GP expressed concern about hypothyroid after a ... - Thyroid UK

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GP expressed concern about hypothyroid after a recent blood test, a couple of questions if anyone is kind enough to take the time to read

Fortheloveofabook profile image

Hello, I have recently had a blood test after visiting my gp with pains in my right leg (which I have had since the birth of my son 13 years ago) that had travelled and become more persistent, as well as pain and numbness in my right arm leading to a cold hand.

A full blood test has shown my folate abnormal , magnesium, kidney , liver , thyroid borderline and cholesterol had a number I don’t understand. Straight away I have been prescribed 5mg of folic acid to be taken for4 months and asked to book an appointment with the gp to discuss results . In the appointment the gp mentioned thyroid levels and perhaps going on medication . He has asked for a repeat blood test in 2 months to compare because problems with the thyroid is hard to diagnose . When I asked about the other levels , especially liver and kidney being borderline , he replied that if one thing is unbalanced , it unbalances them all .

I was just wondering if other people have had similar issues with all of their levels being out of the normal area at the beginning of their diagnosis? Did the levels for kidney and liver level out once starting medication? I am trying not to freak out but seeing the test results is worrying! I’m getting appointments made for me left right and centre and whilst I’m grateful that they are doing their best to look after me , I don’t really know what’s happening .

Also , may I ask - did anyone not respond well to the folic acid ? I could help my energy levels before by eating regularly, however , on the medication, my appetite has gone and I just feel nauseous . It’s making me feel worse than before.

Thanks for taking the time to read .

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Fortheloveofabook
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13 Replies

Welcome to the forum!!!

So you can get better replies, please share your exact blood test results.

For thyroid, especially TSH, Free T4, Free T3 and vitamin D3, B12, folate and ferritin - just share any of those that you have. Also, did you have any antibody tests done?

When you share results, please include the ranges for each as well.

Fortheloveofabook profile image
Fortheloveofabook in reply to FallingInReverse

Hello, no antibody tests yet , I have only had a full blood count because my gp mentioned my symptoms were vague and could mean multiple things. I will be having another test in October, so presumably they will do a more in depth thyroid test.

SlowDragon profile image
SlowDragonAdministrator

please add actual results and ranges for

TSH, Ft4 and FT3

GP should also test TPO and TG antibodies to see if you have autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune

And very important to also test B12, vitamin D and iron and ferritin

Yes kidney function often becomes sluggish when hypothyroid

It will improve once on replacement thyroid hormone

Similarly high cholesterol levels will reduce

make sure next blood test is early morning

Fortheloveofabook profile image
Fortheloveofabook in reply to SlowDragon

Thank you for the information , I will book the test as early in the day as possible . I didn’t realise that the time of day can affect the results . Only a full blood test has been done so far, I’m presuming the blood test in October will investigate the thyroid more in depth to give a clearer picture.

Thank you for your prompt replies . Below are the test results :

Serum TSH level (XaELV) 5.3 miu/L [0.3 - 4.21 - Above high reference limit

Serum free T4 level (XaERr) 17 pmol/L [10 - 22]

Serum magnesium level (XMOm2) 0.99 mmol/| [0.7 - 1]

eGFR using creatinine (CKD-EPI) per 1.73

square metres (XacUK) 86 mL/min;

Serum folate level

(42U5.) 1.2 ng/ml [4.6 - 18.71 - Below low reference limit;

Liver function tests (X77WP)

• Coded entry - Serum alanine aminotransferase level (XaLJx) 14

iu/L [0 - 35]

• Coded entry - Serum bilirubin level

(44E..) 6 umol/L [0 - 21]

• Coded entry - Alkaline phosphatase level (44F3.) 91 U/L

[30 - 130]

• Coded entry - Serum albumin level (XEZeA) 38 g/L [35 - 50]

Calcium adjusted level (XaZyY) 2.32 mmol/| [2.2 -2.6].

Serum ferritin level (XE24r) 80 ng/ml [13 - 150]

Serum

cholesterol/HDL ratio (XaEUq) 2.8

mmol/mmol

• Coded entry - Serum non high density lipoprotein cholesterol level (XabE1) 4.2 mmol/L

• Coded entry - Serum LDL

cholesterol level (44P6.) 3.4

mmol/L; NB the calculation of LDL is valid only for a; fasting sample.

• Coded entry - Serum triglyceride levels (XE2q9) 1.68 mmol/L [0.4 -

1.5] - Above high reference limit

• Coded entry - Serum HDL

cholesterol level (44P5.) 2.3 mmol/L

• Coded entry - Serum cholesterol level (XE2eD) 6.5 mmol/L

SlowDragon profile image
SlowDragonAdministrator in reply to Fortheloveofabook

Was test early morning

Folate deficient

B12 better over 500

No vitamin D test

Ferritin ok - maintain over 70

folate deficient

Presumably GP prescribing folic acid

Once you finish prescription

Suggest you start supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

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

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

SlowDragon profile image
SlowDragonAdministrator in reply to Fortheloveofabook

vitamin D

Can test via NHS private testing service

vitamindtest.org.uk

NHS Guidelines on dose vitamin D required

panmerseyapc.nhs.uk/media/2...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

Retest FULL thyroid and vitamin levels in 6-8 weeks….ideally BEFORE your consultation

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Essential to test vitamin D, folate, ferritin and B12

Lower vitamin levels more common as we get older

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels

Also VERY important to test TSH, Ft4 and Ft3 together

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and 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

Fortheloveofabook profile image
Fortheloveofabook in reply to SlowDragon

Thank you for all the information! It’s really kind of you to take the time out of your day to post this . My test was about 915 am , I did my morning as normal and ate breakfast because it was a non-fasting blood test , I will skip the breakfast and coffee for the next one and book an early morning slot.

Is it worth booking at the same time in my menstrual cycle or does that not seem to have an effect ?

As for levels going down as we get older , I am 42 so I presume the levels are quite low for my age ? I will be looking at my diet and trying to squeeze in some more vitamin and mineral dense foods .

The more I research I do, the more this makes sense. After having my son 13 years ago , I could no longer have the contraceptive pill because no matter which I tried , I felt awful on it. Once stopping it altogether, I went back to the doctors a few times saying I felt really lethargic and didn’t feel myself. I was advised that I have ‘true pms’ get some fresh air , exercise and eat well so I’ve always blamed the weak feeling to where I am in my cycle , or that I’m coming down with something that never turns into anything, or motherhood , grief etc when it may have been the start of the thyroid struggling . Our doctors closed so the gp I saw I had never met before . It seems he is very thorough (as well as the prescription, I have had a phonecall from the doctors pharmacist to check how I am doing on the tablets) which makes me feel like he will get to the bottom of this.

SlowDragon profile image
SlowDragonAdministrator in reply to Fortheloveofabook

Make sure you get thyroid antibodies tested next time

And get vitamin D tested asap

Not sure if thyroid levels vary depending on where you are in menstrual cycle

helvella profile image
helvellaAdministratorThyroid UK

A few days ago, there was a thread on the Pernicious Anaemia Society forum about folate/folic acid. And, despite being in the context of B12 injections, it might be worth a read:

Folate

healthunlocked.com/pasoc/po...

AND

Folic acid = tummyache!

healthunlocked.com/pasoc/po...

Did you have B12 tested? Supplementing folate/folic acid without knowing B12 status is poor practice.

And 5 milligrams of folic acid a day is about as unbalanced as you can get!

Fortheloveofabook profile image
Fortheloveofabook in reply to helvella

Vitamin B12 was in normal range at 498 ngl . Thank you for the links , I’ll have a read through them .

Judithdalston profile image
Judithdalston

I think your GP has done quite well picking up the thyroid/ folate etc, and referring you on checking that nothing is really amiss. But from experience yes once one hormone or vitamin or mineral level is out then others follow for eg improve the thyroid levels and cholesterol levels improve. Yes get the folate up as suggested above, and consider investing in a private full thyroid test with TSH, FT4, FT3 plus antibody TPO plus TgAb and important ferritin, folate, vit d and b12. I had a very raised TgAb result which is rarely tested by NHS to confirm Hashimoto’s thyroiditis.

Fortheloveofabook profile image
Fortheloveofabook in reply to Judithdalston

Thank you . This puts my mind at rest regarding the other levels. October will come around fast and then hopefully things will start to become clearer after the second blood test .

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