My first Blue Horizon blood test results are ba... - Thyroid UK

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My first Blue Horizon blood test results are back! Would be grateful if you could have a look for me please?

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27 Replies

This is my first blood test since increasing my Levo dose from 50mg to 75mg.

(Accord 50mg and Mercury Pharma 25mg. ) I weigh almost 60kg .

It was taken at 8.30am, I hadn’t eaten for 12 hours and my last dose of Levo was 26 hours previous.

Hemi-thyroidectomy 14 months ago. Before this my TSH was 1.59 and I felt well.

I would really appreciate your thoughts on the following results please:

TSH 0.311 (0.27 - 4.20)

Free T4 20.50 (12 - 22)

Free T3 4.2 (3.1 - 6.8)

Ferritin 36.90 (13 - 150) I don’t take supplements and am vegetarian.

Thyroid Peroxidase Antibody <4 (0 - 24) comment: negative.

Total Vitamin D 200 (50 - 200) I take supplements

Magnesium 0.96 (0.7 - 1.0) I take supplements

Zinc 19.7 (9.2 - 19.2) I take supplements

Selenium 3.82 (0.66 - 1.57) I take supplements

Unfortunately Folate and vitamin B12 were not tested due to a lab error but my vitamin B12 levels have previously been on the high side of the range. I haven’t been tested for Folate before so wouldn’t know about that.

Should I try to increase my Ferritin levels to be higher within the range ?

I’m wondering if I should take 50mg Levo 5 days a week and 75mg 2 days in an attempt to get my TSH level up to around 1.5??

Or should I ask to try a different brand of the 25mg, ie the one beginning with W? (can’t remember how to spell it).

When on 50mg my TSH was just below 4, so this extra 25mg has made a big difference

Thankyou so much for your thoughts, I have a GP appointment tomorrow.

I had a NSH blood test for TSH two days after this Blue Horizon one, and my GP messaged me saying she thought I was in danger of going into the Hyperthyroidism range now that I’m on 75mg per day, so will be discussing this with her tomorrow.

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greygoose profile image
greygoose

I’m wondering if I should take 50mg Levo 5 days a week and 75mg 2 days in an attempt to get my TSH level up to around 1.5??

Why would you want to do that? It's not about the TSH, it's mainly about the FT3, and yours is low. It's low T3 that causes symptoms, not TSH at any level.

my GP messaged me saying she thought I was in danger of going into the Hyperthyroidism range now that I’m on 75mg per day, so will be discussing this with her tomorrow.

Oh dear! She's very ignorant, isn't she. You are hypo, with only half a thyroid, you cannot 'go hyper'. I suppose she means 'over-medicated' (in which case she should say so!) but the TSH isn't going to tell you that, despite what doctors think.

TSH is a pituitary hormone. When the pituitary decides there's not enough thyroid hormone in the blood it increases output of TSH to stimulate the thyroid to make more hormone. When the TSH goes low, it just shows that the pituitary is satisfied with the amount of thyroid hormone in the blood. But, it cannot distinguish between T4 and T3. Your FT4 is high, because you are a poor converter, but your FT3 is too low for good health. So, whilst you might be taking too much levo, if that levo is not converted to T3, you remain hypo.

So, how do you feel on that dose? How you feel is as important as the numbers on a blood test.

I would suggest that you refuse to reduce your dose based solely on a low TSH, and point out the low FT3 (although she probably won't know what that is!) and the fact that you are a poor converter, as shown by your high FT4. T3 is the active thyroid hormone, needed by every single cell in your body. You don't have very much. Reducing your levo would probably reduce your FT3 even further.

Alternatively profile image
Alternatively in reply to greygoose

Thankyou for your reply Greygoose, oh dear, what can I do about having a low T3 level, a high FT4, and being a poor converter? How can this be fixed?

greygoose profile image
greygoose in reply to Alternatively

The first thing to do is to optimise your nutrient levels - SlowDragon talks about that below. And, you can try taking selenium, which is essentail for conversion. But, sometimes there's nothing you can do except add some T3 to your dose of levo - which can be difficult to obtain. So try the nutrient route, first.

But, above all don't let her reduce your dose of levo at this point.

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Alternatively in reply to greygoose

Noted, will fight my corner during my conversation tomorrow to keep levo at 75mg.

Will report back.

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Alternatively in reply to greygoose

Update….. GP agreed to keep my Levothyroxine dose the same for three months, but said I wasn’t Ferritin deficient at 36 because the lowest figure in the range was 13, so nothing to worry about.

So will get full iron panel done with Medichecks.

greygoose profile image
greygoose in reply to Alternatively

Well, just goes to see how ignorant he is! For goodness sakes! You don't have to be right at the bottom of the range to be deficient, the ranges are much too wide! He just doesn't understand what ranges are, that's all. And, even if you're not deficient, your ferritin is far too low for good health. BUT before starting supplements you need to have your serum iron tested because it's possible to have high serum iron but low ferritin, and in that case, it's not a good idea to take iron supplements. I honestly don't know what you can do about that level of ignorance. :'(

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Alternatively in reply to greygoose

I know, scary isn’t it. But how many patients across the country are being told this, the majority wouldn’t do their own research or know about support groups such as this one to make them question their gp. If only the ranges were more logical!! 😤

All I can do is get private blood tests and see a private Consultant.

Although I feel like I want to get iron supplements into me straight away, I promise I will get a Medichecks test first. Many many thanks for your insights , it’s much appreciated.

greygoose profile image
greygoose in reply to Alternatively

It is scary, yes! Most people believe that doctors know everything and have their best interests at heart. Neither are true! I often wonder how many people they kill with their ignorance and negligence.

Rather than starting on iron supplements right away, can you increase your consumption of iron-rich foods? But, if you do, make sure you eat a rich source of vit C at the same time to aid absorption - or take vit C supplements.

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Alternatively in reply to greygoose

Yes, from now on I’ll be mindful and I’ll try to eat more iron rich foods alongside vitamin C, but being vegetarian I can’t eat chicken livers etc which I know would give me a big boost. Will do more research into best iron rich vegetarian foods.

greygoose profile image
greygoose in reply to Alternatively

Have just read that NICE consider ferritin levels of under 30 to be deficient, but doctors don't agree - although what they know about it could be written on the back of a postage stamp! So, at 36 you're maybe not deficient, but almost! And in any case, before you get to 'deficient', you have 'too low', which is almost as bad! Funny how they can be so finickity about numbers when it suits them, and other times completely ignore them!

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Alternatively in reply to greygoose

I just don’t understand why the range would go down as low as 13 if 30 is recognised as deficient by NICE, it’s crazy isn’t it. 🤷‍♀️

helvella profile image
helvellaAdministratorThyroid UK in reply to Alternatively

NICE only changed the lower end (in the Clinical Knowledge Summary) fairly recently.

It is not mandatory for anyone to use that revision. Even if it were, it takes time to works its way through.

I'd argue that while 30 is better than 13, being at 30 really isn't good enough - it is just that below 30, serious action is needed. Above 30, maybe less of a panic is needed! :-)

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Alternatively in reply to helvella

I’m going to do my best not to let my levels drop any further Helvella! They are on a downward trajectory 😩

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Alternatively in reply to greygoose

Forgot to say, my selenium levels received yesterday were above range at 3.82. (Range 0.66 - 1.57) so maybe I should take my supplement every other day. So selenium not the cause of my poor T3 converting unfortunately.

greygoose profile image
greygoose in reply to Alternatively

No, that would make it easier, wouldn't it. But, there are so many possible causes, it was just a shot in the dark.

But, as you're over-range I think you should stop it altogether, at least for a while. Too much is not good.

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Alternatively in reply to greygoose

Yes, I will stop them for a month and then only take one every other day. Thanks Greygoose.

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Alternatively in reply to greygoose

Last question, Is it the case that I can’t start to take T3 medication until my Ferritin level has raised? All my other nutrient levels are good. 5 months ago, Folate was 10.7, is this ok? B12 and vitamin D were above range.

greygoose profile image
greygoose in reply to Alternatively

Do you take B12 supplements? Folate could be higher. Do you take a good B complex?

I don't know if you can take T3 with low ferritin - I mean, there's nothing to stop you taking it, but the question is: will it do any good? And I don't know about that. Taking it might help, but not as much as it would if your ferritin is optimal. Then again, it might just be a waste of good T3. Maybe try it and see.

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Alternatively in reply to greygoose

I take health leads vitamin b complex currently but only twice a week because I was worried about my B12 levels going even higher than they are already. Thinking it may be dangerous to go sky high? They were 883 pg/ml. But will be changing to the Thorne Basic B complex that I’ve read about on here. What is the optimum figure for Folate?

greygoose profile image
greygoose in reply to Alternatively

B12 is water soluble, so any excess will be excreted. It's not dangerous to have a high B12.

Folate should be in double figures, at least over mid-range - if they give a range, that is. They don't always. :)

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Alternatively in reply to greygoose

Oh that’s reassuring to know, thanks.

No upper range was given on my results for Folate, just that <3 was deficient.

greygoose profile image
greygoose in reply to Alternatively

Well, it's probably deficient long before that! :)

SlowDragon profile image
SlowDragonAdministrator

Request GP do full iron panel test for anaemia

Your ferritin is borderline deficient

Low iron/ferritin will lower TSH

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

Stop iron supplements 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

Eating iron rich foods pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

Extremely difficult/impossible to maintain good iron by diet if vegetarian and hypothyroidism

List of iron rich foods

dailyiron.net

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

This is derived from meat…..so not suitable for vegetarians

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

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...

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...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue

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 264l

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.

Alternatively profile image
Alternatively in reply to SlowDragon

Thankyou SlowDragon for the links re iron and ferritin. I spent hours yesterday pouring over the information…… I’ve never given any thought to ferritin and iron levels before so it’s a new subject for me to learn about. I’ve never felt the effects of being iron deficient, even though I’ve been vegetarian since the age of 14, but now will be mindful of my diet in respect of iron, especially because I may need T3 medication.

So to confirm, I need to increase my ferritin levels before starting medication for low T3 levels, because that medication doesn’t work well if your Ferritin is low?

I found a blood test run via my gp 5 months ago and my ferritin level then was 42ng and it is now 36.90.

Also at that time 5 months ago, my B12 levels were 883pg (range 197 - 771) so above range

And my Folate level was 10.7ug (<3 being deficiency).

These two were missed off my report this time.

I have just spoken with my Gp who told me I didn’t need a complete iron panel check because I was in range, with 13 being the figure to stay above. I didn’t argue, I just silently resolved to get it done privately.

My GP did however agree today that I could continue on the same dose of Levothyroxine, to be checked again in 3 months.

SlowDragon profile image
SlowDragonAdministrator in reply to Alternatively

So to confirm, I need to increase my ferritin levels before starting medication for low T3 levels, because that medication doesn’t work well if your Ferritin is low?

Yes

I have just spoken with my Gp who told me I didn’t need a complete iron panel check because I was in range, with 13 being the figure to stay above. I didn’t argue, I just silently resolved to get it done privately.

Unbelievable isn’t it …..and extremely common

OlgaB profile image
OlgaB

From my experience: whatever dose you are taking divide it evenly to take the same amount every day. Do not take some days 50mg and other days 75 mg. I was cutting tablets to have the same amount of levo every day. I actually read it on this site, and it was extremely helpful that the cells in our body react not only to the lack or excess of the hormone, but also to the change of the amount. My case was complicated, I was hyper after thyroidectomy, and fluctuations of doses caused pinch and needles in my whole body. I noticed that when the dose was the same pinch and needles would go away.

Alternatively profile image
Alternatively in reply to OlgaB

Thankyou for replying OlgaB, I had been wondering about the merits of changing doses alternately against cutting a tablet in half and so taking the same quantity each day. So that’s good to know for future reference, Although today I’ve been given the go ahead to stay on 75mg per day ……”for now”…..so I currently haven’t got that problem to deal with. (I was worried my gp was going to reduce me back to 50mg, so I was preparing a compromise!)

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