Recommendation request for 2nd opinion and interpretation of results

[sisip]

I'm looking for feedback (via private DM please) from anyone who has been seen by Mr Barnes (Endocrinologist) at Tunbridge Wells or a Dr Christine Suppelt, Rose Cottage Clinic also in Kent. Would appreciate any perspectives on either clinician, both of whom I found on the Thyroid UK practitioners' list.

As background, I've had a thyroid goitre (mostly fuild cysts) which has been aspirated 3 times in the last 10 years through the NHS. I was tested through NHS 11 years ago for thyroid function, and was told all was normal. However, I've continued to have what I now realize (in retrospect) are hypo symptoms (e.g. persistent lethargy/fatigue, cold intolerance, challenges losing weight and having high cholesterol despite very active lifestyle and healthy diet, low mood, etc).

I now understand that the NHS only tested for TSH. I've recently used MediChecks and taken their advanced thyroid test, including vitamins. TSH, T4, and antibodies all came back within a normal range; however T3 was very low end of normal (3.2 in range of 3.1 to 6.8). Below are my results:

TSH = 1.01 (range 0.27 - 4.2)

Free T3 = 3.2 (range 3.1 - 6.8)

Free T4 = 17.4 (range 12 - 22)

Ferritin = 45.7 (range 30 - 207)

Folate = 12 (target > 7)

Vit B12 = 150 (range 37.5 - 188)

Vit D - 130 (range 50 - 250)

I shared these results with a private endocrinologist last week, and he said since my tests were normal, he won't diagnose nor treat hypo (FYI - he's not on the Thyroid UK list). Given my symptoms and low T3, I'm struggling to accept this outcome, hence consider a second opinion via Dr Barnes or Dr Suppelt. Given my result, am I barking up the wrong tree, or would this be worthwhile to get a second view?

Thank you

[SlowDragon Administrator]

Exactly what vitamin supplements are you taking

Are you vegetarian or vegan

Ferritin is definitely on low side

Being anaemic can cause symptoms as direct result

Or low ferritin can be caused by low thyroid

First step improve low ferritin

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 taking any iron supplements stop 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 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

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.

Definitely worth getting an ultrasound scan of thyroid done BEFORE any consultation

thyroiduk.org/testing/other...

[sisip in reply to SlowDragon]

Thank you for the quick and detailed response - very helpful and much appreciated.

You've raised a great point re ferritin, and thank you for sharing the articles showing the similarity of symptoms of low ferritin to hypo - I've just read them, super informative.

After receiving my MediChecks results and also noting the low ferratin, I ordered the Thorne ferratin supplement over the weekend - they should arrive shortly.

Until now, I've only been taking Thorne Vitamin D, Gaba, and Theanine, so the addition of ferritin will be helpful. To round things out, I'll also be adding magnesium, copper, zinc, selenium, iron, vitamin c, and folate to my daily supplemements. I plan to repeat the MediChecks tests in 12 weeks.

In terms of diet, I eat white meat (usually chicken, sometimes turkey) and also fish. I rarely eat red meat - which I appreciate doesn't help with my iron or feritin levels. I do like chicken liver, so will be very happy to add a1-2 times per week.

[SlowDragon Administrator in reply to sisip]

You should test full iron panel ideally BEFORE starting on iron supplement and retest 3-4 times a year

It’s possible to have low ferritin and high iron

Lots of posts and replies by FallingInReverse re iron and ferritin levels

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

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...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

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 weight 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.

[sisip in reply to SlowDragon]

Thank you, ordering the MediChecks iron panel today!

p.s. SlowDragon it sounds like I should wait and see how my vitamin levels look after 3 months, and if symptoms resolved, before seeking that second opinion?

[greygoose]

Cholesterol levels have nothing to do with diet or exercise. Your cholesterol is high because your FT3 is so low. Hope you're not taking statins.

[sisip in reply to greygoose]

Thank you - yes, I've recently become aware of the association between thyroid hormones and high cholesterol. Having re-read my original post , I can see I hadn't made that clear!

[FallingInReverse]

You also say you are supplementing zinc and copper… suggest you test for those before doing so if you haven’t already.

I will also so from my experience monitoring my daughter - undiagnosed but with ambiguous thyroid results - that I have spent the last year or so optimizing her vitamins and it has improved her thyroid numbers and her health.

I’m not sure if one day she will ultimately be diagnosed hypo.

But a first step that’s worthwhile is always optimizing (not just in range) D, B12, folate and ferritin.

With precision dosing based on regular blood tests for those specifically.

I also see you are getting a full iron panel, which is great. Iron supplementing has serious risk of iron toxicity- which can lead to permanent and irreversible organ damage. Actively manage, test frequently, and feel free to start a new post when you get your results and we can weigh in with our experience.

[sisip in reply to FallingInReverse]

Thank you so much for your thoughtful response - much appreciated!

Regarding zinc and copper testing prior to supplementing, I've looked at MediChecks, MMH, and Blue Horizon, and none appear to offer this on their panels, same for selenium.

Sharing your daughter's experience is really helpful and encouraging - thank you - hopefully I'll be reporting the same in a few months. I see that GreyGoose has shared a number of your prior posts - I look forward to reading them and learning more from all the knowledge you've shared! I'll be sure to come back for further input over time. This is my first time joining and posting in a health forum - the quality and generosity of responses here has been outstanding.

Thank you again

[FallingInReverse in reply to sisip]

Well just take care with the zinc and copper. It’s not so much how much you have, but that these two remain balanced.

On this forum we recommend testing most things before supplementing, with a few exceptions like magnesium where tests aren’t reliable and we’re all likely deficient anyway : )

[sisip in reply to FallingInReverse]

Makes perfect sense, thank you!

Have read some of your old posts in the meantime - I ran half marathons for several years (from 2017+), and continue a challenging workout regimen (recently switched to weight training 3 x per week). Your description of feeling intense fatigue after your runs really resonated! That's always me - exhausted and ready to go to bed after my (always morning) workouts... the 'runners high' never materialised

[Wua13262348 in reply to sisip]

Blue Horizon, Essential Trace Elements Blood Test Kit :copper,zinc,selenium, magnesium

[sisip in reply to Wua13262348]

Thank you, searched BH earlier and couldn't see this!

[Wua13262348 in reply to sisip]

It is pretty well hidden on the site and doesn't always come up even using the search facility. It is a venous draw test.