?

Vitamin D is insufficient and GP should be prescribing 1600iu daily. But likely better to self supplement at higher dose

Low vitamin levels tend to lower TSH …..and GP won’t want to treat your hypothyroidism until TSH over 5

High cholesterol is directly linked to being 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.

SlowDragon profile image
SlowDragonAdministrator

work on improving low vitamin levels and get thyroid levels retested Including thyroid antibodies

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once

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

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.

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

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)

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

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

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

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

See detailed reply by SeasideSusie

healthunlocked.com/thyroidu...

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

SlowDragon profile image
SlowDragonAdministrator

Low vitamin D

GP should prescribe 1600iu everyday for 6 months

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

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

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

But with thyroid issues , 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, with thyroid issues we frequently need higher dose than average

Suggest you try 3 x 1000iu per day

Retest in 2-3 months

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, but must be four hours away from levothyroxine

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...

Bubblesgirl78 profile image
Bubblesgirl78

thank you all for your comments I will ask for further follow up. Answering some comments above

Test was at 830am (I hadn’t ate or drank)

I’m not vegetarian

No mention of folates or ferritin that I can see

I used to have B12 injections but they stopped them once my levels got high enough and said I didn’t need them anymore

SlowDragon profile image
SlowDragonAdministrator in reply toBubblesgirl78

used to have B12 injections but they stopped them once my levels got high enough and said I didn’t need them anymore

Obviously you need to push HARD to get these injections reinstated

When they stopped injections you should have been trialled on B12 supplements instead

Vitamin levels are dire BECAUSE you are hypothyroid

if you don’t have Pernicious Anaemia you may be able to maintain good B12 with daily supplements

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 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.

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...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

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

Other options

healthunlocked.com/thyroidu....

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

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

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

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

SlowDragon profile image
SlowDragonAdministrator in reply toBubblesgirl78

Request by email that B12 injections are reinstated

Also request full iron panel test for anaemia, folate and thyroid antibodies are tested for autoimmune thyroid disease

Sparklingsunshine profile image
Sparklingsunshine in reply toBubblesgirl78

The need for B12 injections varies, sometimes it can be due to low dietary B12, or an issue with absorbing enough from diet, however they should have explored the reason why your B12 was low enough to warrant injections. Which aren't easy to get on NHS incidentally.

And if you have Pernicious Anemia, an autoimmune condition where the body doesnt produce the intrinsic factor necessary to absorb B12 from either diet or tablets, then you need regular injections for life.

Just giving a few injections and then saying job done is neglectful to say the least. You could very easily have PA and no amount of tablets will help with that. PA and hypothyroid often go together. Especially if hypothyroid is due to autoimmune issues, autoimmune conditions often hunt in packs.

Bubblesgirl78 profile image
Bubblesgirl78

sorry I should have also mentioned I’m on HRT (I’m mid 40s and started it 2 years ago) I’d put most of the symptoms down to peri menopause before

SlowDragon profile image
SlowDragonAdministrator in reply toBubblesgirl78

When hypothyroid this results in low stomach acid and poor nutrient absorption, regardless of how good your diet may be

Essential to get all four vitamins tested at least annually and maintain at OPTIMAL levels

Highly likely you have high thyroid antibodies

PS

You need to click blue reply button when replying otherwise other poster isn’t alerted

Bubblesgirl78 profile image
Bubblesgirl78 in reply toSlowDragon

thank you your advice has been great. My insurance said they’d cover the referral if I can get a letter from my gp so have an appointment tomorrow to persuade them, fingers crossed

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