blood results. Advice please.

[Quinc]

Might anyone have any comments on these blood results please? Quite a lot tested and all normal range … so why do I Still continue to have symptoms?

Latest results from 28 May

Alanine transaminase (ALT) in Serum or Plasma

28 May

18

U/L

in range

Albumin

28 May

40

g/L

in range

Alkaline Phosphatase

28 May

53

unit/L

in range

Basophils

28 May

0.1

x10^9/L

in range

Bilirubin

28 May

10

umol/L

in range

Cholesterol

28 May

4.1

mmol/L

Cholesterol HDL Ratio

28 May

2.7

in range

Creatinine

28 May

77

umol/L

in range

Eosinophils

28 May

0.1

x10^9/L

in range

Estimated glomerular filtration rate (eGFR) / 1.73m2 in Serum or Plasma

28 May

87

mL/min or mL/min/1.73m2

out of range

Ferritin

28 May

246

ug/L

in range

Folic Acid

28 May

9.3

ug/L

in range

Glycosylated haemoglobin (HbA1c) - IFCC standardised

28 May

31

mmol/mol

in range

Haematocrit

28 May

0.458

L/L

in range

Haemoglobin

28 May

153

g/L

in range

HDL Cholesterol

28 May

1.5

mmol/L

in range

LDL Cholesterol

28 May

2.2

mmol/L

Lymphocytes

28 May

2.2

x10^9/L

in range

MCH

28 May

32.5

pg

in range

MCHC

28 May

335

g/L

in range

MCV

28 May

97

fL

in range

Monocytes

28 May

0.5

x10^9/L

in range

MPV

28 May

10.1

fL

in range

Neutrophils

28 May

3.7

x10^9/L

in range

Non HDL Cholesterol

28 May

2.6

mmol/L

Nucleated RBC

28 May

0

x10^9/L

in range

Platelets

28 May

274

x10^9/L

in range

Potassium

28 May

4.8

mmol/L

in range

RBC

28 May

4.72

x10^12/L

in range

RDW

28 May

12.6

%

in range

Sodium

28 May

139

mmol/L

in range

Triglycerides

28 May

0.8

mmol/L

in range

TSH

28 May

1.84

milliunit/L

in range

Vitamin D

28 May

121.1

nmol/L

in range

WBC

28 May

6.5

x10^9/L

in range

[greygoose]

Very, very difficult to read results like that. But the only thing there that relates directly to thyroid is the TSH:

TSH 28 May

1.84 milliunit/L in range

It may be in-range, but so what. It's too high in the range for someone on thyroid hormone replacement and is suggesting that your FT4 - and therefore your FT3 - is too low and you need an increase in dose. But, you can't know for sure without getting them tested. I would suggest you get full thyroid testing privately to see what's going on.

[Quinc in reply to greygoose]

Thanks Greygoose, is this any more specific?

I did ask for a full thyroid test and assumed this was it? What extra should I be asking for?

Serum TSH level:

1.84 mU/L

Normal range:

0.30 to 4.20

Your result

1.84marker

0.304.20

View test result history

[greygoose in reply to Quinc]

Doesn't matter about the range with a TSH because a TSH is always a TSH and it should be 1 or under.

The most important number is the FT3 and they rarely test that. But an FT4 would be good. Plust antibodies - TPOab and TgAB - and nutrients: vit D, vit B12, folate, ferritin.

[Quinc in reply to greygoose]

The other concern is ... following a private test with more information at hand what actually happens next? My only recourse is to return to the doctor and the only possible solution is to increase (probably) my Levo intake that I dont particularly like anyway ...as it gives me heart bumps on occasions which is why I split 50 into 2 takes a day ... Cant imagine my doctor even suggesting a vitamin regime, who might be able to suggest that? At present my vitamin intake is most random. (Doc will not allow me to refer to Endo at hospital).

[greygoose in reply to Quinc]

Cant imagine my doctor even suggesting a vitamin regime, who might be able to suggest that?

As a general rule, doctors know zero about nutrition! And I have my reservations about most nutritionists and dietitians. So, you're better off sorting that one out for yourself - with the help of people on here. Even if your GP were to prescribe certain nutrients you can almost guarantee they'd be the wrong ones - i.e. the cheapest!

My only recourse is to return to the doctor and the only possible solution is to increase (probably) my Levo

No so. You could buy your own thyroid hormone replacement: levo, T3, NDT. There are places on the internet where you can buy your own without prescription. If your GP is going to be obstructive and not do his job properly - which is to make you well - then he cannot blame you for going it alone (with the help of this forum).

50 is only a starter dose, anyway. Not surprising it gives you heart bumps. Your FT4 is probably very low and your FT3 - the active hormone - even lower. He should be testing them and not dosing by the TSH. And he should have increased your levo to 75 mcg six weeks after starting it. He is negligent. But, you don't have to put up with his megalomanic treatment - or lack of it. You have your word to say and he should be taking your wishes/needs/opinions into consideration. He is not god!

[Quinc in reply to greygoose]

Brilliant support and information … thanks so much. This is such an important forum. I shall return to doc and ask for raise from 50-75 Levo.

Can Levo always make you feel better (eventually with right dose) or sometimes do folk need additional T3 supplements and do doctors ever offer this?

[greygoose in reply to Quinc]

It depends how well you convert T4 to T3.

T4 (levo) is basically a storage hormone which doesn't do much until it is converted into T3, the active hormone. Not everyone is good at that. So, if you're a poor converter, yes, you do need T3 added to your levo.

Do doctors ever offer T3? Most of them don't even know what it is! I think it has happened - usually by an endo because GPs cannot initiate prescribing it anyway - but it's very rare.

[SlowDragon Administrator]

Just testing TSH completely inadequate

You will need to retest privately

How much levothyroxine are you taking

Which brand

Exactly what vitamin supplements are you taking

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Just TSH, Ft4 and Ft3 test - £32

monitormyhealth.org.uk/thyr...

10% off code here

thyroiduk.org/testing/priva...

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

[Quinc in reply to SlowDragon]

Thanks SlowDragon,

I currently take 50 mg Levo per day - 25 in the morning and 25 at night - Wockhardt.

I am really confused as to what vitamins I need and how much .. I currently take a Vit B Complex (Pinktirbe Liposomal) that includes 500ug of B12 maybe 3 times a week ....

and I take a Zipvit Magnesium 500mg maybe twice a week.

But confess that vitamin intake random and depending on mood (energy Boots fizzy tablet with 500mg VitC every now and then)

I think I should try the private test

All very best,

Quinc

[SlowDragon Administrator in reply to Quinc]

How long have you been on just 50mcg levothyroxine

This is only the standard STARTER dose

Levothyroxine doesn’t “top up” your failing thyroid, it replaces it.

Essential to be on high enough dose levothyroxine

Typically dose is increased slowly upwards in 25mcg steps until on roughly full replacement dose. This is usually around 1.6mcg Levo per kilo of your weight per day

So unless very petite, most people will eventually be on at least 100mcg Levo per day

How old are you

How much do you weigh in kilo approximately

If been left long time on only 50mcg ……look at getting dose increased SLOWLY…..initially at extra 12.5mcg per day

Retest after 6-8 weeks

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

Some people need a bit less than guidelines, some a bit more

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

[Rapunzel]

Hey Qunic. You've had some responses from two of our wise birds. Pay heed, is my ninepen'orth. So a good start will be full thryoid panel. Often when you have these done privately, your NHS GP will be sniffy about them. If you have them done via Monitor My Health thyroiduk.org/testing/thyro... thyroiduk.org/testing/priva... they can't be sniffy, because the results come from an NHS laboratory. Hope that helps

[Quinc in reply to Rapunzel]

Thanks Rapunzel ... think its time to take a private test ... but do they actually make recommendations afterwards? And I am very confused about required vitamin intake that is required

[Lottyplum in reply to Quinc]

Hello Quince - just keep asking questions on here to help you move forward! I used Monitor my Health for TSH, T4+T3 blood test+my GP accepted them. She also accepted the recommendations from Thyroid UK when an increase was needed. The blood test for B12, ferritin, folate+D3 (with results posted here) will help you on the vitamin front. I now recognise that vitamin intake is essential and I can't afford a hit+miss approach. You need to be armed with information from the forum to challenge the ignorance from GPs in general. Mind you, the same can be said for Endos who, too, are less well informed than our wonderful admins here!!

[Quinc in reply to Lottyplum]

Thanks Lottyplum

[Lottyplum in reply to Quinc]

You are very welcome.🤗

[Rapunzel in reply to Quinc]

SlowDragon can help you with this, All I'll say about vitamins is that not enough heed is paid to them and for we thyroidies, being in the 'normal' range is not enough - we need to be in the top quartile of the range and until we are, your levo won't be working at its full capacity to replace your thyroid hormones.