new here - help me understand results

[Rovo]

hi I’m new here and struggling with getting my doctor to refer me to endocrinology. Had private blood tests which showed low cortisol and low t3 and t4 but normal tsh. NHS then further tested cortisol and tsh - with no further action required (cortisol borderline at 175nmol/L. Symptoms are fatigue, nausea appetite all over the place and brain fog. I’ve attached my private blood tests and I’m interested in how important the t3 and t4 results are? Is there anyone who can help me understand as my doctor isn’t worried.

[SlowDragon Administrator]

was this test done early morning?

Are you taking any medications or vitamin supplements

Obviously below range Ft4, Ft3 and cortisol need urgent investigation

Looking at possibly Central hypothyroidism

see this flow chart

gps.northcentrallondon.icb....

Secondary hypothyroidism

Low T4, TSH low, normal or slightly raised

Refer these patients

Can differentiate from non-thyroid causes by history,

TSH/FT4/FT3 + other anterior pituitary tests

9am cortisol needs to be >200nmol/l before thyroxine replacement

bestpractice.bmj.com/topics...

ncbi.nlm.nih.gov/pmc/articl...

endocrinologyadvisor.com/ho...

academic.oup.com/jcem/artic...

ec.bioscientifica.com/view/...

academic.oup.com/jcem/artic...

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to NHS

thyroiduk.org/contact-us/ge...

Meanwhile you need thyroid antibodies, vitamin D and ferritin levels tested

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...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Also look at saliva cortisol test

regeneruslabs.com/products/...

Please add on profile gender and Approx age

Have you had cholesterol levels tested

[Rovo in reply to SlowDragon]

thank you so much - this gives me loads to look into - for reference I am a 40 year old woman and usually fit and healthy but had to stop going to the gym and 6 weeks ago because of lightheadedness - hence the tests. the test was done at 8.30am after no food. I also had other elements checked at the same time including cholesterol and ferritin but didn’t think to include them as I didn’t realise they were related - see attached.

I’m taking fluoxetine and no supplements, I’ll look into getting thyroid antibodies and vitamin D tested - thank you so much, any other advise?

Test tesults

[Rovo in reply to Rovo]

more

Test results

[Rovo in reply to Rovo]

more

Test

[SlowDragon Administrator in reply to Rovo]

Ferritin is deficient

You need full iron panel test for anaemia

Any obvious reason for low ferritin eg

are you vegetarian or vegan or heavy periods

cks.nice.org.uk/topics/anae...

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

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.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Ferrodyn supplement

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

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...

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...

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.

[SlowDragon Administrator]

iron/ferritin deficiency as possible CAUSE of anxiety

livestrong.com/article/3856...