I have been feeling very fatigued and generally unwell for well over a year now.
I got blood tests last Sept and my TSH was 0.97 (0.35-5.00) and free t4 was 12.3 pmol/l (9.0-21.0) I have recently been feeling a lot worse and it was tested last week and TSH is 0.87 and free t4 10.3 pmol/l within the same ranges.
I know the TSH seems fine but the t4 appears the low end of the range and I’m wondering if it could be causing symptoms.
is it normal for it to decrease within a year?
I also got my active Vit B12 tested and it is 51 pmol/l it doesn’t have the full range beside it but states 25-70 is in intermediate range.
My serum ferritin is 65 ug/l (15-200)
I just feel everything is a bit low and far from optimal is there anything I should be asking for help with.
Written by
Flora100
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What time of day did you take these tests? Highest TSH is at 9am or earlier.
Certainly a low FT4 will be causing symptoms and no doubt your FT3 if it were tested (the NHS generally doesn't) would also be low which again, causes symptoms.
Often GPs only look at TSH but you should point out to your GP how low your FT4 is and this can indicate secondary hypothyroidism or central hypo where the pituitrary doesnt respond appropriately to low thyroid levels.
Have you had thyroid antibodies tested? NHS only test TPO type but privately you can also test Tg.
Do you follow any kind of diet such as being vegetarian or vegan? Do you eat red meat?
Your B12 is far too low and supplementing this up to 75 ++ will help how you feel overall. Thats something you can do to help yourself.
Ferritin should be around 90 - 100 for best use of thyroid hormone. Suggest increasing iron rich foods in diet and eating them often. Chicken livers, pate, red meat etc
Your low folate & B12 results will be causing you symptoms. As soon as you stop a supplement your level will begin dropping right back to where it started, so you need to be taking one continuously and buy your own after any prescription has finished.
Firstly I am not medically qualified and what follows are some thoughts for your consideration.
Your low t4 combined with a low tsh suggests that your pituitary gland is not producing enough tsh to stimulate your thyroid to produce more t4. This hypothesis seems to be supported by the more recent results in which both have lowered. Normally as t4 drops then tsh increases.
If the tests are accurate and the above is correct it could indicate central hypothyroidism. If you Google the term then there is loads of information about it.
It might be worth discussing this with your GP and asking for a trial prescription to see how you respond to levothyroxine.
Re b12. B12 deficiency is quite common in people with hypothyroidism. The catch 22 is that supplementing b12 makes getting a diagnosis quite tricky. Have you read the PA forum on HU? It is an excellent resource.
Thank you for your reply. This seems to make sense I couldn’t find much info online about the TSH being low as well as the T4 being on the lower side.
I will speak to my doctor about this at my appointment on Thursday and ask if there’s any chance of a trial.
I will check there regarding the B12 thanks I will buy some B12 supplements and consider the private injections to see if they will help however I want to wait until after Thursday.
Look at increasing iron rich foods in your diet to improve ferritin
B12 and folate far too low
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
A week later add a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
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 and may need separate methyl folate couple times a week
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) and continue separate B12
Post discussing how biotin can affect test results
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