Appreciate help understanding my latest blood test results - thank you!

[sosayra7781]

Hello all. I have been a member of this community for a few years but I have never asked for help with my blood test results before so any help is highly appreciated. ** IMAGES IN REPLY (Page 1 + Page 2) **

Prior taking my annual routine blood test I had a telephone consultation with my GP and mentioned I have been losing quite a lot of hair for some time (no bald patches, thank god) and my period has been changing and skin of hands and face is getting drier so I suspect I am slowly going through perimenopause. Apparently, GP ordered extra tests for that reason but I could not tell which ones. I asked for Free T3 and Free T4 to be included but, sadly, I was once again told they are unnecessary and not available on NHS. 

• I was diagnosed with autoimmune hypothyroidism (Hashimoto's) at 24 and started taking 50mcg of Eutirox daily.

• I am 45 years old, currently taking 125mcg Levothyroxine daily. Always been on T4 only. General health is ok. I am overweight and I know I should/ could eat better and do regular exercise, which I am not really doing at the moment. I am limiting gluten and dairy. Over the years I tried several diets (vegan, FOPMAP, gluten free, sugar free, keto, etc.) but found them very expensive and difficult to maintain in the long-term whilst the progress with weight loss was always really slow.

• I haven't taken any supplements for 4-5 months because I am trying to understand if I have any vitamin deficiency. Previously, I was self-prescribing myself vitamin D3+K2 plus others that I alternated (omega 3-6-9, probiotics, zinc).

I have a telephone consultation with a GP in less than 2 weeks, specifically to discuss my high cholesterol, which is a sort of annual ritual, as to them everything else looks within range. Whilst I recognise I can improve this value slightly with better diet and regular exercise, I believe my thyroid condition and partly bad genetics (my mother has the same issue with cholesterol but she is naturally slim and does not have any thyroid condition) are also critical factors. Doctors always try to prescribe some meds to lower cholesterol, which I always refuse and will do also in this occasion. Like many people in this forum, I am frustrated by the lack of real understanding and support for our thyroid issues.

Thanks so much for any insight you may provide to help me make sense of the results and be ready for the GP consultation!

[sosayra7781]

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[sosayra7781 in reply to sosayra7781]

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[helvella Administrator Thyroid UK in reply to sosayra7781]

Well done! That works.

[SlowDragon Administrator in reply to sosayra7781]

Actually….this page …has iron test results

Shows iron is ok …it’s just ferritin that’s low

So you need to increase ferritin by iron rich foods in diet, not by taking supplements

No vitamin D test results

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

[SeasideSusie Remembering in reply to sosayra7781]

Bone profile looks OK.

I can't comment on sex hormones but they are marked normal.

HbA1c is good.

FBC is good.

[sosayra7781 in reply to SeasideSusie]

I really appreciate you help SeasideSusie . Thank you!

Actually, by checking the brands of Levothyroxine I take daily, I realised that I mistakenly wrote my current dosage. Apologies, I am taking 125mcg of Levothyroxine daily (I have corrected the mistake in the original post). So an increase of 25mcg would take take it to 150mcg.

Really grateful for all the valuable info you and SlowDragon shared with me and the time you took to look at my test results. Lots of reading to do and I am already feeling more confident about discussing my cholesterol value with the GP! Thanks again! 🙏

[SeasideSusie Remembering in reply to sosayra7781]

sosayra7781

Vit D: 93nmol/L

Not too bad at all, and the good weather we are having at the moment may even improve this a bit.

The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L.

TSH: 2.11 (0.27-4.20

FT4: 18 (10.50-24.50) = 53.57% through range

The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.

Your results suggest an increase in your dose of Levo would be beneficial. Ask for an increase of 25mcg using the following information to support your request:

From GP online

gponline.com/endocrinology-...

Under the section

Cardiovascular changes in hypothyroidism

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He confirmed, during a talk he gave to The Thyroid Trust in November 2018 that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw(Not working as expected?)

You can obtain a copy of the article which contains this quote from ThyroidUK

Email : [e-mail]

and ask for the Dr Toft article from Pulse magazine. Print it and highlight Question 6 to show your GP.

Cholesterol is likely high due to undermedication (it is a symptom of hypothyroidism), although triglycerides is the important test and yours is fine.

B12: 475ng/L (197-1000)

This is low. According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

Folate: 9.2 (3.8-9999)

I have taken folate result from other sheet because B12 and folate work together.

Obviously a pretty stupid range so we just interpret that as the range is >3.89 and for this we would say aim for a level in double figures.

With these two results I'd suggest supplementing with a good quality B Complex containing methylcobalamin and methylfolate. I have used Thorne Basic B for a long time and always been happy.

If you look at different brands then look for the words "bioavailable" or "bioactive" and ensure they contain methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid). Avoid any that contain Vit C as this stops the body from using the B12. Vit C and B12 need to be taken 2 hours apart.

When taking a B Complex we should leave this off for 3-7 days before any blood test because it contains biotin and this gives false results when biotin is used in the testing procedure (which most labs do).

Ferritin: 28ug/L (13-150)

NICE consider this to be iron deficiency:

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

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

But your iron test shows good levels of serum iron and saturation, so you don't appear to have iron deficiency just low ferritin. You could ask your GP what he suggests but iron tablets will increase your serum iron and saturation which may lead to toxicity so really you should try and raise ferritin level from food. Try eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

bda.uk.com/resource/iron-ri...

everydayhealth.com/pictures...

[SlowDragon Administrator]

Was test done early morning, ideally before 9am and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

FT4: 18 pmol/l (Range 10.5 - 24.5)

Ft4 is only 53.57% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

So plenty of room for dose increase in levothyroxine

Ferritin is extremely low and deficient at 28

GP should do full iron panel test for anaemia

Low iron and/or low ferritin frequently linked to hair loss

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

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency

Also See page 7 on here

rcn.org.uk/-/media/royal-co...

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

An article that explains why Low ferritin and low thyroid levels are often linked

preventmiscarriage.com/iron...

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.

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...

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

Medichecks iron panel test

medichecks.com/products/iro...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Good explanations of iron

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

Excellent reply by Blearyeyed about iron in this post

healthunlocked.com/thyroidu...

[sosayra7781 in reply to SlowDragon]

Thank you so much SlowDragon !

Actually, I am terribly sorry for the mistake but I am taking 125mcg Levothyroxine daily. (I have now edited correct dose in post).

Yes, test was done at 8:35am sharp, and last dose of Levo was taken 24hrs before test.

My chemist's always provides the same brands: MercuryPharma for 25mcg and Almus for 100mcg.

Really grateful for all the terrific info you and SeasideSusie have so kindly shared with me and the time you spent looking through my results. 🙏 I feel much more confident about discussing my results with the GP.