Blood results within range. Is this a problem?

[Barny12]

Hi all,

I posted this query a few days ago and it was kindly analysed for me by greygoose (comments further down). However, I didn't understand what he/she was telling me - so I wonder if anyone could explain for me? Do the results indicate hypothyroidism? Do I need meds or can I tweak via diet/vitamins?

Thanks very much - I'm a newbie here so struggling to understand references to percentages in particular.

After being diagnosed with atrial fibrillation five years ago and an ambiguous NHS blood test showing possible subclinical hypothyroid symptoms I decided, as my diet is mostly plant based, to take a vegan multivitamin/mineral including iodine. I had a private thyroid test done a few months later which appeared to be within "normal" parameters apart from ferritin.

I've just had another test (done at 9am) to see how things are, and again all seemed to be within parameters, apart from the B12 (which I supplement).

* Vitamin D (25 OH) 70 (50 - 200 nmol/L)

* Magnesium 0.96 (0.66 - 0.99 mmol/L)

* CRP <0.60 (<5.0 mg/L)

* Ferritin 51.80 (30 - 400 μg/L)

* Serum Folate 38.10 (8.83 - 60.8 nmol/L)

* Active B12 >150 (37.5 - 150 pmol/L)

* TSH 1.86 (0.27 - 4.20 mIU/L)

* Free T4 15.0 (12.0 - 22.0 pmol/L)

* Free T3 4.7 (3.1 - 6.8 pmol/L)

* T4 Total 86.7 (66 - 181 nmol/L)

* Anti-Thyroglobulin Abs 14 (<115 IU/mL)

* Anti-Thyroidperoxidase abs <9.0 (<34 IU/mL)

* Cortisol (Random) 450.0 (73.8 - 507.0 nmol/L)

greygoose replied:

"* Vitamin D (25 OH) 70 (50 - 200 nmol/L)

Too low. Should be more like 100

* Magnesium 0.96 (0.66 - 0.99 mmol/L)

Irrelevant. The results are not reliable with magnesium. Not worth testing.

* Ferritin 51.80 (30 - 400 μg/L)

Too low. Should be over 100.

* Serum Folate 38.10 (8.83 - 60.8 nmol/L)

* Active B12 >150 (37.5 - 150 pmol/L)

Good.

* TSH 1.86 (0.27 - 4.20 mIU/L)

On the high side.

* Free T4 15.0 (12.0 - 22.0 pmol/L) 30.00%

Too low. Should be more like 50% through the range.

* Free T3 4.7 (3.1 - 6.8 pmol/L) 43.24%

Too low. Should be just slightly lower in range than the FT4. The fact that it is higher is an indication that the thyroid is failing.

* T4 Total 86.7 (66 - 181 nmol/L)

Irrelevant.

* Anti-Thyroglobulin Abs 14 (<115 IU/mL)

* Anti-Thyroidperoxidase abs <9.0 (<34 IU/mL)

Negative, but that does not entirely rule out Hashi's.

* Cortisol (Random) 450.0 (73.8 - 507.0 nmol/L)

What time was the blood draw for this test? Cortisol levels change throughout the day - as does TSH.

It's not just about being in-range, it's about being in the right place within the range. All your results are in their ranges, but that does not make them normal for you. "

[FallingInReverse]

How do you feel? Any symptoms?

Vitamin D and Ferritin should be brought up.

For Vit D - this works for many of us: grassrootshealth.net/projec...

Recommend taking with 100 mcgs of vitamin K in the form of MK-7

Ferritin is much trickier, especially tough to increase when you are vegetarian.

But first step is to get a full iron panel, as it’s possible to have high iron and low ferritin, and excess iron is toxic over time causing irreversible organ damage. Here are thing in an iron panel but you might see others as well:

Iron

Total iron-binding capacity (TIBC)

Transferrin saturation

Ferritin

High Sensitivity CRP (CRP-hs)

If you are in the UK (I am not) I think I know enough to say that you won’t get treatment for those thyroid numbers.

But improving your ferritin and D are great next steps, while you watch and see how your thyroid goes.

That’s my layman’s opinion. You may get others : )

[Barny12 in reply to FallingInReverse]

Thanks for the great reply.

Feeling and symptoms are complicated because of my afib, but from what I've read hypothyroid-wise I'd say:

arrhythmia (obviously!)

osteoporosis (newly diagnosed last year)

excess belly fat which I'm totally unable to shift

dry skin

high cholesterol

tiredness

I had an iron panel done back in February this year (although I was supplementing with multi vits/minerals at the time):

Iron 15umol/L (Range 12 - 32)

Total iron-binding capacity (TIBC) 60umol/L (Range 28 -54)

Transferrin saturation 25% (range 22 - 36%)

Ferritin 37ug/L range 24 - 336)

High Sensitivity CRP (CRP-hs) Below 5

What do you think?

[SlowDragon Administrator in reply to Barny12]

high TIBC = anaemia

mountsinai.org/health-libra...

Ferritin far too low

Iron too low

Aim to improve to bring ferritin to at least 70 minimum

Retest full iron panel 3-4 times year when supplementing

[Barny12 in reply to SlowDragon]

Wow, this is really interesting! I had no idea as most of the readings are within ranges. I wonder why my GP hasn't suggested treating my anaemia?

Can you tell my how this may relate to the thyroid issue: do any of my results suggest hypothyroid? Will medication be needed?

[SlowDragon Administrator in reply to Barny12]

NHS only obligated to treat vitamin deficiencies

Down to you as individual to maintain OPTIMAL vitamin levels

We have hundreds of people turn up here with well under 30 and frequently left untreated treated

Posts that mention ferritin deficient

healthunlocked.com/search/p...

For good thyroid function it’s important to maintain optimal vitamin levels

Retest FULL Thyroid and vitamins again in another 3 months

It may take longer than 3 months to improve low iron/ferritin

Your thyroid may well be fine once vitamin levels are good

[Barny12 in reply to SlowDragon]

Thanks very much for being so helpful.

[SlowDragon Administrator]

Very difficult to maintain good iron/ferritin on plant based diet

are you male or female

Approx age

How long been vegan

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

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 - but is not suitable for vegetarians or vegans

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Iron deficiency

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...

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.

[Barny12 in reply to SlowDragon]

Thanks for replying.

I'm male and 60 years old.

Re full iron panel please see above reply to FallingInReverse.

[SlowDragon Administrator in reply to Barny12]

So looking for ferritin between 100-200 as a bloke

[greygoose]

Well, why didn't you tell me you didn't understand what I was talking about? I could have explained. You didn't say you wanted to know if you should be on thyroid hormone replacement. And I cannot guess how much you know about thyroid before posting, you have to tell me.

As I understood your post, you just wanted your results analysed. So that's what I did. I would have told you that whilst your thyroid hormone levels are slightly low, you are not yet hypo. And no doctor would diagnose you as such on those results.

I'm sorry you didn't understand what I told you, but I wasn't working with the full facts, was I. I wish you'd said.

[Barny12 in reply to greygoose]

I did reply to you 5 days ago, you must not have seen it and I was really keen to get some explanation hence me posting on here again:

in reply to greygoose

5 days ago

Thanks for the analysis - I'm a newbie round here, though so could you let me know what all this means? Am I hypothyroid? Or is this something I can tweak with a change of diet/vitamins or do I need meds? Can't imagine my GP will be interested as the results seem within range...

[greygoose in reply to Barny12]

No, I didn't see it. I have the impression there are quite a few responses I never get to see because the alert system is so erratic. My apologies.

No, you're not hypo at the moment. But you could be heading that way. But your GP will only be interested in the TSH, I'm afraid. They're pretty ignorant when it comes to thyroid.

You certainly do need to tweak your nutrients! But that probaby won't make much difference to your thyroid results. On the other hand, low nutrient levels do cause symptoms, so optimising them might make you feel better in some ways.

Brief thyroid 101:

TSH is a pituitary hormone. When the pituitary senses there's not enough thyroid hormone in the blood, it raises the TSH to stimulate the thyroid to make more.

The thyroid hormones are T4 and T3. T4 is basically a storage hormone that doesn't do much until it is converted into T3. T3 is the active hormone and it is needed by every single cell in your body to function correctly. And, when it is low, all sorts of nasty symptoms can arise anywhere and everywhere in your body and brain.

People who don't have any sort of thyroid problem are called 'euthyroid'. Usually a euthyroid TSH is around 1, never over 2, and you are technically hypo when it gets to 3. But the NHS like it to go over 10 before they will diagnose!

People who are hypo tend to have high TSH and low FT4/3.

People who are hyper - Graves' Disease - have very low/suppressed TSH and very high FT4/3. To know if you have Graves' you need your TSI and TRAB tested. (Pretty certain that is not your case. )

However, it doesn't always follow that pattern.

If you have Autoimmune Thyroiditis - aka Hashi's - where your immune system slowly destroys your thyroid, you can swing between hypo and mildly, temporarily, hyper. To know if you have Hashi's, you need your TPO and Tg antibodies tested.

And, then, there is a condition called Central Hypo, where the fault lies with the pituitary (Secondary Hypo) or the hypothalamus (Tertiary Hypo) rather than with the thyroid itself (Primary Hypo). With that you will have low TSH and low FT4/3.

The reason we calculate the percentages through the range is so that we can compare results from different labs. Because different labs can have different ranges. If you are euthyroid, your TSH will be around 1, as I said, and FT4 and FT3 around 50% through the range - whatever the range - with the FT3 slightly lower than the FT4.

Hope that helps.

[Barny12 in reply to greygoose]

Ah, that's really helpful. Thanks very much.

[greygoose in reply to Barny12]

You're welcome.