Thyroid Bloods - Opinions Sought

[Nicacoco]

Hi everyone,

Have recently had the below blood results from private testing and I'd love the benefit of those who have more knowledge than myself.

Brief history - total thyroidectomy 2019 and a downward health spiral ever since, significant weight gain (three dress sizes and no sign of stopping), there has been no point of any day in the last 3 years when I have not been 100% exhausted, hair doing a runner, dry skin, mental fog, anxiety the whole shebang, rapidly increase joint and muscle aches, ( weight induced perhaps), soles of feet are agony for the feet few steps after I get up from rest. Massive attitude from GP surgery when I last requested a blood test from them in November 2022 (the first test they allowed me since 2019), haven't got capacity to be arguing with them for another, so here we are with a private test. There's all sorts of extra bits and bobs that likely have no bearing, but I'll copy them all over just in case anyone spots meaning. I'm aware the ferritin is low and the B12 is high.

TSH 5.57 mIU/L

Free T4 19.8 pmol/L

Free T3 3.4 pmol/L

T4 Total 136.0 nmol/L

Anti-Thyroglobulin Abs 24 IU/mL

Anti-Thyroidperoxidase abs 20.5 IU/mL

Cortisol (Random) 396.0 nmol/L

Reverse T3 30 ng/dL

Reverse T3 Ratio 0.11

Vit D (25 OH) 68 nmol/L

HbA1c 31 mmol/mol

Magnesium 0.80 mmol/L

CRP 1.67 mg/L

Iron 7.1 umol/L

UIBC 62.5 umol/L

TIBC 70 umol/L

Transferrin Saturation 10.2 %

Ferritin 10.00 ug/L

Serum Folate 9.41 nmol/L

Vit B12 490 pmol/L

Active B12 >150 pmol/L

[Forestgarden]

Hi there, what dosage of levothyroxine are you on? Do you have ranges for each of your blood test results? Others will comment on vitamins etc., but your ft3 is rock bottom, while your ft4 is towards the top of the range. You've probably got room to increase levo slightly, but its doubtful if that would have much impact on your ft3 as it seems you are a poor converter of t4 to t3. One reason might be your vitamins etc. These need to be optimal, not just within range. So the first thing to do is supplement anything thats low, then see if that brings your ft3 levels up.

[Jaydee1507 Administrator]

Welcome to the group.

So your TSH is above range, or likely to be, you haven't added the ranges for each test. If you could do that it would be helpful as ranges vary between labs.

I'm assuming you are on Levo. How much do you take and how do you take it?

Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.

Your TSH is high for the level of FT4 you have although you don't seem to be converting well.

Are you taking any supplements?

Ferritin is deficient. GP should prescribe you iron tablets although you can buy iron over the counter.

Folate isn't optimal. Suggest you start a good methyl B complex. Some suggestions:

Slightly cheaper options with inactive B6:

amazon.co.uk/Liposomal-Soft...

Contains B6 as P5P an active form:

bigvits.co.uk/thorne-resear...

healf.com/products/basic-b-...

Explanation about the different forms of B6:

helvella.blogspot.com/p/hel...

B complex comparison spreadsheet:

healthunlocked.com/thyroidu...

Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Many members like the ‘Better You’ range of mouth sprays that contain both bit D & K2. Use this calculator to work out how much to take to get your level to 100-150.grassrootshealth.net/projec...

Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process).

Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.

[pennyannie]

Hello Nicacoco and welcome to the forum :

The thyroid is a major gland and responsible for full body synchronisation from your physical ability through to your mental, emotional, psychological and spiritual wellbeing, your inner central heating system and your metabolism.

Without a thyroid it is essential to be dosed by your Free T3 and Free T4 reading and not a TSH seen is isolation which is likely all you get processed in primary care.

Once hypothyroid and taking T4 - Levothyroxine the TSH should be towards the bottom of the range and we generally feel best when this is low in the range - a TSH over 2 starts to indicate under medication.

We generally feel best when our T4 is in the top quadrant of it's range with the T3 tracking slightly behind at around 60-70% through it's range.

Seeing as we have no ranges - put another way - the accepted conversion ratio when on T4 only medication is said to be 1 /3.50 - 4.50 - T3/T4 - and we generally feel best when we come in this little ratio at 4 or under -

so if I divide your T3 into your T4 I am getting 5.82 - so outside and wide of the accepted ratio - showing you struggling to convert the T4 thyroid hormone replacement medication.

No thyroid hormone replacement works well until your core strength vitamins and minerals - especially those of ferritin, folate, B12 and vitamin D are up and maintained at optimal levels -

I now aim for a ferritin at around 100-folate around 20- active B12 around 125 ( serum B12 500++ ) and vitamin D around 125.

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1, T2 and calcitonin + a measure of T3 at around 10 mg + a measure of T4 at around 100 mcg - with T3 said to be around 4 times more powerful than T4,

T4 - Levothyroxine is a pro-hormone and needs to be converted in your body into T3 the active hormones that fires up and runs all your bodily functions - much like fuel to a car.

Some people can get by on T4 only - Levothyroxine.

Others find that T4 seems to stop working as well as it once did and that by adding in a little T3 - likely at a similar dose level that their thyroid once supported them with - they can restore hormonal balance and feel better.

Others find they can't tolerate T4 and need to take T3 only - Liothyronine.

Whilst others find their health improved by taking Natural Desiccated Thyroid which contains all the same known hormones as the human gland and derived from pig thyroids, dried and ground down into tablets referred to as grains.

Currently your GP can only prescribe T4 and the obligatory anti depressants should you not feel quite right and likely made to feel as though it's all your fault - it is not -

but it is a post code lottery and it would appear in certain areas of the country, that NHS financial constraints from ICB/CCG health boards rather than medical need are in place.

Obviously if you can afford to go privately the landscape is very different -

Thyroid UK - the charity who supports this forum hold a list of patient recommended thyroid specialists and endos both NHS and private so you might like this list for future reference - just email admin @thyroiduk.org.

What was the reason for your thyroidectomy please?

Is that ferritin reading of 10 a typo ???