Hi, had annual thyroid check at GP and got result back today. I take levothyroxine and TSH is 3.8
Thyroid blood test: Hi, had annual thyroid check... - Thyroid UK
Thyroid blood test
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SlowDragonAdministrator
How much levothyroxine are you taking
How do you feel
Was test done as recommended
early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Just testing TSH is inadequate
And generally many (most?) patients on levo will need TSH at least 2.
Most important results are ALWAYS Ft3 followed by Ft4
And essential to regularly test and maintain OPTIMAL vitamin D, folate, B12 and ferritin
SlowDragonAdministrator
Is your hypothyroidism autoimmune?
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG 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.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease and when on inadequate dose of levothyroxine
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)
Request GP test vitamin levels (and thyroid antibodies if never been tested)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Testing options and includes money off codes for private testing
Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG 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
Just TSH, Ft4 and Ft3 test - £32
monitormyhealth.org.uk/thyr...
10% off code here
thyroiduk.org/testing/priva...
Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65
(Doesn’t include thyroid antibodies)
monitormyhealth.org.uk/full...
10% off code here
thyroiduk.org/testing/priva...
Hi SlowDragon , I had Ferritin tested May 2021 & result was
Serum ferritin level (XE24r) 18 ng/ml [30 - 150
Was tested again August 2022 and result was
Serum ferritin level (XE24r) 34 ng/ml [30 - 150]
Was told it was fine then
Also got the following results in August 2022
Serum transferrin level (XE2dx) 3.13 g/L [2 - 3.6]
Transferrin saturation index (XaERN) 15 % [15 - 50]
Serum iron level (X76tH) 11.5 umol/l [5.8 - 34.5]
Goodness me! Your ferritin is terrible at 34! We, as thyroid sufferers, need our ferritin at around 90-100. You must increase iron rich foods in your diet regularly. Liver pate, black pudding, beef, liver etc. Your iron levels are also quite low.
How do you feel? You probably don't feel well with a TSH of 3.8. But please do explain what SlowDragon has asked. What time of day was the test? When did you take your last dose of Levo before the test?
Those on medication for hypothyroidism usually feel their best with a TSH around 1 or below.
SlowDragon FancyPants54
One thing i did see is raised CRP can affect Ferritin level and my CRP was raised at the time
There was this noted at bottom of the blood test when Ferritin was 34
Serum C reactive protein level 11 mg/L [0.0 - 5.0]; Above high reference limit
Serum ferritin level 34 ug/L [30.0 - 150.0]; Note raised CRP. The Ferritin value may be lower than this once
the acute phase response is over.
Tbh, I don't feel too bad or maybe how I feel i've just got used to as the norm? Bit tired & occasional light headedness but other than that okay
Test was at 9.10am & had taken last dose of Levo the night before
Request GP redo test including Ft4 and Ft3 as well as vitamin levels and CRP
High CRP will falsely raise Ferritin levels
Last dose Levo 24 hours before test
As you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Thank you SlowDragon - do you think GP would be likely to restest Ferritin if asked? Do i just give them the reason that CRP was raised on last test for wantongit retested?
Ferritin deficient below 30
August 2022 results show you were low/borderline anaemic
Optimal ferritin at least over 70
Retest now via GP
And request/politely insist vitamin D, folate and B12 levels tested
cks.nice.org.uk/topics/anae...
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Medichecks iron panel test
medichecks.com/products/iro...
Look at increasing iron rich foods in diet
Eating iron rich foods like liver or liver pate once a week plus other red meat, 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
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-...
drhedberg.com/ferritin-hypo...
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
healthunlocked.com/thyroidu...
Posts discussing Three Arrows as very effective supplement
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Iron patches
healthunlocked.com/thyroidu...
Thyroid disease is as much about optimising vitamins as thyroid hormones
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.
Thanks SlowDragon - what reason would I give to GP for wanting to test Ferritin now.when they haven't suggested it since August 2022? When it came back at 34 in range, they just left it
Would it be worth mentioning th note about the raised CRP?
Serum C reactive protein level 11 mg/L [0.0 - 5.0]; Above high reference limit
Serum ferritin level 34 ug/L [30.0 - 150.0]; Note raised CRP. The Ferritin value may be lower than this once
the acute phase response is over.
Say
A) previous test May 2021 was 18
B) following test in Aug 2022 was 34
(borderline deficient)
However CRP (inflammation) was high at 11
As Ferritin is an acute phase reactant and rises with inflammation it’s likely/possible ferritin was falsely high
your transferrin was also rock bottom at 15%
urmc.rochester.edu/encyclop....
Your iron was also low
Iron 11.5 pmol/l (Range 5.8 - 34.5)
Only 19.86% through range
Alternatively test privately
Are you vegetarian or vegan
SlowDragon Nope not vegan or vegetarian, eat red meat alot during the week too
Would this sound okay as a mesaage on my online GP message request:
Hi, I am wondering if it is possible to get my Ferritin & Iron levels tested again? Ferritin was 18 in May 2021 & 34 in August 2022 - there was a note saying raised CRP (inflammation) can give false higher Ferritin levels so the 34 could have been lower. Transferrin Saturation was also 15% so the very bottom of the range
Also request either
25mcg dose increase in levothyroxine now as you have symptoms (and list them…..don’t say tired…say fatigue)
Or request thyroid levels retested including Ft4 and Ft3 as you still have residual hypothyroid symptoms
low vitamin levels are a direct result of being on inadequate doses of levothyroxine
Low vitamin levels result in poor conversion of Ft4 (levothyroxine) to Ft3 (active hormone)
Low Ft3 results in lower vitamin levels
SlowDragonAdministrator
How much levothyroxine are you taking
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
onlinelibrary.wiley.com/doi...
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
guidelines on dose levothyroxine by weight
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Also here
cks.nice.org.uk/topics/hypo...
SlowDragon taking 100microgram of Levo
And how much do you weigh
TSH over 2 is too high for majority of thyroid patients
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