Understanding my results

[TechCat]

Hi,

Would anyone be able to help me make sense of the following blood results?

I went to the doctor's as I've been experiencing constant headaches with dizziness. I don't have the headline symptoms of hyperthyroidism.

I had the following results in January

Serum free T4 level 21.7 pmol/L [11.0 - 22.6];

Serum free triiodothyronine level 6.5 pmol/L [3.5 - 6.5]

Serum TSH level 0.02 mu/L [0.2 - 4.0]

B12, Ferritin all in range

Serum vitamin B12 level 468 ng/L [211.0 - 911.0]

Serum folate level 10.8 ug/L [3.0 - 14.4]

Serum ferritin level 47 ug/L [10.0 - 291.0]

Advised to repeat and had these results this week

Serum free T4 level 14.8 pmol/L [11.0 - 22.6];

Serum free triiodothyronine level 4.5 pmol/L [3.5 - 6.5]

Serum TSH level 0.06 mu/L [0.2 - 4.0];

Do these look like things are improving ?

The doctor wants to see me again, so I have an appointment in two weeks but I don't know what questions I should be asking or what needs to be considered?

Thank you in advance

[greygoose]

Hi TechCat, welcome to the forum.

Not exactly improving, no, more like swinging the other way.

Serum free T4 level 14.8 pmol/L [11.0 - 22.6] 32.76%

Serum free triiodothyronine level 4.5 pmol/L [3.5 - 6.5] 33.33%

From being at the top of the range, they are now too low. And suggesting hypothyroidism.

The TSH has hardly moved, but that's not surprising because it's very slow at responding to thyroid hormone levels. But, it's the least important number, anyway, and varies throughout the day, being highest around 9 am and lowest around midday. What time was the blood draw for these two tests?

Your B12 is a tad low - would be better over 550. And your folate could be better. So, I would suggest a daily B complex - one containing methylcobalamin (B12) and methylfolate. Thorne do a good one.

But your ferritin is a disaster! You need to see your doctor about that one, and try and get a full iron panel done.

No vit D?

As for what you should ask your doctor, ask him to test antibodies. You could have Autoimmune Thyroiditis - aka Hashi's - causing levels to fluctuate like that.

[TechCat in reply to greygoose]

The first test was around 3pm and the second 10am.

I saw a doctor after the first test and they told me all my levels were good...

Ok great thanks for that advice I will get that ordered.

Looks like they didn't test vit d no. Should I ask for that at my next appointment?

[greygoose in reply to TechCat]

Well, it's always a good idea to get blood taken at the same time every time, so that you can compare results. With both of those times the TSH would have been lower than ideal to impress doctors!

And whilst your levels in the first test weren't 'bad', they were unusually high. 'Normal' (euthyroid) would have been around 50% through the range, those were more like 100% and should have aroused suspicion that something was 'going on'. But doctors are notoriously bad at interpreting blood test results - especially thyroid bloods.

Yes, it would be a good idea to ask for vit D. And TPO and Tg antibodies.

[TechCat in reply to greygoose]

Great ok thank you.

I'll ask for these at my next appointment.

Great I'll try and get an appointment at a similar time but it's often take what you can get unfortunately at the moment.

Thanks for taking the time help !

[greygoose in reply to TechCat]

Yes, I understand. But it's often worth holding out for a better timed appointment rather than just accepting any old time and hoping for the best. Especially where TSH results are concerned because often that all they test or all they look at. With those two tests it didn't matter so much, because the TSH was obviously going to be low with those high Frees. And, with the second one, although the Frees were much lower, the TSH wouldn't have had time to catch up, anyway. But, for the future, getting the right results is often better than getting them quickly.

[SlowDragon Administrator]

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

Also both TPO and TG thyroid antibodies tested at least once to see if you have autoimmune thyroid disease aka Hashimoto’s

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms before becoming increasingly hypothyroid

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 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

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 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

work on improving ferritin up to at least 70 by increasing iron rich foods in your diet

[TechCat in reply to SlowDragon]

Great thank you for the advice

[SlowDragon Administrator in reply to TechCat]

Test vitamin D

Can test via NHS private testing service

vitamindtest.org.uk

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...