**EDITED 17.06.24 TO ADD MORE SYMPTOMS I REMEMBERED**
My Private Doctor wants to trial me on combined T4/T3.
Lab Results
Feb 2023
TSH - 1.33 (0.27-4.2)
T4 - 18.9 (12-22)
T3 - 4.6 (3.1-6.8)
D3 - 158 (50-200)
Iron - not tested
Ferritin - not tested
B12 - 204 (25.1-165)
Folate - not tested
May 2024
TSH - 1.9 (0.27-4.2) *had stopped taking metformin for a few months
T4 - 16.2 (12-22)
T3 - 4.6 (3.1-6.8)
D3 - 171 (50-200)
Iron - 10.2 (5.8- 34.5)
Haemoglobin - 114 (120-150)
Stauration - 18 (15-50)
Ferritin - not tested
B12 - not tested
Folate - not tested
June 2024
TSH - 3.05 (0.27-4.2) *still not taking metformin, but planning to restart
T4 - 19 (12-22)
T3 - 4.9 (3.1-6.8)
D3 - 130 (38-180)
Haemoglobin - 118 (126-270)
Ferritin - 20 (20-420)
B12 - 76 (39-210) * have not been taking b complex with B9/B12 for a few months
Folate - 4.6 (4-25)
So the question is should I be medicated on the basis of the above results, or should I just be focusing on increasing my Iron and Ferritin ?
My other concern with medication is - if I start medication, do I then have to commit to thyroid medication for life?
I have seen the struggles of thyroid patients when attempting to find their ideal dose and dealing with Drs and Endos and I am worried about being a thyroid patient given the care that is present under the NHS and tricky that can be to navigate for thyroid patients.
I am already being monitored privately for my pre-diabetes and hormones and have had surgery privately for the latter (fibroids) so I am trying to keep interventions to that which is strictly necessary.
History
I feel as if my thyroid has been up and down now for over 12 years and maybe longer.
I started having blood tests for another reason i.e. hormones and pre-diabetes and this is when the Thyroid issue was picked up.
As far back as I can remember i.e. @ 12 years ago, I’ve had hypo symptoms but my thyroid results have been ‘mostly’ in range for most markers but never really across the board i.e. I do not think I’ve ever had optimal TSH, T4 and T3 concurrently.
For example historically;
TSH
- TSH remained in range from @ 1.1 - 1.4 when I was younger, but in recent years now hovers around 2 - 2.3 and has on more than a few occasions crept up above 2.5 and further still on a few occasions above 5 and 6 (range (0.7 - 4.6).
- I have also noticed a trend from my blood tests that when my FT3 is higher than usual (but still not 'optimal') that my TSH is very high i.e. between 2.5 and 6 suggesting that my thyroid is possibly working harder?
- It’s also possible that my TSH has gone above 5-6 more than I realise (basing this on how I was feeling at the time) but was not tested as the NHS is not great for thyroid patients with the average diagnosis time being @ 10 years and I believe my case has only being discovered as I am monitoring another issue privately which is also dependent on the Thyroid working well.
- T4 - has hovered up and down between 12 and 18 over the last 12+ years but rested mainly around the 14-16 mark (range 12-22).
- T3 - has always been very low i.e. hovered around the high 3’s and low 4’s (range 3.1 - 6.8)
- rT3 - this has not always been tested. Apparently there are no labs in the UK that test rT3, so it has to be shipped abroad making it very expensive and so Dr’s don’t tend to test it. But on the few occasions when it was tested between the years of 2017-2019 it was always very high i.e. above or at the top of the range i.e. 20, 20, 29 (range 10-24) and 0.37 (range 0.14-0.54)
- Antibodies - have always remained consistently low or undetectable, although I will ask my Dr to test them again in @ 2 months.
My suspicion is that I have a rT3 or possibly a conversion issue caused by a few issues, which I have been working through over the years;
Iron/ Ferritin - this I believe to be the primary issue.
- My Iron/ Ferritin/ Haemoglobin/ saturation etc has been chronically low my whole life and even to the point where I would be dizzy walking down the road as a teenager when my periods began. I have struggled repeatedly to get this up only to give up in frustration.
- I am currently trialing heme iron to see if this will work.
- Also had a surgery a number of years ago, which necessitated a blood transfusion and I had the best months of health I’ve ever had in my life shortly after.
Cortisol/ Adrenal Health - I would say this is a close second to the Iron/ Ferritin issue.
- My AM Cortisol is always chronically low when it has been tested in the past.
- I have a very disrupted cycadian rhythm and have struggled with Insomnia for years I.e. over 15 years. I am not sure why this is but I have had periods of incredible fatigue to the point my GP thought I might have CFS.
- An Endo did a ‘Short Synacthen’ test a few years ago and I only just passed it i.e. my body reacted very weakly in the finally moments. I remember him commenting on this fact when he got the test results back. It’s possible that this is why my thyroid is working harder? (He also decided to put me on Metformin as part of that consult as he likely saw the pre-diabetes no one had yet picked up on.)
- D3 - again it was only until I started monitoring my hormones and insulin levels that I realised that this was chronically low and likely the reason I had HORRIBLE flu’s and colds every year. Previously I was at the very bottom of the chart i.e. not even in range i.e. chronically insufficient. Supplementing D3 10,000 iu + K2, helped me get this to a very good part of the chart to the point where I only supplement now @ 3x a week. I have dark skin so I probably should have always been doing this years ago. I also have an autoimmune condition and feel best when this is at the top of the range = no relapses.
- B12 and Folate - I have always had high-ish B12 or B12 over range with Folate being mainly at the bottom of the range unless I supplement. The B12 is a mystery because it has at times been very high even when I am not supplementing?
- HBA1C/ Insulin - this has been getting better the last two years and I think this has helped or rather ‘masked’ my TSH. My Doctor has me on metformin for this and I do mild intermittent fasting I.e. 16/8 to keep this under control and feel this has had a positive effect on my health. I understand that good FT3 levels however are necessary for good insulin signalling.
To date my SYMPTOMS have included the following:
- Fatigue / Exhaustion
- Insomnia
- Carpel Tunnel
- Cold hands/ extremities
- Weight gain
- Cracked/ breaking nails
- Thinning hair
- Dry skin
- Thick calloused cracking skin on feet (EDIT)
- Missing outer eyebrows (EDIT)
- (Anaemia ???) (EDIT)
- Edema - this has been very severe in the past (EDIT)
- Unexplained bouts of depression, anxiety, low moods, low motivation, low level agrophobia, and just feeling not great.
- Constipation (for as long as I can remember)
- Heart palpitations (noticeably when B12/ folate is high ???)
- Pain in calves
- Frozen feet i.e. neuro symptoms
- Body aches
^^ I’ve found the above extremely frustrating and wondering if it is now time to medicate despite ‘being in range’?
Long post so thanks in advance for your help/ thoughts.
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ShiningStar77
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Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)
Post discussing how biotin can affect test results
Thanks SlowDragon yes I usually take Thorne 2-A-Day Multi which has similar ingredients to the Thorne Basic-B plus a few other things and then take the Methyl guard @ 3-4x a week (so not every day as it's quite heavy duty).
I order both from iHerb as I want fresh stock as opposed to inventory stock on Amazon.co.uk.
I take ONE (1) of the 2 a day per day so not the recommended 2 = 10mg of P5P. I also usually take them Mon to Fri and take the weekends off. So the bottle lasts me @ 3 months.
Also should have made it clear I only take ONE (1) cap of the Methyl factors 3x a week and not the recommended 3 capsules. So that bottle of 90 lasts me about 6+ months.. That one capsule contains an additional 15mg of P5P.
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
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
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.
Personally I would work on improving low vitamin levels then retest thyroid and vitamin levels again
I've had chronically low iron since I was a child. I remember peeking over my results whilst at the Drs when I was a teenager and seeing the concern on my parents and Drs face.
I've always been anaemic, then had horrifically heavy periods and then fibroids.
I also have a heterozygous blood adaptation which makes some of my red blood cells smaller and sickle shaped to protect me from malaria (hugely useful in the Northern hemisphere), which does not help as those cells rapidly renew themselves.
I've recently started taking the three arrows and will start again with my supplement regime.
So I am wondering if I should keep working on the Iron or start taking thyroid meds as I am very symptomatic I suspect as a result of (1) poor conversion (2) high rT3?
Re rT3....a member's easily understood explanation
"rT3 is the inactive form of T3. When your T4 gets too high, it starts converting to more rT3 than T3 so that the FT3 doesn't go too high - it's a sort of safety brake to protect you. But, if you're a poor converter, having your FT4 too high can make your conversion even worse. But, don't worry about the rT3 itself, it's just a way of recycling the componants of thyroid hormone, because it is then converted to T2."
Low iron...see SlowDragon's excellent reply re thyroid/ anemia conection
If I started thyroid meds, would I be able to stop if the iron situation improved ?
No! You are hypothyroid and therefore need to be medicated with replacement thyroid hormone(s) for life
Your doctor is correct you need T4/T3 combo in a therapeutic dose to suit you as an individual
Low T3 is key here!
Why am I so certain....personal experience!
Low (cellular) T3 left me barely able to function....long story of decades of wrong diagnosis and treatment
Until you achieve your personal optimal thyroid hormone level taking exogenous iron is only part of the solution....it may even be difficult to tolerate as happened to me.
I'm not sure what you understand by "optimal"....the aim is not to have results within range but to have them sitting on the exact point within the range where symptoms are resolved.
It looks as if you should have been medicated years ago but medics possibly focussed on TSH which is not a reliable marker
There can be a genetic component to thyroid disease as I and many others have discovered
It is essential that you optimise vit D. Vit B12, folate and ferritin to support thyroid function
If antibodies have tested low in the past, eliminating thyroid autoimmune disease/ Hashimotos, then no need to re-test.
My other concern with medication is - if I start medication, do I then have to commit to thyroid medication for life?
Absolutely, because avoiding thyroid medication when required is detrimental to health
So do yourself a favour listen to this doctor who hopefully will help you gradually achieve the therapeutic thyroid hormone dose you need and continue to work on supporting nutrients
That will take time and a lot of patience, there is no quick cure...improvement is a slow process and you have a lot of "catching up" to do.
Go check out The Iron Protocol on Facebook (it’s a group), and listen to a podcast with Caitlyn Haritgan and read the guides in the FB group. You’ll likely fix your symptoms with heme iron supplementation. I don’t think you need thyroid medication personally. Supplement Lugol’s iodine-dint care what misinformed people say about it, please research it yourself. It will bring your TSH up temporarily when you start but it will also bring up FT3 and FT4 and push out any halides you have as they fit the iodine receptor in cells too. Taking iodine will give you energy and push out halides. Also check out Dr Brownsteins Salt loading Protocol.
CountryMidwife 'Supplement Lugol’s iodine-dint care what misinformed people say about it, please research it yourself.'
I note from your profile that you joined this forum earlier this year. Please take into consideration the fact that this forum has been here for fourteen years, and the admin you are responding to SlowDragon has been here for nine years. So it's more than likely that she has a lot of experience! Long time members here have researched many, many of the issues surrounding thyroid dysfunction that crop up regularly on this forum.
'Go check out The Iron Protocol on Facebook (it’s a group), '
Please do not assume that everyone is, or wishes to be, on other social media platforms. When a member asks for help on this forum, we do what we can to help them, and do not send them to other social media platforms for advice.
It appears to me that Caitlyn Haritgan is a marketer. She might know something about iron and "wellness" but her main claim is skill in marketing.
Senior lifecycle marketer with a focus on technology, media, and wellness. I build bridges to tear down silos. Passionate about testing, accessibility, and the Oxford comma.
From Linkedin profile.
For those (like me) who didn't know what is meant by the term:
What is lifecycle marketing?
Lifecycle marketing is the mix of strategies a company uses to positively influence customer behavior as they move through each touchpoint of the marketing cycle, from the initial attraction to becoming a brand advocate.
(I'm not including links because they could appear to be in some way promoting something. Easy enough to search - I have not obscured anything by changing words, etc.)
Lifestyle Marketing!! Is that another version of being an "Influencer".
What happened to good old King's English
Sounds like flogging goods via the internet using marketing speak!
OK....I'm not "in the vibe!"
It's one of these days...and just had the third generation of a NZ family who, over many years, have come looking for the cottage an ancestor was born in on our property.... in the 19th century. All lovely people but we demolished it long ago...rather poignant.
Their ancestors wouldn't have understood Lifestyle Marketing either...survival was their aim!
Delete this if necessary helvella ....but that's it off my chest now!!!
Hedgeree what is interesting is that two private Drs have now prescribed me Metformin.
The first was a referral on work private health insurance, the second was an Endo I followed from another clinic. They both felt I should be on some sort of medication especially given my father is a T2 diabetic. My NHS GP scoffed and laughed at me when I mentioned 'pre-diabetes'. But then again this is the same NHS GP that nearly contributed to my early demise when he would not refer me to a specialist for something else when it was clear that I was very ill - I would later be diagnosed within weeks and the specialist Drs were so angry they wrote to him. I very quickly changed GP.
My HbA1C was @ 6.0 when I was put on metformin and at one point I got it down to 4.8/ 4.9. So if you can just speak to your GP or another GP in your practice. Failing that consider a private prescription , which will cost you @ £90 every 6 months for the metformin. It is a super cheap drug so I am not sure why your GP would object especially as you clearly could do with it.
Your thyroid blood results are good, it is normal for them to fluctuate a bit. Some people tend to have a mildly be below average fT3 and some an above average. If you have noticeable hypothyroid signs and symptoms they are unlikely to change with 'optimal' hormone levels (whatever that means). I had severe hypothyroidism with good hormone levels, it was caused by endocrine disrupting chemicals in our environment.It would help to have a detailed description of your signs and symptoms, how severe they are and how they affect you
I worked with someone who has Thalasemia trait. Microcytic hypochromic rbcs. She couldn't run for the bus. Hemoglobin maxed out at 124 but usually lower. Her iron level was fine and she was supplementing a good B complex. B12 and folate were excellent. It is unfortunate but various inherited traits reduce the body's capacity to rise to some types of physical challenges.
I think the OP should work hard on improving her iron and B vits. Drinking 16 ounces of milk per day will provide roughly 150 mcg iodine, not dangerous. She could instead consume the equivalent in yoghurt. Studies in the UK indicate that there is some iodine deficiency because the primary dietary source is dairy as also in Canada. Most adults stop consuming dairy and studies indicate that a rather high percentage of teens and adults are not getting adequate amounts.
The OP does not have Hashimoto's based on antibody testing. She says she is not vegan or vegetarian, but chances are the dietary choices are imbalanced and her consumption of greens and protein sources is suboptimal. Given that she is also taking metformin due to prediabetes, she should reduce her readily fermentable carbohydrate intake and replace with good sources of protein.
Yes..... vit D, vit B12 folate and ferritin must be optimal to support thyroid function but that is only part of the story....thyroid hormones need to be at levels which are adequate for the individual not to suit numerical levels.
Her FT3 is low and without an adequate and constant supply of this most important hormone the body cannot function properly.....I've experienced low ( cellular) T3 and it is a serious condition that pots of yoghurt cannot resolve. I daily eat a lot of full fat Greek Yoghurt and it didn't help me.
If someone has no antibodies, there is a possibility the problem is lack of adequate iodine. That's all I'm saying. It doesn't obviously refer to someone with Hashi. And I'm not meaning that 100% of people with underfunctioning thyroids have iodine deficiency. It is common worldwide. As is iron deficiency anemia in women and children.
gabkad There appears to be an element of confirmation bias in your post.
I believe that my post is very clear and at no point do I mention an Iodine deficiency - I've been tested for all minerals etc
Rather my post clearly indicates that I believe I have other limiting factors i.e. Iron deficiency anaemia and Cortisol issues and I believe they are creating conversion/ rT3 and low T3 issues, which then prompts the question do I need to be medicated?
I have tried to pose my question with as much data as possible to avoid precisely these sort of speculative responses that lead down rabbit holes.
I don't know whether your symptoms indicate functional B12 deficiency, but I think you may benefit from getting to the bottom of your low ferritin levels. I know how ill I felt when iron anaemic and my list of symptoms were similar to yours. It also corresponded to being diagnosed hypothyroid, and whilst I do have elevated thyroid antibodies, low iron can also cause the thyroid to struggle. I would add that if it were me now I would probably be thinking about the Cambridge Iron Clinic.
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Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Update to Previous Thread with Results
Test results from Medichecks... thoughts on vitamin deficiencies with hashimoto's please, thanks.
Help with Lab Results
my results today 
Do I still need Levothyroxine
