Results - now what? (thyroid goitre, low TSH, some antibodies...)

[Ownedbyamuddyspaniel]

Hi all

My previous post is here

healthunlocked.com/thyroidu....

My thoughts in the next post to avoid this one being much too long!

I'd be grateful for your input?

Thanks

In short, I'm constantly physically exhausted and have been for a number of years post lots of surgery. I also have an elevated heartrate much of the time (about 10/15 beats above previous resting) with some episodes of tachcardia for no reason.

I have a repeat of a thyroid goitre which became apparent in August. It's been looked at on ultrasound, the short report is:

Multinodular goitre "right nodule corresponds to lump felt. Largest left lobe has spongiform appearance, no suspicious nodule noted, no suspicious features" .

NHS bloods taken at 10.30am, fasted, only water

Lola bloods taken just after 10am, fasted, only water

I had been taken a well woman vitamin but stopped around 8 weeks ago. Still taking 1000iu D3, Magnesium glycinate 1800 mg, I've added K2 after previous advice.

NHS blood test results:

!Serum total 25-hydroxy vitamin D level 53.9 nmol/L [>50.0]; 50 nmol: sufficient

(Note: I have been taking 1000iu since February)

!Serum ferritin level 200 ug/l [13.0-150.0] – over reference range

Renal

Serum sodium level 137mmol/L [136.0-145]

Serum potassium level 4.2 mmol/L [3.5-5.1] Serum urea level 4.3 mmol/L [2.8-8.1]

Serum creatine level 56 umol/L [45.0-84.0]

Serum immunoglobulin A1 level 1.76 g/L [0.7-4.0]

!Serum folate level 4.7ug/L [3.9-26.8]; Indeterminate level. Please interpret with reference to clinical state and other indices

Serum iron tests

Serum iron level 13.6 umol/L [5.8-34.5]

Total Iron Binding Capacity 31.3 umol/L [24.2-70.1]

Transferrin Saturation 30% [15.0-40.0]

Serum C reactive protein level 1.2 mg/l [0.0-5.0]

Full blood count

Total white blood count 4.1 10*9/L [4.0-10.0]

Haemoglobin concentration 143 g/L [120.0-150.0]

Platelet count – observations 211 10*9/L [150.0-410.0]

Red blood cell count 4.43 10*12/L [3.8-4.8]

Haematocrit 0.4 L/L [0.36-0.46]

Mean cell volume 91 fL [83.0-101.0]

!Mean cell haemoglobin level 32.3 pg [27.0-32.0] Above high reference limit

!Mean cell haemoglobin concentration 355 g/L [315.0-345.0] Above high reference limit

Neutrophil count 2.5 10*9/L [2.0-7.0]

Lymphocyte count observation 1.1 10*9/L [1.0-3.0]

Monocyte count – observation 0.4 10*9/L [0.2-1.0]

Eosinophil count 0.0 [0.0-0.1]

Basophil count 0.0 10*9/L [0.0-0.1]

NRBC 0.00 10*9/L

Bone Profile (SCP)

Serum albumin level 40 g/l [35-52.0]

Alkaline phosphatase level 64 u/L [35.0-104.0]

Serum calcium level 2.23 mmol/L [2.15-2.5]

Calcium adjusted level 2.21 mmol/L [2.2-2.6]

(see above re taking 1000iu vitamin D since February)

Serum vitamin B12 level 524 ng/L [197.0-771.0]

Liver Function Test (CP)

Serum total protein level 68 g/L [64.0-83.0]

Plasma alanine aminotransferase level 25 u/L [0.0-35]

Serum total bilirubin level 7 umol/L [0.0-21.0]

I've then got Lola Elite 360 results - I've got loads so I'll post what I think is relevant.

Anti-Thyroglobulin ABS 18 IU/mL (<115)

Anti-Thyroidperoxidase abs 9.6 IU/mL (<34) ?? Internet suggests this is slightly elevated?

FT3 4.1 pmol/L (3.1-6.8)

FT4 18.3/L (12.0-22.0) (this seems to be creeping up)

TSH 0.32 mlU/L (0.27-4.20)

Cortisol 315 nmol/L (ref. range 6am-10am 166-507 (test was taken at just after 10am)

!Haematocrit 0.471 L/L (0.350-0470)

Haemoglobin 150 g/L (120-160)

Kidney function sodium 135mmol/L (133-146)

CRP (High Sensitivity 1.01 mg/L (0.5)

!Ferritin 226 ug/L (13-150)

Magnesium 1 mmol/L (0.7-1.0)

Transferrin 2.1 g/L (2.0-3.6)

Transferrin Saturation 34.3% (20-50)

Active B12 124 pmol/L (37.5-150)

Vitamin D 60 nmol/L Adequate 50-<75 Optimal 75-200 (see above re taking 1000iu since Feb)

Serum folate 9.82 nmol/L (8.83-60.8)

!Cholesterol 5.06 mmol/L (0-5.0)

HDL 1.5 mmol/L (1-10)

HDL Cholesterol ratio 28.7% >20

LDL 3.2 mmol/L <3

Non HDL Cholesterol 3.61 mmol?L <4

[Ownedbyamuddyspaniel]

So, from what I've learned from you well informed folk here...

Vitamin D and Folate are definitely low, I've ordered the Ignennus Super B complex recommended on here. I'm not sure how to deal with the D? Big loading dose?

B12 look OK'ish but I might benefit from it being higher?

Are these enough to make me feel as poorly as I do? the full blood results look to me like they are leaving towards macrocytic anemia which might explain how I feel?

I could do with guidance on the antibodies please

Ferritin is high, but iron doesn't seem to be - could be thyroid or the vitamin deficiencies?

Cholesterol is surprising, I need to check the results from February but I had a private health assessment then and the GP described my results as fabulous and now some are out of range.

What about the goitre - how does this fit in?

Thanks

[SlowDragon Administrator]

NHS blood test results:

!Serum total 25-hydroxy vitamin D level 53.9 nmol/L [>50.0]; 50 nmol: sufficient

(Note: I have been taking 1000iu since February)

Suggest you increase to 3000iu daily and retest in Feb

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly when supplementing

Can test via NHS private testing service

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[SlowDragon Administrator]

Active B12 124 pmol/L (37.5-150)

Serum folate 9.82 nmol/L (8.83-60.8)

I've ordered the Ignennus Super B complex recommended on here

Good plan

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

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

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[SlowDragon Administrator]

Anti-Thyroglobulin ABS 18 IU/mL (<115)

Anti-Thyroidperoxidase abs 9.6 IU/mL (<34) ?? Internet suggests this is slightly elevated?

Antibodies are negative as both are below range

However

20% of Hashimoto's patients never have raised antibodies so you might want to consider an ultrasound scan of thyroid especially as you have developed a goitre

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Gluten intolerance is often a hidden issue too.

Request coeliac blood test BEFORE considering trial on strictly gluten free diet

High cholesterol is linked to being hypo

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

Cholesterol is surprising, I need to check the results from February but I had a private health assessment then and the GP described my results as fabulous and now some are out of range.

Hashimoto’s frequently starts with transient hyperthyroid type results…..this would tie in with low cholesterol in Feb ….

Then after early hyper phase thyroid becomes increasingly damaged and more hypo

High ferritin and lower iron levels

Higher ferritin can be due to inflammation

Higher ferritin more common after menopause

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.

[Ownedbyamuddyspaniel in reply to SlowDragon]

Thanks @SlowDragon that's all really useful. I'm working my way through the links

[Ownedbyamuddyspaniel]

Does anyone else have any thoughts?

[Mandyj2 in reply to Ownedbyamuddyspaniel]

Hi, I think your cholesterol readings are good and I can see why your previous practitioner in February said they were fabulous. If possible could you post the previous cholesterol numbers please?

I’m afraid I know very little about thyroid stuff, I’m trying to work it out too!

[Ownedbyamuddyspaniel in reply to Mandyj2]

Screenshot attached with Cholesterol results from February. There are definitely some changes.

Screenshot with cholesterol results

[Mandyj2 in reply to Ownedbyamuddyspaniel]

Thanks Ownedbyamuddyspaniel, both sets of results are really good!

All results in mmol/L.

Your HDL is consistent at 1.5. Your recent LDL is slightly higher but only by an increase of 0.6.

Your Triglycerides in February state 0.6, recent 0.78. I think they were rounded down and more like 0.6549. So have only risen by 0.1251.

Both these increases are so tiny and could be because you are ill, have eaten slightly differently, added more sugar or gluten, tests taken at different times or simply down to rounding up or down differently across labs.

Your triglycerides are super low, 0.6549 in February and 0.78 recently! The Diabetes U.K. sites recommends under 1.7 on a fasted test.

I prefer to use the Triglyceride/HDL ratio, this calc works well when LDL and HDL numbers are in range, we want this ratio to be under 1.0. Yours is 0.437 in February and 0.524 now - FABULOUS!

I think your blood sugar is good and you’re fit and eat well. Am I right, I’m just curious?!

Hope this helps.

Here’s a calc to monitor: omnicalculator.com/health/c...

[Ownedbyamuddyspaniel in reply to Mandyj2]

Mandyj2 thank you!! I guess I was freaked by the above range reference. The private GP who did the February tests was really scary so I was pleased she had something positive to say about my cholesterol (she wasn't keen on my belly fat which i didn't think was too bad 😅)

My HBA1C is good at 32 mmol/L. My Dad was T2, high cholesterol, high blood pressure and I'm keen to avoid that path if possible.

You might be right about gluten. I generally eat a low carb/low gluten (and low dairy) diet as I know it makes me feel better but the GP was also testing for celiac this time so I ate gluten for c.3.5 weeks before (I know that's potentially not long enough).

I don't feel well, I'm really fatigued but I think that's potentially the low vitamin levels and/or a thyroid issue which I'm trying to get an understanding of.

Thanks for your input 💐

[Mandyj2 in reply to Ownedbyamuddyspaniel]

Hi, your Hba1c is great too! I watch cholesterol closely because of heart disease in all four grandparents so I understand your concerns.

Your triglycerides will have risen with the addition of gluten for the coeliac test, even though they are slightly higher they are still super low so nothing to be worried about there. I’ve had to add carbs to stop weight loss due to hyperthyroidism and my trigs went from 0.2 to 0.9 inside two months!

Scary/snotty doctors will always find something to comment on: if it’s not fat it’s flat feet! Ignore them but I’m so pleased she had to acknowledge your great cholesterol panel! Small wins and all that!

I’m hoping getting vits to optimal will help too, hope you feel back right soon. X

[Ownedbyamuddyspaniel in reply to Mandyj2]

Thanks Mandy