new, seeking advice re test results

[Phoenix_24]

Hi, I’m new and I’m hopi g you can offer some advice and help interpreting these results.

I’m 44F and generally healthy but have been struggling with what I thought were perimenopause symptoms. Heavy periods, cystic acne, anxiety and depression, fatigue, joint and muscle pain and weight gain. In addition I have had dry skin, constipation, cold intolerance and hair thinning for a number of years. I’ve had blood tests a few times over the last 3 years and they came back normal until now. After these results the gp wants to see me and wants me to be checked for antibodies. I have an appointment next week but in the mean time would really appreciate your thoughts and advice interpreting these results and figuring out what I need to ask the gp. I include only the ‘abnormal’ results below.

Thank you in advance for your help!

Serum TSH level 65.7 miu/L [0.27 - 4.2];

-Serum free T4 level 6.9 pmol/L [10.5 -22];

-Transferrin saturation index 3 % [15 - 50]

-Serum iron level 3 umol/| [5.83 - 34.5];

-Serum transferrin level 3.94 g/L [2 - 3.6]

-Serum ferritin level 8 ng/ml; Female Ferritin Reference Range; 17-60 years: 13-150 ug/L

-Mean cell haemoglobin level 24 pg [27 - 34]

-Red blood cell distribution width 17.2% [10 - 15]

-Mean cell volume (42A..) 75.2 fL [80- 100]

-Red blood cell count (426..) 4.16 10^12/L [3.8 -4.8]

-Haematocrit 0.313 [0.37 - 0.47]

-Haemoglobin concentration 100 g/L

[115 - 165]

-Basophil count 0.1 10^9/L [0.02 - 0.1]

-Serum Cholesterol 5.46 mmol/L

-Serum total 25-hydroxy vitamin D level (Xabo0) 40 nmol/L [50 - 140]

[PurpleNails Administrator]

Welcome to forum,

Your GP is testing TPO & TG antibodies to check if you have an autoimmune condition damaging your thyroid. Most hypothyroidism is cause by this, (known as autoimmune thyroiditis or Hashimoto’s) but all hypothyroidism what ever the cause is treated the same.

Your results show you are very hypothyroid. The TSH is a pituitary hormone & It signals the thyroid to lower or increase production. Most have a TSH around 1. at 10 it is considered overt & yours is very high.

Symptoms are caused by low thyroid hormones (FT4 & FT3) not the TSH & your FT4 is currently under range. There’s no question you will need replacement thyroxine (this is called levothyoxine or LT4).

Usual starting dose is 50mcg, sometimes doctors can start on a higher dose using a calculation of 1.6mcg Levo per 1kg body weight, but some find it a shock to the system.

You might want to start on a 50mcg but increase at a gradual pace. Often this is 6 weekly - retesting and increase by 25mcg per day after each test. If you tolerate increases well you can push for faster / greater dose increase.

What shouldn’t happen is doctor says here’s a 25mcg starting dose we’ll check you again in a few months.

Cholesterol is high but this is caused by low thyroid levels, once you are replaced adequately this should improve. Should the doctor suggest treating the cholesterol there are references advising treatment should be delayed until thyroid treated.

Nutrients are often low when hypothyroid. As stomach acid is often low and absorption is affected. Was folate & B12 tested?

Ask to be tested for gluten allergy as this is common with thyroid autoimmune.

Nutrients need to be optimal for Levo to work well, not just anywhere in range.

Your iron & vitamin D are also very low & you’ll need supplements. Doctor should prescribe this, but often NHS treatment are insufficient dose to improve a deficiency and doctors do not also recheck after course prescribed. It might be something you’ll need to monitor and supplement yourself.

There is another thyroid hormone called FT3 (free Triiodothyronine) this is the active thyroid hormone. NHS do not often tests it, but many test privately to ensure T4 is converting to T3.

At this stage starting on replacement & improving nutrient level is the main aim.

Recommended that future tests should be arranged for first thing in morning, fast overnight & delay levo dose until after draw. This shows the highest TSH & Lowest FT4.

If you take any supplements containing biotin you should stop it 3 days before test there potential for biotin to skew the testing process.

Read lots of posts on here & information from thyroiduk.org this will help you learn how doctor is treating you & you can track & guide treatment to what’s is best for you.

Keep posting & ask anything you think of.

[Phoenix_24 in reply to PurpleNails]

thank you for the warm welcome and for all the information. Really appreciate you taking the time to give such a detailed answer.

I am relieved that there is a reason for how I’ve been feeling but this was not what I expected.

To answer your question my B12 and folate were normal - folate level 5.8 ng/ml [3 - 26.8] and B12 level 646 ng/L [197 - 771].

I have been anemic for a couple of years despite being prescribed iron tablets so would this have been the disease progression?

What could be the cause if not an autoimmune condition?

[PurpleNails Administrator in reply to Phoenix_24]

Folate is too low, look at taking a B complex with methylfolate. (Not folic acid which is synthetic)

Hypothyroid can contribute to anaemia (hypo can cause the heavy periods).

As you been anemic for a long time has doctor thought to refer you?

Almost certainly autoimmune - Over 90% of hypo due to autoimmune (even on occasions when antibodies are not positive, an ultrasound scan confirms autoimmune damage)

Rarer causes are:

- congenital mal-development of thyroid (which is detected at birth)

- a pituitary issue (your TSH is responding as expected)

- Severe iodine deficiency (exceptionally rare in UK)

- Several specific Medications causing complications (patients are warned of potential)

- previous radioactive treatment (for either cancer / overactive thyroid)

[Mixteca in reply to Phoenix_24]

As you have a long-standing history of anaemia and significantly low iron levels despite supplementation, I would personally see an iron specialist for further advice. I can pass on info if you want to go down that route. The key tests are ferritin and transferrin saturation %. Mine was 18%, which was a significant deficiency.

You may still be B12 deficient or have pernicious anaemia regardless of test results. Tests for these are a good idea before supplementing, if only to rule this out.

[Phoenix_24 in reply to Mixteca]

Mine is 3% so that does seem extremely low. I will bring it up with the GP, thank you .

[Mixteca in reply to Phoenix_24]

Sounded serious to me and why I mentioned mine. I needed an iron infusion to get levels up quickly. Important as I inject B12 regularly.

[Phoenix_24]

ok thank you. I will get some vit B complex.

Doctor hasn’t referred me for the anemia just prescribed iron. Who should they refer me to?

[PurpleNails Administrator in reply to Phoenix_24]

Anaemia that doesn’t respond to iron supplement should be further investigated by haematologist. I think GPs focus on haemoglobin levels. Unless this is low they’ll just keep prescribing iron, but not question why it not resolving the issue.

[Phoenix_24]

that is really helpful, thanks so much!

[McPammy]

I feel you should be starting levothyroxine immediately with a TSH that high and T4 so low. Your Dr needs to act swiftly. You could do witn some Ferris Fumetate for your low ferritin and vit D supplement too. Often people with thyroid conditions have low vitamin levels. You must be feeling pretty bad. Your symptoms remind me of mine when my GP refused to check my thyroid bloods when I was in my early 40’s. He kept saying i was depressed when I wasn’t I was in lots of pain and symptoms you’re describing. after ages they agreed and my TSH was 36. I was prescribed levothyroxine immediately 100mcg a day. Remember not to take iron meds close to levothyroxine med. take iron at least 4 hours after as they are contraindicated. If T4 levothyroxine doesn’t relieve your symptoms get your T3 checked also. Levo T4 sits in your body waiting to be converted to the most important hormone T3. Lots of people have trouble converting T4 levo to T3. With low T3 you will always struggle. One step at a time though for now. I do hope you get the levothyroxine quickly and importantly start feeling better soon which may take a few months.

[Phoenix_24]

Thank you for the advice and for sharing your experience too. I do feel really awful, I have done for a while. Sad thing is I saw it as a personal failing that I couldn’t function the way I thought I should be able to.I really hope the medication will help and that it doesn’t take too long.