Friends thyroid results, please can anyone advise?

[Opal79]

Hi! A fellow Pernicious Anaemia sufferer and friend of mine needs some thyroid help please! I'm also hypothyroid / hashi and still 18 months into my journey and not quite there yet so feel the need for advice!. She had some bloods taken this week and the results to me look less than optimal, while being in 'normal' range.

She is ahead of me by a few month's into every other day B12 injections for P.A and she, like me, also has Hashimoto’s but thyrid bloods last year were good. She takes all cofactors for this although sees her Vit D could be alot better so will be raising this now to optimal levels. Her ferritin and folate are high due to supplementing and a recent iron infusion.

It's interesting also that since her last panel 10 months ago, her antibodies are much better than they were. She thinks this must be due to going gluten and dairy free since, and injecting B12. However her TSH is higher than it was, and both FT4 and FT3 lower than optimal.

Her mum had P.A and a very late in life diagnosis (& sadly too much damage done) and she was then dx hypothyroid shortly after as this seemed to be concealed by the P.A. My friend is concerned that now she could be heading in the same direction too as following a similar pattern.

I do have the tracker pics of Thyroid bloods from last to this year but unsure how to share more than 1 pic here so can try and do so if anyone needs to see.

I did say to her that maybe her lower vit D could be causing a dip with thyroid levels especially given her antibodies are way lower than last year? But I'm still learning so want to ensure I give her the correct info and anything to change or add please? I explained quite alot of NHS GP's wont prescribe levo with these levels but she wants to try anyway, so any info she could go armed with would be amazing if anyone can help please?

Thanks for reading 😊

[greygoose]

Sorry, impossible to read those results. They are too small and if you try to enlarge them, they just go fuzzy.

I did say to her that maybe her lower vit D could be causing a dip with thyroid levels especially given her antibodies are way lower than last year?

Antibody levels have little to do with anything. They're either postive for Hashi's or negative. They fluctuate all the time, independant of anything else. Once you have had a positive reading, the level is irrelevant and it's not even worth retesting.

TSH/FT4/FT3 will also fluctuate to a greater or lesser degree. That is the nature of the disease. The immune system is trying to kill off the thyroid, mistaking it for the enemy, and continually attacks it. As the cells in the thyroid die, they release certain amounts of thyroid hormones into the blood, causing levels to fluctuate. And they also release small quantities of Thyroid Peroxidas and Thyroglobulin, which causes the level of antibodies to rise as they remove it from the blood.

So, if her FT4/3 are lower than usual, and her antibodies are lower than before, it would suggest that there hasn't been an attack on her thyroid recently.

Nutrients are low due to low stomach acid, which in turn is due to low levels of FT3. But they don't cause low thyroid levels.

So, if you can type out those results and ranges, we'll be able to discuss all this further, and how it's likely to affect your friend.

[Opal79 in reply to greygoose]

Hello thanks so much for your reply and apologies for the rubbish pic! Thanks for the clarification, we wondered if the B12 injections had made a positive difference to the hashi antibodies but it sounds as though this isn't the case? I'm abit confused about if FT4 and FT3 are lower as well as antibodies that there's been no recent attack on thyroid. What would cause lower FT4 or FT3 then do you mean it's due to low nutrients as a result of low stomach acid? Sorry I'm abit confused.

Here's all the results, thanks so much again!

Crp hs - 1.680 mgl (<3)

TPOab - 16.5 kIU/L (0 - 34)

TGab - 12.3 kIU/L (0 - 115)

TSH - 2.55mIU/L (0.27 - 4.2)

FT4 - 16.5pmol/L (12 - 22)

FT3 - 4.7pmol/L (3.1 - 6.8)

Folate - 45.4nmol/L (<7)

Ferritin - 396ug/L (30 - 264)

Active B12 - 150pmol/L (37.5 - 188)

Vit D - 91.4nmol (50 - 250

[greygoose in reply to Opal79]

I'm abit confused about if FT4 and FT3 are lower as well as antibodies that there's been no recent attack on thyroid.

Well, it's quite simple, really. If there has been a recent attack on the thyroid, FT4 and/or FT3 levels will be high because of the dying cells depositing their store of hormone into the blood, as I explained above. If both are low then those are her new 'normal' levels and her thyroid is struggling to make enough hormone (as seen by the TSH level you posted above).

If there has been a recent attack the antibodies will be high because they've come along to clean up the blood.

So:

recent attack = high FT4 and/or FT3 + high antibodies

no recent attack = new 'normal' low FT4 and FT3 + lower antibodies (but still high enough to be positive for Hashi's)

Therefore, if both hormone levels and antibodies have reduced since last blood test, their probably has been an attack on the thyroid since the last blood test.

But, all that is irrelevant, really, just a way of demonstrating their indirect relationships.

What would cause lower FT4 or FT3 then do you mean it's due to low nutrients as a result of low stomach acid?

No, as I said, the other way around. The low thyroid hormone levels cause the low stomach acid, which in turn causes the low nutrient levels.

Having said that, I got the impression from your main post that she had Hashi's. But her antibodies are low in-range, and do not suggest that. What were they before? They are only positive, and proving Hashi's, if they are over the top of the range. If they were within the range last time then it really, really doesn't matter what level they are or were, they're negative! So absolutely not worth commenting on.

However, her TSH is too high, and suggests that her thyroid is struggling for some reason. Her FT4 is ok, but only because her TSH is high-ish. Her FT3 is a bit on the low-side.

Her ferritin is high. And as her CRP (inflammation marker) is low, the high ferritin needs investigation. Has she seen her doctor about it?

[Opal79]

Hi thanks so much for explaining. So sorry I'm still confused (bad brain fog here! Still trying to get optimal myself lol)...

I was getting my head round the following you kindly explained, thanks so much! But at the end where you wrote ' therefore...' did you mean to say if hormones and ab's have reduced it'll mean no attack? As the paragraphs above it look to say the opposite. Or am I reading this wrong/misunderstanding please? So sorry! -

"So:

recent attack = high FT4 and/or FT3 + high antibodies

no recent attack = new 'normal' low FT4 and FT3 + lower antibodies (but still high enough to be positive for Hashi's)

Therefore, if both hormone levels and antibodies have reduced since last blood test, their probably has been an attack on the thyroid since the last blood test."

Thanks so much for explaining about low stomach acid too. She wants to find out why she isn't absorbing nutrients but from my reading on things, it's due to thyroid. Can other factors be at play also please?

Yes she defo has hashis, it was dx by a GP a few years ago. I've asked for her results but they're on her laptop so I'm waiting for her to send me them. She assures me they're positive though, so above the ranges. The last couple of tests including the ones above have been negative though. She put that down to B12 injections healing her stomach and therefore calming her autoimmune response but it sounds from what you've said that it probably has less to do with that and more to do with normal ab fluctuations is that right? Sorry just making sure I've understood all this because she also tells me she has been misdiagnosed and neglected by doctors over the years but at one point her TSH was about 28 AND they did nothing!! Hence her thinking that last years b12 injections and iron infusion helped her TSH as well as her antibodies. I'm guessing this isn't actually the case and more likely its been her thyroid wildly fluctuating over time instead but wanted to check due to my confusion!🙈

Yes she had an iron infusion recently by the B12/iron specialist doctor, who we both see, he is amazing . He said that her ferritin will be very high due to the infusion as it is meant to last a year or two. Before infusion her ferritin was at 6, and she'd had years of being told have periods etc when all along it was likely P.a (and poss thyroid too by what you're saying?).

In response to your advice regarding ab attacks being recent and causing FT3 and/or FT4 to raise, for my own thyroid I'm abit concerned as recent tests for me showed out of range TPO but my FT4 was optimal (TSH wasn't though so I've been trying to persuade GP to increase levo and just gone up a small increment). My FT3 was quite low end normal though but better than a few months previous. So based on your advice, the thyroid results could be almost false results due to recent ab attacks have I understood right please? I can ask in a separate post if easier but thought would add incase you could clarify please?

I will post my friends dx hashi results when she gets back to me if it helps. Thanks so so much for your help we both really appreciate it and apologies for so many questions 😊