Thyroid test results- still not ideal?

[SirVixofVixHall]

DD is 12, recently diagnosed with Hashimoto's. TSH was 50 4 weeks ago, but they upped her levo to 75 mcg and today her results are
TSH 2.45
T4 15.6
T3 6.9
Ferritin 27
B12 442.
To me her TSH is still too high, her T4 a bit low. Her ferritin seems low. Am I right? I'm wondering what to say to the Doc as they say these levels are all "fine" but although her goitre is shrinking, and she's a bit less "flat" she is still shattered. Any advice?

I saw your other thread.
You'll get more advise here healthunlocked.com/thyroiduk☺

Thank you Bebrave. I am worried about how tired she is still.

Yes definitely room for improvement. Many GPs will be happy if the test result is 'within range' rather than take note of how the patient feels. Most people will report feeling significantly better once the TSH is below 1.
Yes the ferritin needs to come up, that will help. Ferrous fumarate is usually well tolerated.
B12 can be raised too, in Japan the lowest acceptable figure is 500 and as a population they have a very low rate of dementias and other neurological issues.
Was she also tested for folate and Vit D?
You will need to be assertive and state that you're seeking to optimise all these things, not just accept 'within range' as the best that can be achieved.

I love Michael Sheen...
She was tested for Vit D but that result isn't in yet. They didn't test folate, should I ask for that at her next test?
She is on Solgar"gentle iron". I was giving her that anyway, before we knew she was hypothyroid , as I'd thought her exhaustion could be due to low iron (she is vegetarian). So Heaven knows what it was a few months ago. What is a good ferritin score? I've read it needs to be at least 70, is that right?

Hands off, I love him the most
'Normal' range for ferritin is 15-350 ng/ml, although every hospital trust has guidelines to initiate iron therapy if the result is

Mine is 22, and was lower, and the GP has ticked it as "normal" Grrr.

Her t3 is quite good - can you post range?

Don't forget there's a significant symptom delay. Up to 3 months especially after so long. With a goitre, her thyroid will still be producing some t3, which is what the gp may be thinking about.

I'd agree a tsh of nearer 1 will be best. Is long has she been on this current dose?

Actually I bet longer than 3 months. I was very ill for a long time at 20. Very thin and weak.

She's been on 75mcg for five weeks. She started on 25 mcg but actually got worse, her TSH went from 70 something (I think, I can't quite remember) to over 100, and then down to 50 when her dose was upped to 50 mcg. Her T4 at the start was very low, they didn't measure her T3 until last week, so I don't know how that has changed, just what it is at the moment.
I don't know the ref range for T3, are there differing ranges then? The receptionist was really reluctant to give us the levels at all, insisting that the GP had said they were all "fine" and "normal".
Any idea when Dd should expect to be feeling less tired, or will it take her ferritin levels to improve before she feels better? She is a bit more sparky, I can see that she isn't quite as flat and sluggish, but she is still very tired and finding it hard to do extra curricular things that she used to love.

Her goitre was large and the thyroid very vascular (the scan showed the thyroid to be "very enlarged") but although it is still swollen it isn't as big as it was a month ago.

She needs more levo in my opinion. Once medicated, normal ranges are a bit of a misnomer. It's about getting the individual optimal. Usually around 1 for TSH and upper quarter of range for FT4 - around 20. She'll need more than a maintenance dose of iron to raise ferritin. I took 3x210mg per day for 2 months to go from 10 to 46 ferritin.
Vit D result is key for her too. I think you need to see the GP again and explain that her symptons are still debilitating.

TBH t3 is very variable during the day as it's half life is a few hours- they may want to know as with a goitre at the moment it's still producing t3 too rather than relying on all the t4 being converted to t3 in the rest of the body. Im guessing their motivations and that could be why.

I do think nearer 1 would be ideal, especially long term. Could you get another test in another 6 weeks?

They usually wait 12 weeks after a dose change, partly as it can take that long to get to full blood levels and also as symptoms are more accurate then. But it depends how bad you were and for how long. I think there's a cfs level you can get to as muscle literally wastes (I've experienced it a few times) and then it takes longer as you've simply got to build stamina, lost muscle etc. In my own experience that was longer; nearer 6 mo, especially if tsh is still not exactly bang on. I was a young 20 when I got it.

I'd also say the ferritin needs to be within normal range (if you look at the ref range it says 70-200 ish is normal) and agree tablets need to be stronger. I took 2 x 400 mg a day. I think vit d should be checked too esp at this time of year. The rda for children was raised to 10 (mg? Ug?) recently but she may need more if it's not in the higher range. 10 mins in the midday sun as much body exposed will also help (as long as can cope before burning)

That's all really helpful. She has definitely lost strength and muscle tone. She used be a good runner etc, but not now. I can see now that she has had a goitre for at least a year. I didn't know that the goitre itself produced T3.
Hopefully we'll have her Vitamin D result this week.

www.victoriahealth.com/product/Gentle-Iron/662 this is the iron she is taking, both of us have been on one a day (I'm also hypo) should we be taking more? She's very slim and about five foot one and a half.

I'm not 100% about that but I don't think the thyroid itself is dead yet so there could be t3 still being made - tbh I don't think the experts know all the ins and outs of what actually happens. However at some point it will be.

I guess I'm saying for now perhaps watch and wait following their advice and request more tests in 6 weeks. You could get a second opinion to be sure? Is she consultant led?

This is a higher dose and what the GP prescibed me 3 times a day.www.amazon.co.uk/Ferrous-Fumarate-210-Tablets-1X84. think gentle iron is tolerated better but takes longer to increase levels. I use it for mainenance. Iron is absorbed better with vit C and mustn't be taken within 4 hours of thyroid meds as it impacts levo absorption.

Oh ok, she has been taking her iron about an hour after her levo this week, so I will shift it to suppertime instead. I'll look into getting both of us some stronger iron- anyone have any thoughts on Spatone? When I took it , it made my heart race, but friends have suggested it for dd.
She is now under the care of a paediatric endocrinologist in the hospital, although she may still be seeing the paediatrician who she first saw. She had an appointment this week, which they cancelled as she was seen five weeks ago and so they felt it wasn't necessary to see her again so soon, unless her levels were still too low. I'm a bit concerned about this as the GP has said the levels are now fine, so we don't have an appointment in place for the endo, and yet she is feeling rough still, and is only 12. I think we're ging to try and push for an appointment asap, and then we can chat about whether she needs more levo.

That's not right they cancelled the appointment without knowing her clinical symptoms. Perhaps complain to PALS to see if they can get you another appointment? GP probably won't increase her dose without the endos advice. 5 to 6 weeks on one dose is enough time to reevaluate systoms.

Just to say - what Bebraveagain has said is absolutely the ideal dose for an adult but may be too much for a 12 yo child. Paediatric protocols are always weight dependent esp if she weighs less than 50kg.