Advice Please

[CallMeSunny]

I have been following your very informative helpful forum since the beginning of this year as I’m struggling to understand why I am so totally exhausted and feel generally run down each and every day. I do have Inflammatory Arthritis which is not totally controlled and at the beginning of the year (1st) was diagnosed with a DVT (leg) for which I am prescribed Rivaroxaban, but several of my bothersome symptoms don’t seem to be part of the RA package, so I completed Thyroid UK’s symptoms list; I ticked 20 boxes. My next step has been to have bloods tested (Blue Horizon) and I now have the results. I’d be very grateful if your expert members would have a look and let me know if they think I could make improvements etc. The bloods were taken at 9am, I had only had water to drink (no food) since 7pm the previous day. I’d stopped Biotin, Omega 3, Calcium Citrate, Vitamin D3 + Mk7, Folic Acid 5 days previously and my weekly injection of MTX was 2 days beforehand.

TSH. 1.59 [0.27-4.20]

Free T4 15.2 [12.0-22.0

Free T3 3.5. [3.1-6.8]

Total T4 90.5 [66-181]

Anti thyroglobulin Abs. 12 [<115]

Anti Thyroidperoxidase abs. <9. [<34]

Serum Folate 41.7 [8.83-60.8]. Active B12 >150 [37.5-150]. Ferritin 93.1 [13-150].

Calcium. 2.47 [2.2-2.55]. Vitamin D (25 OH) 130 [50-200] Magnesium 0.87 [0.66-0.99]

Iron 20.1 [5.8-34.5]

Cholesterol levels are high (post Christmas, so will hopefully improve over this next month) also HbA1c is top figure of range. RBC a little low and MCV 102.4 [81-98] high.

I am 77 years old, BMI 24.1. Apologies for so many results!

[TiggerMe Ambassador]

Hello, welcome along 🤗

Your results all look pretty good!

Except your thyroid free's

Free T4 (fT4) 15.2 pmol/L (12 - 22) 32.0%

Free T3 (fT3) 3.5 pmol/L (3.1 - 6.8) 10.8%

T4:T3 Ratio 4.343 

The fact that your TSH at 1.59 is deemed 'normal' suggests that your pituitary gland isn't sending out enough signal to raise the TSH and activate more hormone production... this is often called Central Hypo and a little tricky to get acknowledged

I don't know if any of the other medication might be causing this?

Certainly your levels are low and could well be behind your raised cholesterol, HbA1C and enlarged red blood cells

[CallMeSunny in reply to TiggerMe]

I’m very grateful you took the time to reply to me, thank you. Following on from your’s and Slow Dragon’s replies, I guess I need to speak to my Rheumatologist. No doubt other members on this site as well as NRAS forum will have similar issues. Interesting conundrum!

[SlowDragon Administrator]

This looks like the culprit

Methotrexate

pubmed.ncbi.nlm.nih.gov/374....

Conclusion: Methotrexate is associated with decreased TT4 levels in RA patients, and glucocorticoids is associated with decreased TT3 levels. Drugs of RA treatment may affect the thyroid function of patients while treating RA, which may be one of the causes of secondary thyroid diseases in RA patients.

[CallMeSunny in reply to SlowDragon]

Many thanks SlowDragon for your helpful reply. As I note in my reply to Eeyore, I guess it’s over to my Rheumatologist and keep my fingers crossed he can help. My GP’s advice was, “Tell the patient to take a multivitamin with iron”!

[TiggerMe Ambassador in reply to CallMeSunny]

Good old SD, so it is a known issue which should make it easier to get the correct treatment 🤞🙃

Worth printing off to show to your Rheumatologist

[TiggerMe Ambassador in reply to SlowDragon]

Great detective work SD 👏

[CallMeSunny in reply to TiggerMe]

Hear, hear!

[SlowDragon Administrator in reply to TiggerMe]

Thanks to Google 😉

[TiggerMe Ambassador in reply to SlowDragon]

Shame Dr's don't Google more often! 🙃

[SlowDragon Administrator in reply to TiggerMe]

As the saying goes …..”you can’t teach old dogs new tricks “

[TiggerMe Ambassador in reply to SlowDragon]

Trouble is these old dogs are passing their fleas on to the pups 😕

[gabkad]

The blood thinner can be causing internal bleeding. Did they check for occult blood in the stools? Your ferritin is low. What is your hemoglobin?

[CallMeSunny]

Thanks for replying gabkad: I had faecal blood tested..all clear. HB 125 [120-160]. MCV 102.4 [81-98]. RBC 3.7 [3.8-5.8]. Mean Cell HB 33.8 [27-33].

[humanbean in reply to CallMeSunny]

MCV 102.4 [81-98].

Over the reference range Mean Cell Volume (the average size of your red blood cells) is often found with low vitamin B12 and/or low folate.

Ask your doctor to test them both, and make sure to ask for a printout of the actual results and the reference ranges. Then come back here and post the results and ranges.

The below range RBC (Red Blood Cell Count) suggests anaemia. Anaemia has multiple causes, not just low iron.

These might be helpful :

cks.nice.org.uk/topics/anae...

cks.nice.org.uk/topics/anae...

[CallMeSunny in reply to humanbean]

Thank you for your kind reply humanbean. My B12 is above high range and folate is within range… both results (and ranges) given in my intro above. Everyone comments on how well I look (grrr…as I feel utterly drained), but I’m in awful pain everyday with lower right lumbar spine issues, same side hip issues plus RA flare. I’m normally a positive person but my reduced quality of life is beginning to upset me. Thankfully I have a good sense of humour, persistence and a cup half full attitude!