I’ve had strange unexplained bruising all over my legs so got a variety of blood tests through my docs. Only thing that has come back is what I believe to be under active thyroid. Is unexplained bruising a common symptom? I should add that in 6 months post partum.
I had thyroid tested pre and during pregnancy as through fertility testing I’d found elevated antibodies (medichecks) and T4 and TSH always came back normal.
Recent results attached. If anyone has any advice for what I should ask my doctor in follow up appointment that would be helpful please.
thank you.
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Lola33
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Thank you. Follow up appointment is a week away. Would you suggest I ask to be seen sooner? I don’t feel too bad but can relate to some of the symptoms mildly.
Could you ring 111 or out of hours, that is severe hypothyroid and needs treating urgently. My FT4 was 7 in December and I felt extremely tired but my TSH was nowhere near as high as yours. GP should have prescribed Levo irrespective of whether you had an appointment looming.
The blood test was only yesterday and results only came through this morning. Apparently doc hasn’t seen them yet but I now have a telephone appointment this afternoon to discuss.
Thank you. My follow up with the doctors is a week today. I am able to see my blood test results prior to them being seen by a doctor. Would you suggest I ask to be seen sooner? How urgent is this? I am breast feeding my baby so am worried if there will be any impact on him.
I will ask about the other tests you mention. Thank you!
Severe hypothyroidism - such as your results strongly suggest - can result in a condition known as a Myxoedema crisis (or sometimes, Myxoedema coma - but that is a bad name because you do NOT fall into a typical coma). Which is one of the most severe endocrine emergencies.
I'm not in a position to judge the chances of that happening to you - of course. But it is a known and predictable consequence of allowing severe hypothyroidism to go untreated.
The NHS website refers to it (on something like the fifth page!):
Myxoedema coma
In very rare cases, a severe underactive thyroid may lead to a life-threatening condition called myxoedema coma. This is where the thyroid hormone levels become very low, causing symptoms such as confusion, hypothermia and drowsiness.
Myxoedema coma requires emergency treatment in hospital. It's usually treated with thyroid hormone replacement medicine given directly into a vein. In some cases, other treatments such as breathing support, antibiotics and steroid medicine (corticosteroids) are also required.
The supply of folate to the breast milk takes precedence over maternal needs even when the mother is severely folate deficient. The increased folate requirement during lactation may be of considerable importance in the nutrition of developing populations where dietary folate intake is suboptimal and prolonged lactation the rule. In these populations lactation may be a common conditioning factor for severe folate deficiency in adults.
Thanks everyone for your help today. Doc has prescribed lethothyroxine which I’ll pick up later today. I think just 50mg to begin with. Follow up blood test in 6 weeks. She said she will add a few other blood tests in there (vit d and calcium) but seemed reluctant to add folate, ferritin, b12 and coeliac as said my full blood count came back totally fine and doesn’t indicate absorption issues. Might be ones I need to push for or go privately?
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
If on any iron supplements…..Stop iron supplements 5-7 days before testing
Sorry for the slow reply. Thank you so much for all this helpful information.
Very frustratingly, my prescription contained a mix of brands! (Teva and Alma’s). I’ve started in Almus and seems ok so far, so I will speak to pharmacy to see if I can swap the Teva to this. Not sure how that will go down!
I did completely forget to mention to GP about the antibodies. Argh! I have ordered the iron panel from medichecks as well as the complete thyroid panel because I’m inpatient and don’t have the energy or time to chase up docs at the moment. I will forward the new thyroid results with antibodies testing to GP then as that will be most up to date. The other one was pre pregnancy.
I’ve seen you say that you should test on a Monday or Tuesday if using private. Please can you explain why that is?
I will follow up with coeliac testing once these results are through and shared with doc.
Many people find Levothyroxine brands are not interchangeable.
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Mercury Pharma also boxed as Eltroxin.
Both often listed by company name on pharmacy database - Advanz
Accord only make 50mcg and 100mcg tablets.
Accord is also boxed as Almus via Boots,
Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
Teva is the only brand that makes 75mcg tablet.
So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Vencamil (currently 100mcg only) is lactose free and mannitol free. 25mcg and 50mcg tablets hopefully available from summer 2024
I am relieved that you are getting something, at last.
In most people, issues absorbing B12 mean that your B12 level will fall slowly. And impaired absorption of B12 is quite common in hypothyroidism. This is partly because in health, we do store a reasonable amount of B12 therefore the impact of low B12 takes time to develop.
Many look at macrocytosis (larger than normal red blood cells) as a key indicator of B12 deficieny. And anaemia. Macrocytosis would appear in a full blood count. But the macrocytosis is a symptom that very slowly occurs as B12 deficiency worsens.
And some people with very serious B12 deficiency never present with anaemia. Low iron tends to make red blood cells smaller - microcytosis.
If you are becoming B12 deficient AND are iron deficient, things like macrocytosis might never occur because the effects of low B12 and low iron appear to cancel each other out.
An FBC cannot show adequate B12. It can and does show when B12 deficiency is getting serious but not before then.
Also, many who have been pregnant will have been taking folic acid. That can hide the effects of low B12.
Finally, although by only a small amount,m lactation requires more B12!
Further, a B12 test would establish whether you are absolutely fine or on the potentially slippery slope.
It might seem tempting to just take a B12 supplement. But if you do that, any B12 blood test could appear higher than your reality.
Folate should always be tested at the same time as B12.
I'd have hoped ferritin was completely uncontroversial - even automatic - as a nursing mother!
Thank you. This is so helpful to know and help me understand. As mentioned in my most above, I have ordered medichecks tests for iron, folate, b12 etc as I’m impatient and want results asap!
You’re right, I was on a pregnancy multivitamin which included folate. I’ve also been taking a breastfeeding multi vitamin supplement from the same brand but actually ran out a few weeks back and haven’t replaced. The positive of this is there isn’t anything in my system ahead of the medichecks tests so should be a true reading. I’m keen to get back on the supplements as soon as my results are through.
Would you mind explaining what you mean by ferritin being uncontroversial? Sorry for not understanding.
On a side note, through fertility testing, I discovered I had the MTHFR gene mutation, which I understand means I can’t absorb folic acid and should always take folate instead. Is this at all relevant when exploring thyroid issues?
I'm afraid I really don't know. My brain has not properly followed all the MTHFR gene issues - especially as there are several genetic variants involved, and it is complicated!
There is also folinic acid - just to confuse further!
I very often go to this site because it tends to be very focussed and also has some decent references.
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Unexplained weight loss
Unexplained infertility - could it be low TSH?
getting loads of bruises
Unexplained symptoms advice needed please
Hashimoto’s, leg cramps, ankles and feet really stiff and feel bruised.
