Understanding Advanced Test follow-up to initial NHS test

[Flamborian]

I had an initial NHS thyroid function test on 21 Oct 24, discussed here:

healthunlocked.com/thyroidu...

My appointment with GP is scheduled on 28 Nov. In the interim, I have followed up this NHS test with a private test including vitamins, as advised here. Both test results are shown below.

I would be grateful for any comments on the advanced results and any advice/ issues to raise with GP. Especially grateful for any advice on optimising my vitamin levels (especially any recommended high quality brands/suppliers).

From the latest results:

- With testing at 0830hrs instead of 1830hrs, the TSH level has over doubled to 230.79%

- Free T3 is 37.84%

- Free T4 has increased from 6.82% to 18% (due to time to day?)

- Initial NHS results said they were 'suggestive of subclinical hypothyroidism caused by Hashimoto’s disease'. Any relevance of the additional TgAb result, which also looks high?

- Any advice on the Ferritin, Folate and B12 results?

- Vitamin D is noted in the test as “insufficient” with the following Doctor’s Overview advice:

"This insufficiency may worsen to vitamin D deficiency if you don't increase your intake of vitamin D. Taking 800 -2000 iu (20-50 mcg) of vitamin D per day for ten weeks will improve your vitamin D levels. You can then decrease your intake to 400 iu (10mcg) per day to keep your vitamin D at healthy levels

What is a “healthy” vitamin D level for hypothyroidism?

The test result Doctor’s overview also said:

"TSH levels can transiently rise in response to stress, illness or heavy exercise and research suggests that at the 5 year mark, 60% of people will have normal thyroid function.

There is therefore a small risk of progression to underactive thyroid and this is estimated to be around 2-5% per year."

I am unsure whether the results are suggesting it is still better to “wait and see” or are indicating that commencement of replacement TSH is imminent. I am fairly active. I don't have any chronic/profound symptoms (I think) though have noticed:

-Feeling fatigued early evening after exercising (falling asleep watching TV).

-Taking longer to recover after weight sessions

-Slower weight loss than expected

-Muscle pains beyond usual post exercise/gym soreness

-Persistent bloodshot eyes (not infected)

-Cuts taking a lot longer to heal

-Cholesterol levels are rising

-Blood pressure is rising.

-Cold extremities and an occasional Reynards-type phenomenon

Many thanks and apologies for the long post.

-------------------------------

Results

Male age 64

NHS Test on 21 Oct 24 @ 1830hrs

TSH 5 miu/L (Range 0.35-4.7) 106.90%

Free T4 8.7 pmol/L (Range 7.8-21) 6.82%

Thyroid peroxidase antibodies >1000 iu/ml (Range 0-75)

(TPOab)

Private Test on 18 Nov 24 @ 0830hrs

Inflammation

CRP HS 2.180 mg/L (Range: < 3)

Iron Status

Ferritin 97.70 ug/L (Range: 30 - 518)

Vitamins

Folate - Serum 33.1 nmol/L (Range: > 7)

Vitamin B12 (Active) 76.4 pmol/L (Range: > 37.5)

Vitamin D 43.3 nmol/L (Range: 50 - 250)

Thyroid Hormones

TSH 9.340 mIU/L (Range: 0.27 - 4.2) 230.79%

Free T3 4.5 pmol/L (Range: 3.1 - 6.8) 37.84%

Free Thyroxine 10.2 pmol/L (Range: 12 - 22) 18%

Autoimmunity

Thyroglobulin Antibodies

(TgAb) 446.00 kIU/L (Range: 0 - 115)

Thyroid Peroxidase Antibodies

(TPOab) >600 kIU/L (Range: 0 - 34)

[Regenallotment Ambassador]

Goodness poor thing you must feel dreadful.

You will need a loading dose of vitamin D, recommended here to take D3 with K2, I find the most economical and simple to deliver is the drops bought from Amazon. We have one called Horbäach 4000iu, one drop is approximately 1000iu and to raise your levels I’d suggest 6-8000iu a day for 3 months and retest. GPs routinely underdose Vit D and have no idea how much they slow down recovery by doing this. They don’t study nutrition much I hear.

Folks also suggest magnesium as a co factor of vitamin D, I confess I’ve never bothered looking it up, magnescomes in many forms and biglycinate is best tolerated, if you have a tendency to constipation then the citrate form is good. Some can’t get on with magnesium supplements at all in which case a topical cream or bath salts rich in magnesium can work as an alternative.

Thyroid, 100% Hashimotos then, should start treatment immediately (but may want 1 more NHS test in which case insist on morning and asap). Your symptoms alone should be enough to diagnose.

A patient to patient tip is to ask for a trial, that seems to get things moving if Go is reluctant.

Remember starting doses can make you feel worse before you feel better, you get a good week or so followed by awful weeks followed by gradual improvement and the decline. So steel yourself for a 6 weekly phone appointment request for a trial of the next dose up (listing symptoms).

You should read up on NICE guidelines for Hashimoto’s treatment, this is you and your situation. It’s worth showing your GP as they can look this up on their system too.

These can be found in the pinned posts section here healthunlocked.com/thyroidu...

Good luck!

PS. Ask GP to test for coeliac before going gluten free.

[Flamborian in reply to Regenallotment]

Thank you very much for the very helpful reply. I am hoping that my GP is informed and supportive. Before the initial Thyroid tests GP and cardiologist were pushing me to increase blood pressure meds dosage and to start on a statin (I am not keen). Now, with the benefit of the Thyroid test results, it seems the better course of action is to sort out the hypothyroidism first.

[SlowDragon Administrator]

High thyroid antibodies confirms autoimmune thyroid disease

TSH over 5 and high thyroid antibodies and symptoms…..you should be starting on levothyroxine

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

Guidelines of dose Levo by weight

approx how much do you weigh in kilo

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

[Flamborian in reply to SlowDragon]

Thank you very much for the reply.

I am 118 kg, so it looks like titration could take a while!