Neuropathy

[Margaretindevon]

Could someone shed some light on what is going on with my test results please. I was diagnosed with Hypothyroidism about 30 years ago after I had my goitre removed. Shortly after I had tingling and burning in my feet, I was not on any medication at first. Then I was put on Levothyroxine, and as far as I can remember the burning and tingling in my feet stopped. Please forgive the vagueness as I am now 87!! I was on 125mcg, then last year, in her wisdom, my Dr. dropped it to 100mcg. The trouble in my feet is dreadful, and I am now also getting it in my hands, especially just after I have gone to bed. I am also diabetic type 2, but the foot problem started years before I was diagnosed as diabetic. I am also overweight, but have mobility problems. This was my latest blood test on 24th Oct. I am sorry about the extra bit at the bottom but do not know how to get rid of it! Sorry about the length of it to!!

Is there anything that I can do to reduce the pain in my feet, please, if possible naturally as I don't like taking all these pills.

Margaret

Test Result Normal Range

24-Oct-2024

HbA1c levl - IFCC standardised 54 mmol/mol - mmol/mol

Comment: (CN) - Stable. discuss at planned review Providing none of the exclusion criteria are met, HbA1c of 48mmol/mol or greater can be diagnostic of diabetes. Values <48 mmol/mol do not exclude diabetes. Misleading results may be obtained in any situation where red blood cell lifespan is affected, this includes anaemia and certain medications. Please refer to the Diabetes UK website below for more information. diabetes.org.uk/Professiona... reports/Diagnosis-ongoing-management-monitoring/New_ diagnostic_criteria_for_diabetes/

Full blood count - FBC

Comment: (RPALabReports) - Acceptable - no action

Haemoglobin estimation 146 g/L 120 - 150 g/L

Total white cell count 6.7 10*9/L 4.0 - 10.0 10*9/L

Platelet count 226 10*9/L 150 - 400 10*9/L

Haematocrit 45 % 36 - 46 %

Red blood cell (RBC) count 4.95 10*12/L 3.80 - 4.80 10*12/L

Mean corpuscular volume (MCV) 92 fL 83 - 101 fL

Mean corpusc. haemoglobin(MCH) 30 pg 27 - 32 pg

Neutrophil count 4.57 10*9/L 1.8 - 7.4 10*9/L

Lymphocyte count 1.5 10*9/L 1.1 - 3.5 10*9/L

Monocyte count 0.5 10*9/L 0.21 - 0.92 10*9/L

Eosinophil count 0.07 10*9/L 0.02 - 0.67 10*9/L

Basophil count 0.05 10*9/L 0.00 - 0.13 10*9/L

Nucleated red blood cell count 0 10*9/L - 10*9/L

Comment: If advice is required regarding the interpretation of abnormal full blood count results please see pathfinder (haematology/documents) or the haematology NGH intranet page.

Serum TSH level 3.7 mu/L 0.27 - 4.2 mu/L

Comment: (CN) - Normal

UrinalysisMore information icon

Comment: (CN) - Normal

Urine creatinine 5.1 mmol/L - mmol/L

Urine microalbumin 3 mg/L - mg/L

Urine albumin:creatinine ratio

Comment: See comments. Urinary microalbumin undetectable.Unable to accurately calculate albumin/ creatinine ratio. Ratio within normal reference limits.

Blood haematinic levels

Comment: (CN) - rasied B12 ? on supplements, discuss at planned review

Serum vitamin B12 1319 ng/L 197 - 771 ng/L

Serum folate 20 ug/L 3.0 - 20.0 ug/L

Serum ferritin 26 ug/L 13 - 150 ug/L

Comment: Treatment with iron should be initiated in pregnancy for patients with a Ferritin level <30 ug/L

Chemistry Tests

Comment: (CN) - Discuss at planned review

Serum sodium 135 mmol/L 133 - 146 mmol/L

Serum potassium 4.3 mmol/L 3.5 - 5.3 mmol/L

Serum creatinine 69 umol/L 45 - 84 umol/L

eGFRcreat (CKD-EPI)/1.73 m*2 68 mL/min - mL/min

Serum total protein 68 g/L 60 - 80 g/L

Serum albumin 44 g/L 35 - 50 g/L

Serum alkaline phosphatase 114 iu/L 30 - 130 iu/L

Serum bilirubin level 7 umol/L - 21 umol/L

Serum ALT level 13 iu/L 5 - 33 iu/L

Serum cholesterol 6.5 mmol/L 0.0 - 5.2 mmol/L

Serum triglycerides 1.6 mmol/L 0.0 - 2.3 mmol/L

Comment: Non-fasting samples for lipid evaluation may have falsely elevated triglyceride levels which will invalidate LDL Cholesterol estimations. Please fast patients if triglyceride measurement and/or LDL Cholesterol estimations are required.

Serum HDL cholesterol level 1.5 mmol/L - mmol/L

Serum LDL cholesterol level 4.3 mmol/L - mmol/L

Serum cholesterol/HDL ratio 4.3 -

Se non HDL cholesterol level 5 mmol/L - mmol/L

AKI warning stage 0 -

Comment: AKI Stage 0

Blood Pressure 152 / 82 mmHg - mmHg

Body weight 83.3 kg - kg

[Regenallotment Ambassador]

Oh Margaret in Devon, you poor thing your feet and hands must be so uncomfortable. I’m all cross and ranty on your behalf!

You are going to have to get your GP in line.

The dose reduction they’ve given you has caused your TSH to rise suggesting your dose is too low. They haven’t tested FT4 (unless I missed it) and they should.

Ask for a dose increase immediately. Clearly 125mcg suited you perfectly.

Ask for the low ferritin result to be investigated, that suggests some iron deficiency but without a full iron panel we don’t know enough.

[traveltime]

hi Margaretindevon … you must be at your wits end. On top of the thyroid meds, is it worth double checking iron panel and b12 deficiency?

Not a medic, but from reading round … (plus I seem to have all 3) since iron deficiency, hypo and b12 probs seem to go hand in hand. your ferretin seems low (?) and I can’t see an iron profile (TIBC , transferrin, serum iron), your folate/b12 seem high? I’d def try to get some proper symptom-led b12 deficiency analysis and iron panel, if you’re up to it. High folate can be a b12 deficiency indicator, apparently. Also, b12 tests can be false high because of supplements or actual problems with the test.

my tingly feet/legs etc have got so much better with B12 loading doses and now iron supplements.

Also agree with regenallotment 100%

[pennyannie]

Hello Margaret in Devon :

Once on any form of thyroid hormone replacement it is recommended in the NHS guidelines that the TSH is kept under 2 - and for reference many of us feel better at the lower end of the range .

With a TSH over 3 you will be dealing with hypothyroid symptoms - please ask that your previous dose of T4 - x 125 mcg daily - where you felt better than you are now - be reinstated.

Your metabolism has been slowed down by this dose decrease and I can't see a reason why this was done as there is no T3/T4 readings showing your levels of thyroid hormones too high and presume it might be age related - as this happened to me when I turned 65 - and I became much more unwell.

2 years ago your T4 was at just around 57% through its range - and since there was no T3 blood test run - its difficult to say for sure - but I doubt those symptoms you experienced had anything to do with your original dose of Levothyroxine - T4.-

T4 is a pro-hormone and needs to be converted into T3 in the body - as T3 is the active hormone that runs all the brain and body functions - in order for this process of conversion to work well we also need to maintain our core strength vitamins and minerals - those of ferritin, folate, B12 and vitamin D - at optimal levels - as when hypothyroid the body struggles to extract key nutrients from our food no matter how clean and well we eat, so many forum members find they need to supplement same to support their thyroid hormone conversion.

Both Ferritin and B12 are flagged -

A ferritin under 30 - is generally flagged for further investigations as you are technically seen as suffering with iron deficient anemia - please see your doctor and if like me you will likely get an iron panel run or need a colonoscopy and endoscopy before you can start supplementing -

The NHS prescription iron tablets tend to upset the stomach and bowel of many - make sure you take these tablets with vitamin C to bowel tolerance

I couldn't tolerate the iron tablets and purchased Gentle Iron which suited me well - but any iron bisglycinate option will be kinder on your stomach - and there are various brands - you can buy over the counter.

Your B12 looks very over range - so again I think it needs a closer look unless of course your supplementing and it's a false high.

I'm sorry I don't know enough about all these other biomarkers to say anything that makes any sense - just that some look slightly outside their ranges.

Just for reference I know I need to maintain my ferritin at around 100 - folate around 20 - active B12 125 ( serum B12 500++) and vitamin D up at around 125.