Firstly I'd just ike to say how great you all are with the info, help & support you provide on this site. I've always been someone who likes to know everything I can about a condition and to make sure I do all I can to help myself when I'm faced with anything new health wise whether it be conventional or non conventional medicine as I believe they both have their merits.
I saw a private Endo 10 weeks ago because I've been suffering debilitating fatigue and depression for over a year and my TSH has been between 4.5-5.6 during that time. The Endo said she could see my thyroid was struggling even though my TSH at this test was only 4.31 & as I come from a family of people with Hypothyroidism, she wanted to particularly test me for Hashimoto's. That was negative. Also my ferritin earlier this year was 18 and I was put on Ferrous Fumarate for 3 months but have stopped now as GP said it was fine at 38.
The Endo put me on a starter dose of Levo for 3 months back in August to see how I'd do & asked me to keep a diary as well which I've done. I'm about to go back to be re-tested to see how I'm doin on Levo. I definitely have way more energy and feel better in myself overall but still feel there's room for improvement especially with weight & energy. I know what dose I should be on for my weight & I suspect she will up my dose when I see her again but I was just wondering if anyone else had experienced this rather than full blown thyroid issues. I've listed my blood results if that helps.
TSH - 4.310 (0.27 - 4.20 mlU/L)
Free T4 - 10.70 (12-22 pmol/L)
Ferritin - 38.70 (13 - 150 pg/L)
Free T3 - 4.0 (3.1 - 6.8 pmol/L)
Cortisol 310
Haemoglobin A1c(IFCC) - 37.20 (29 - 42 mmol/mol)
Serum Folate - 6.26 (3.89 - 26.80 ng/ml)
B12 - 506 (197 - 771 pg/ml)
Vitamin D - 83 (50 - 200 nmol/L)
Written by
SharpClaws
To view profiles and participate in discussions please or .
Your results definitely indicate hypo …..Ft4 was below range
I come from a family of people with Hypothyroidism, she wanted to particularly test me for Hashimoto's. That was negative.
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)
NHS only tests TG antibodies if TPO are high
Have you had BOTH TPO and TG antibodies tested?
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
An ultrasound scan helpful if both antibodies negative
Which brand of levothyroxine are you currently 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)
Come back with new post once you get next test results
Vitamin levels
my ferritin earlier this year was 18 and I was put on Ferrous Fumarate for 3 months but have stopped now as GP said it was fine at 38.
Ferritin is still barely within range as ferritin below 30 is deficient
But NHS only tests and treats vitamin deficiencies
Hi. Thanks so much for the informative and speedy response. It looks like I've only had TPO antibodies done not TG. I have Globulin results but not TG. I'll ask her at next appointment.
The tests I had done were at 9am with nothing to eat or drink except water. I had read all your advice before I went. I find I suffer terribly with constipation if I take something for ferritin which then makes you feel miserable as well.
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)
Post discussing how biotin can affect test results
Despite what doctors think, you do have full-blown thyroid issues.
Someone with no thyroid problems (euthyroid) would have a TSH of around 1. If it reaches 2 it means your thyroid is struggling. And at 3 you are technically hypo.
TSH is a pituitary hormone. When the pituitary senses there is not enough thyroid hormone in the blood, it increases its output of TSH to stimulate the thyroid to make more hormone. But pituitaries can have problems just like thyroids, and they don't always work 100% efficiently. Yours, for example, would appear to be a bit sluggish, because with an FT4 two points under-range, one would expect the TSH to be a lot higher. Did the endo not look at the FT4 level? Never mind the TSH, that FT4 is screaming hypo.
How much levo did she put you on? It should have been 50 mcg but often doctors are over-cautious and start patients on too low a dose. And she should have retested you after six weeks. But you should be aware that dosing by weight is only a rough guide, not set in stone. You might need more - you might even need less. But with hormones - all hormones - we need to start on a low dose and increase slowly, to give the body time to adjust. We cannot just suddenly jump to what we think is the right dose, mainly because we could be very wrong, but also because that puts too much stress on the body.
Is she going to do the test during your appointment? That's really not a good idea. Obviously she's only going to look at the TSH, no matter what tests she does, and the TSH is highest before 9 am. After that, it drops sharply until it is at its lowest around midday. In order to get the increase in dose you need, you need to have the highest TSH possible. Plus, you should fast over-night, as some food can lower TSH - as can tea and coffee. Also, leave a 24 hour gap between your last dose of levo and the blood draw.
So, as you can see, getting tested at the endo's is usually not a good idea. But there's no way they can force you to do it when they want it - just refuse and say you'll do it at a more convenient time. Because either they don't know that TSH levels change throughout the day, or they don't want to know.
Your ferritin is not ok at 38. It should be more like 100. Your folate and vit D are too low, and your B12 could be higher. Your cortisol is low but that could pick up as your FT3 rises.
Hi Greygoose. Thanks for the detailed response. She did look at it all and maybe that's why she said it was abnormal. As you say, you'd expect the TSH to be higher with my T4 2 points under. All of the tests were done at 9am with nothing to eat or drink except water. I saw her first for a consult, then had blood tests done and a follow up appointment 3 weeks later to discuss the blood tests. I'm on 50mg as you say and I do think she will raise it when I next see her. I will post my results once I've seen her on 14th November.
When taking iron supplements, do you take a good dose of vit C with it? That not only helps with absorption of the iron but also helps you avoid constipation.
she wanted to particularly test me for Hashimoto's. That was negative
Please share the exact tests/results you had for this. There are 2, and it’s not uncommon for only one to be tested.
Ferritin we aim for 100, but you should never supplement iron without a full iron panel, a methodical dosing regimen, and regular testing.
Thyroid others here will provide more articulate guidance, but your TSH and free Ts are still suboptimal by any measure. My guess is a starter dose was Levo 50 mcgs daily? If so, you are due for an increase to either 62.5 or 75 mcgs daily.
Cortisol we’d need a range/time of day for this one.
Hi. Looks like she only tested for TPO not TG. I will ask her for that. Yes, started on 50mcgs daily so guessing she will increase me when I see her in 2 weeks. All bloods including cortisol taken at 9am at the hospital where she's based and cortisol range they use is:
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
If taking any iron supplements stop 5-7 days before testing
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
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.
Post discussing just how long it can take to raise low ferritin
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.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Fluctuating TSH should I increase meds
Will B12, Ferritin, Folate levels rise on higher dose Levo?
TSH supressed again GP & Endo keep changing my dose
Bloods results help please
