Can anyone help with these blood results? Thyroid etc

[veneeroftheweek]

I had a load of blood tests done recently as I was feeling really sluggish and achy. As a result of these I've had my thyroxine dose increased from 50mcg to 100 mcg and I've been put on a course ferrous fumerate tablets.

The doctor hasn't actually called me back for an appointment (I just got a call to go and collect the prescription) and I've just collected a printout of the blood results so I'd like to double check with someone the things that seem to be causing an issue. I can see TSH is too high and hopefully this will be sorted with the thyroxine. T4 seems ok. I thought they were testing T3 but it seems they didn't. How crucial is this test?

So, serum TSH 9mU/L (0.27 - 4.2)
Serum free T4 level 15.2 pmol/L (10.5-24.5)

These are the blood results which I think relate to the iron tablets. Assuming I'm not missing anything, I guess this will be resolved with the iron tablets.

Haemoglobin estimation 111 g/L (120-150)
Red blood cell distribution width 14.6% (11.6-14)
Mean corpusc. Hb. conc. (McHC) 309g/L (315-345)
Serum ferratin 9ug/L (10-160)

The one thing that I am confused about is this one:

Erythrocyte sedimentation rate 15mm/h (1-12) it says Abnormal - contact patient. Obviously I will speak to the doctor about this but I'm wondering whether this is something that is likely to be sorted with the medication I've been given and this may be why they haven't followed it up.

Can anyone shed any light on this? Thanks

I can't comment on the one you don't understand, but even without T3 testing, your TSH is high enough to warrant increasing your thyroxine. So don't worry about the T3 test.

Yes, thought so. It explains why I've been feeling so crap! Presumably the T3 will only become an issue if I don't see an improvement on the increased dose.

Also when I had my ferritin checked I think (this was two years ago) the base was 14 or 15, not 10. Mine was 9 and that was considered very low, so combined with your TSH it's no wonder if you've been feeling crap! Hope the meds kick in soon.
Also beware: can't remember if it was ferrous fumerate or sulphate, but one of them gave me horrendous gastric symptoms and I had to swap to the other one which seems gentler on the bowels.

Ferrous fumerate is the gentler one apparently. No horrible side effects so far, unlike when I was pregnant and on ferrous sulphate. That was grim!

That's interesting about the change in base line. I wonder why that is.

TSH is far too high but hopefully will reduce with your increased thyroxine dose

ESR is associated with anaemia - which also shows up in your Hb / ferritin results

Est isn't associated with anaemia it is associated with inflammation and infection. Normal is below 10 but the cutoff increases with age - if you are over 50 it is 30.

Your symptoms are unlikely to be related to your iron deficiency as although your ferritin is low (the range is analyser and reagent dependent) your haemaglobin is above 100 - you have latent iron deficiency and it should resolve pretty quickly.

Your symptoms are more likely due to your thyroid problems.

Thanks for the reply. So it sounds likely that the medication should hopefully sort this out.

What would be the usual time for a retest? Three months?

retest in 8 weeks for the thyroid

"A common cause of high ESR is anaemia, especially if it is associated with changes in the shape of the red cells"
labtestsonline.org.uk/understanding/analytes/esr/tab/test/

*AveEldon
"A common cause of high ESR is anaemia, especially if it is associated with changes in the shape of the red cells"
labtestsonline.org.uk/understanding/analytes/esr/tab/test/ *

The author of that site doesn't understand the principle of the test - the red cells sediment out due to c-reactive protein (or immunoglobulins) coating the cells and causing them to form stacks (rouleaux) in the sample bottle that makes them fall quicker. The shape of the cells has little bearing on how quickly the cells fall. The fact that the ESR is raised in these anaemias is not due to the anaemia, but the condition causing it. It is termed anaemia of chronic disease. The raised ESR is not caused by the anaemia, but the condition causing the anaemia - this could be rheumatoid arthritis, gastric inflammatory diseases, myeloma plus many more conditions.

~my qualifications - 20 years working as a specialist biomedical scientist in haematology and transfusion. Educated to masters level and working in the laboratory as well as teaching to undergrad level~

Your ferritin is below range, so you should be asking for an infusion to bring it up quickly. To support the conversion of the T4 you are taking into the T3 your body needs, your ferritin level needs to be at least 70 and preferably nearer 100. It took me four years to raise my levels to there from where you are now, because the nob haematologist lied to me and told me they didn't give infusions. Four years is a long time to suffer with low ferritin.

You need your TSH to be round about 1 and that FT4 at the top of the reference range, so make sure you go back and get re-tested in six weeks.

An iron infusion? Is that something my GP could organise or would I need to be referred somewhere?