This is my first post. I’ve been avidly reading back through past information and found it very empowering - I’ve been inspired to take control of my health.
I’ve just had results back from a Medichecks thyroid panel and would appreciate your thoughts.
Full information about my history and symptoms in my bio, but I’ve essentially been very fatigued and felt rubbish for at least three years. I tested positive for thyroid antibodies in 2016 as part of fertility investigations and was prescribed Levothyroxine for conception/pregnancy, but not at any other time. I asked my GP last week to run a full thyroid panel based on this, but she said they’d only do TSH initially, hence the private test.
I took my blood as per your instructions. Results as follows:
CRP HS 4.57 (<3)
Ferritin 37.9 (30-207)
Folate - serum 13.2 (>7)
Vitamin B12 - active 55.3 (37.5-188)
Vitamin D 38.8 (50-250)
TSH 3.55 (0.27-4.2)
Free T3 4.9 (3.1-6.8)
Free thyroxine 13.6 (12-22)
Thyroglobulin antibodies 295 (0-115)
Thyroid peroxidase antibodies >600 (0-34)
Thank you.
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IndieKid
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Welcome welcome!!!! Excellent bio and great details in your post above.
Others will come along with some more comprehensive links/info, but my quick initial questions:
- Is it correct you are not on any thyroid hormone replacement?
- Do you take any other vitamins or supplements?
Have you been sick recently? Wondering if you know what the elevated inflammation result might be from?
You’ve come to the right place - lots of us could have written your story, and although it’s a bit of a long road, the advice from this forum will put you on your way at least!
Classic profile of un-treated autoimmune underactive thyroid.
You do need to pursue treatment. I am in the US and so we need some UK folks to weigh in on how you can best navigate that.
Your thyroid is struggling. You will need to look to replace the thyroid hormones your body needs to function. These low Ts are causing your symptoms.
And because of that, your vitamins are deficient across the board and each of those creates their own specific sets of symptoms. Each of those needs to be supplemented.
As to exactly “how” - let’s see if some of our awesome forum-mates come along today with the details for that. There are target levels, and types/brands of what you will consider that the collective wisdom of the forum will share.
I can also come back after the workday and add some more info!!!
But the good news is that you have some very low hanging fruit items here to address to get you on your way to feeling better!
It can be a long road, but you are now at the starting line!-
edit: I should also point out that even though your numbers are sub optimal, the NHS is a whole different story - so what your body is telling you and what the medical establishment will recognize as needing treatment are very far apart.
Practically, we need a UK forum person to add to my response.
Thanks so much for the info. It’s a massive relief to have an explanation for how I’ve been feeling and as you say, I can crack on with addressing the vitamins.
Having read about some of the other forum user’s struggles with this and the prevailing approach of NHS doctors, I do worry that it’s not going to be straightforward to get medical support. I’ve already heard from my GP that they wouldn’t test my vitamin d ‘because everyone is deficient’, that there’s no point doing a full thyroid screen because they won’t do anything unless TSH and T4 are out of range, and in response to me asking for more blood tests that they ‘cost the NHS money’. They’ve been so passive in response to my symptoms - I’ve basically had to consult Dr Google and go to them with theories. Seems like this one might be right! I had naively assumed that they would be looking at my history in relation to the symptoms, which is why I hadn’t explored thyroid as an answer sooner. So glad I found this forum!
Having said that, I am going for blood tests first thing tomorrow, for the things they will test. Should have results later next week. In the meantime if anyone UK-based has any advice/information/tactics for my follow-up GP appointment after the blood tests, I’d be most grateful.
Just to add, I requested access to my past blood test results last week. This has also given me access to letters from during my pregnancies with additional results. Having gone over them I have also had the following, in case anything is relevant:
CRP-HS - This is a measure of inflammation and yours is slightly over range. Optimal is less than 1. It doesn't tell you where the inflammation actually is. Common sites would be lungs, gut, joints, thyroid but there could be other places. Improving your vitamins and minerals would probably lower your CRP.
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Ferritin - Optimal for ferritin is 90 - 110 micrograms/L. Your result is barely in range and needs improvement. Ideally you would get an iron panel done first, because in some cases serum iron can be high while ferritin is low, and in that case taking iron supplements isn't the best suggestion. If your ferritin was below range your doctor might do an iron panel, but since yours is in range they would probably refuse.
This is the best finger-prick iron panel I know of :
Folate - In the case where the folate test doesn't have an upper level, we usually suggest optimal is around 20 micrograms/L.
A good supplement is methylfolate, dose 1000 mcg per day. A few people have tolerance issues with methylfolate in the early days and have to start low then build up dose gradually. Read this link.
Once folate level is optimal the patient can continue to take the same folate supplements but for fewer days of the week to maintain their optimal level.
Vitamin D supplementation will raise the absorption of calcium from the diet. To make that calcium for into bones and teeth rather then end up lining your arteries, you need to take magnesium and vitamin K2.
For info on magnesium and vitamin K2 supplements, do a search of the forum. You'll find they have been mentioned many, many times.
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By optimising and then maintaining your nutrient levels you should feel quite a bit better than you do now. What it will do to your TSH, thyroid hormone levels and antibodies remains to be seen. Doctors will rarely treat hypothyroidism when TSH is within range or just over range.
With luck, improving your nutrients might even improve your TSH output and push it higher to speed up a diagnosis. I wish we didn't have to rely on luck, but so many of us do - and we are always at the mercy of our blood tests rather than our symptoms because doctors think that blood tests are all that count.
I don’t normally answer these questions as there are other people here who can rattle of the answers more easily than I can. However, as answers are currently thin on the ground, I’ll offer my two cents worth (as a UK-based layperson, meaning this is all to the best of my knowledge, but should be checked with a health professional).
Your TSH, FT3 and FT4 all fall within the reference ranges, so the NHS is unlikely to do anything at all for you currently. However, your antibody levels are both high, indicative of an autoimmune condition impacting your thyroid. As a result, you should repeat the test at intervals or get your GP to repeat the test at intervals, as you can expect your thyroid results to degrade from where they currently are at some point in future.
Your vitamin D is low. If your GP is like mine he/she will either ignore it completely or they will suggest you supplement with vitamin D3. Note that the latest science and government policy differ around this. Whilst most of us would supplement and get some sunshine, the science suggests that a diverse, more plant-based diet, together with sunshine, is the way to go. For more info, listen to the podcast about osteoporosis at link.chtbl.com/s9cwxMzY?lid... – it is focused on osteoporosis, but the advice around vitamin D is not specific to that condition AFAIK.
Your CRP is elevated, indicative of inflammation or recent infection. However, all sorts of other things can cause an elevated CRP, including high blood pressure, smoking, diet containing high levels of processed foods, lack of exercise etc.
With your results, I would not be worrying, but would repeat the tests to see how things progress, and I would try to switch to a more Mediterranean-style, mostly plant-based, diet, together with exercise and sunshine. If that's not practical, then supplement (in that case remember the K2 and magnesium that humanbean mentioned). That’s me – I don’t know about your current diet or exercise – you might have those right already 😊 The other question is - do you have other autoimmune conditions currently?
I'm not sure that its possible to get enought Vitamin D from food alone. I'm a lifelong vegetarian and get plenty of sunshine as I'm outside alot but I've struggled with low vitamin D for years. I take 4000iu of D3 and K2 and I'm certainly not over replaced.
The number of food stuffs containing decent levels of vitamin D is quite small. Mostly fish etc. And if hypo or heading that way its even harder due to low stomac acid and malabsorbtion.
You probably know already how hard it is to get the NHS to start treating Hypo. Some members have reported having to wait until their TSH gets to 10 before they are taken seriously.
Sometimes a below range FT4 or FT3 can get their attention, or high antibodies, as you have. It very much depends on the GP. Your thyroid results arent great but I'm not optimistic that they are bad enough yet to merit being offered treatment.
However your vitamins are all pretty rubbish and that wont be helping your health. Your ferritin, B12 and Vitamin D all need improving. If they were better it might help your thyroid function. A lot of low vitamin symptoms mimic those of hypo. You definitely need to pay attention to your diet and start supplementing to optimise them.
Thanks for all of your replies. I’m vegetarian (but I’m not going to rule out animal derived supplements - feeling better is my priority right now). I walk a fair amount, but have stopped intensive exercise (I was previously doing strength based classes and yoga). I’ve gained a lot of weight over the last couple of years. I guess I need to try and find the energy to get on top of diet and exercise and see if that helps. It’s so hard though feeling exhausted all the time.
I'm veggie too, I take D3 with K2 as this ensures it goes into bones and teeth, not organs and blood vessels.
Methylfolate, not folic acid, methylfolate is the more bioavailable version, easier to absorb and utilise.
You can get a good quality B complex which will contain B12 and methylfolate, but a caveat is if it contains biotin or B9 make sure you dont take it for several days before a thyroid test. It interferes with the test and can skew results.
B12 is so important for veggies as getting enough B12 from our diet is well nigh impossible. You can use mouth drops, a mouth spray or tablets. Just make sure its methylcobalamin, the most bio available form.
Ferritin, another tough one for veggies, I'm post menopause so ferritin is no longer an issue for me. Iron can be harsh on the stomach. Maybe post asking for suggestions about the best iron supplements. I spent much of my life on ferrous fumarate but as I said it can be unpleasant due to side effects like stomach pain, bloating and nausea.
Ok, so I am not as specialised as others in this group but I can give you my thoughts from having a very similar experience.
I KNEW my thyroid was playing up. It runs in the family and I had ALL the symptoms. I couldn’t get anywhere with my GP and they said it was stress from lockdown and menopause (aged 44, 2021). So I went down the medichecks route. I did two blood tests with full thyroid panel, cholesterol, vitamins etc which were 6 months apart. In between I took supplements (vitamin D, 200 selenium) and it didn’t really make a difference. Still felt fried
I filled in patient access for my GP and listed all the bloods results I had from medichecks, said I felt like crap and that I wanted a new review that included the below as it is clear and I’m heading to hypothyroidism based on private blood tests. They kind of have to then as you’ve done the work and your private bloods show autoimmune thyroiditis. They can’t ignore it.
Full thyroid: TSH, FT4, FT3, TPO, TgAb
Vit D, ferritin, B12, B6
Full RBC, WBC
Cortisol
I insisted on a morning appointment due to cortisol
I then was very firm I wanted referring to an endocrinologist, as GPs won’t do anything until your TSH is over 10 and I said I wasn’t willing to wait until my thyroid was completed disintegrated. She explained I was asking for preventative medicine and that’s not their job. I held firm armed with knowledge.
Due to my cortisol being very low they had no choice but to refer me for Addisons disease. They endocrinologist took 5 mins to diagnose and issue Levo.
I now only work with him. I googled until I found his secretaries email and I now email her when I want blood tests, when I feel the Levo needs reviewing based on symptoms and I do 6 monthly private bloods through medichecks to keep an eye on it myself. You have to advocate for yourself and do an element of self management to get anywhere.
I have a good relationship with my endo because we have a knowledgable conversation that only takes 5 mins and we discuss what I want and what he thinks. So far so good. I have cut the GP out.
I always send thank you card to the secretary and am mindful not to bombard her. I follow gluten free, but it’s made no difference to my antibodies unfortunately. I’ve just started a 30 day gut health supplement protocol and based on my last bloods I’ll be taking vitamin D, B complex and eating more organ meat (🤢) to get those levels up.
Keep pushing. Your health matters but from my perspective I’m learning it has to be us in charge of driving it
Edit - I also had a very low heart rate and dropping it would get to around 38-39 when sleeping or sitting at rest. This also helped drive the GP into action and has an ECG. It was further ammunition if you like when I said I don’t have a bad heart, I have what I have been telling you for 2 years - thyroid problems!
Oh wow, thank you for sharing your story. Thankfully you’ve found a good endo. From what I’ve been reading that doesn’t always seem to be the case. You’re so right about having to be your own advocate.
Here are the Current NHS guidelines for GP's re. when to start levo for hypothyroidism (they are mainly TSH based). nice.org.uk/guidance/ng145
They "CAN CONSIDER" treatment when they have "2 TSH RESULTS that are OVER-RANGE BUT UNDER 10" (eg. i was treated with TSH 5.7 then 6.8 with very high TPOab and symptoms)
These should be 3 months apart to rule out a transient rise in TSH from an unrelated temporary cause.
In your case , due to the high TPOab , they should be keeping an eye on your thyroid results at intervals, as the high TPOab level tells them that you are more likely to become overtly hypothyroid at some point in the future.
'Overt' hypo means TSH is over range AND fT4 is under range .
'Sub-Clinical' hypo means TSH is over range But fT4 is still within range. ( your TSH is still within range, so you are not yet classed as sub-clinical.. but if it does keep rising and goes over range , then you will be)
Also , in your case your fT4 is already quite low in range .... so keep an eye on this yourself and inform GP if it goes below range .. NHS may not notice this as they sometimes only test TSH.
"1.5 Managing and monitoring subclinical hypothyroidism
Tests for people with confirmed subclinical hypothyroidism
Adults
1.5.1Consider measuring TPOAbs for adults with TSH levels above the reference range, but do not repeat TPOAbs testing.
Treating subclinical hypothyroidism
1.5.2When discussing whether or not to start treatment for subclinical hypothyroidism, take into account features that might suggest underlying thyroid disease, such as symptoms of hypothyroidism, previous radioactive iodine treatment or thyroid surgery, or raised levels of thyroid autoantibodies.
Adults
1.5.3Consider levothyroxine for adults with subclinical hypothyroidism who have a TSH of 10 mlU/litre or higher on 2 separate occasions 3 months apart. Follow the recommendations in section 1.4 on follow-up and monitoring of hypothyroidism.
1.5.4Consider a 6-month trial of levothyroxine for adults under 65 with subclinical hypothyroidism who have:
a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions 3 months apart, and
symptoms of hypothyroidism.
If symptoms do not improve after starting levothyroxine, re-measure TSH and if the level remains raised, adjust the dose. If symptoms persist when serum TSH is within the reference range, consider stopping levothyroxine and follow the recommendations on monitoring untreated subclinical hypothyroidism and monitoring after stopping treatment."
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