Latest results - are these any more significant?

Hi

I have posted her before and got some really good advice, that maybe my levels are too low (I have Fibro but always believed there is an underlying cause).

I went back to the doctor (yet again) as I am now getting desperate to find out what is going on. I am veering between whether I have a B12 deficiency or if it is my thyroid, or in fact, both! My B12 came back slightly higher this time but my serum T4 is lower than ever before but at the same time my TSH remains low. Could this be more of a pituitary problem?

I am getting to the point I won't be able to go back to the doctors again (silly I know!) - I had a slightly elevated liver function test this time around too and I did a phone conversation with the doctor - he wanted to talk liver, I wanted to talk B12 and thyroid and I am afraid he was very dismissive and it has left me (yet again) feeling like this is all in my head and like I know nothing. It was the nurse practitioner who did the tests this time, she is lovely, and I am sure will listen but I am put off by the doctor.

Can you advise please? My latest thyroid tests (for May) are at the bottom.

And thanks again in advance to anyone who takes the trouble to respond.

MPx

Dec

Serum Free T4 level was 13.3pmol/l (7.0-17.0)

Serum TSH 1.53 mu/L (0.40-4.50)

Total thyroxine(T4) 118 nmol/L 59-154

April (private test)

TSH 2.50 mIU/l 2.50 mIU/L 0.27-4.2

Free Thyroxine 15.5 pmol/L 12.0 - 22.0

Free T3 4.8 pmol/L 3.1 - 6.8

Total thyroxine(T4) 118 nmol/L 59-154

Thyroglobulin Antibody 16.9 IU/mL 0-115(negative)

Thyroid Peroxidase Antibodies 9.1 IU/mL <34 (negative)

May

serum T4 11 (7-17)

serum TSH 1.7 (0.4-4.50)

13 Replies

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  • ...maybe take a look at drrind.com where there is a page detailing various conditions with the variations in results of TSH FT4 FT3 etc. It looks to me as if you may have Adrenal Insufficiency - and probably not something your doc will want to talk about as they only deal with Adrenals when they are shot !

    Am afraid I am not an expert in the field of Adrenals - I'm just a simple Hashi's girl with Fibro thrown in. But hey everything is connected.....it's just a thought !

  • Thanks Marz

    I also had my cortisol tested at the same time and it came back at 372 (250-650) so again, that will be seen as normal by the doctors. Will take a look at the link though, thanks so much. MPX

  • ...once on the Homepage click onto Thyroid Scale under the heading Popular Links !

  • >Latest results - are these any more significant?

    Please could you post a list of your current symptoms and medication, both thyroid hormones and anything else, including dose changes over the last few months.

    Thanks.

  • Hiya

    Yes of course. I have fibro so all the symptoms of that plus some others so...

    Extreme fatigue

    hair loss on head (more thinning that bald batches) and baldness on bottom half of legs

    Cold feet

    Burning on shins

    Temperature is often low

    migraines

    Muscle weakness

    breathlessness

    fatigue after exercise (very rare to exercise though these days)

    Cognitive impairment, difficulty concentrating, getting words muddled, forgetting things/names, constant foggy feeling (always doing something 'stupid'!)

    Dislike of social situations

    unable to tolerate stress (I used to have very very high stress levels)

    Moody and irritable (can have flashes of anger)

    easily gain weight (i have to fast every other day to keep my weight level) but I went out for a meal for my birthday yesterday and I am three pounds heavier today!

    Difficulty staying asleep

    joint/muscle pain - particularly my back which completely went the other week

    osteoarthritis in hands

    high cholestrol

    Sometimes I have elevated liver function tests

    Digestion problems sometimes when I eat food and then just bring it straight back up again (though not that often and hasn't happened for a whlle.

    I am on amitriptylene for the fibro to help me sleep and sometimes over the counter pain killers when the pain is bad (but I keep those to a minimum). I haven't had any treatment for thyroid. I am looking at whether thyroid or B12 or both could be a problem.

    Thanks

    MP x

  • Thanks Melody. Does your GP have any thyroid function tests on record from the period before you became ill? I was thinking these might be useful for comparison. Your GP might have done a TSH +/- T4 as part of a routine health check at some point in the past. Your symptoms do sound rather 'hypothyroid' in nature but none of your bloods confirm this so far.

    What are the results of your full blood count? And your fasting glucose?

    >I also had my cortisol tested at the same time and it came back at 372 (250-650)

    A cortisol reading cannot rule out adrenal insufficiency - this requires a short Synacthen test.

    >I am on amitriptylene for the fibro to help me sleep

    Amitriptyline can induce sleep and reduce pain but often aggravates drowsiness and fatigue. Do you find this to be a problem?

    If you don't mind me asking, do you snore? Sleep apnoea, often associated with snoring, can cause severe chronic fatigue in some cases.

    >breathlessness

    Do you ever feel breathless at rest, on when lying down? If so, have you been assessed for respiratory or cardiac causes?

    >easily gain weight (i have to fast every other day to keep my weight level) but I went out for a meal for my birthday yesterday and I am three pounds heavier today!

    What is your weight and height? Don't answer if you don't feel comfortable. Do you not feel very tired when fasting? I also wonder how it will affect your metabolism.

    Kind regards,

    Bob

  • Oh, and amitriptyline readily causes weight gain.

  • Hi

    No other thyroid tests that I know of. I have been feeling ill for 5 years since after my little girl was born but don't think my thyroid was tested before then - I never went to the doctors that much before!

    I had the fatigue before I was on amitriptyline - this has helped me sleep better but still v. bad fatigue.

    Breathlessness - I had had the respiratory tests and a lung function test - all fine. No shortness of breath when sat or lying down, no.

    No I don't snore.

    Only been fasting recently - doesn't have any affect on my tiredness, but it makes me less bloated, feel lighter and helps keep my weight level otherwise I can put a pound a day on.

    Height is 5ft and I am 9 stone 7 but was a stone lighter around a year ago and not doing anything different.

    As far as I am aware ami causes increased appetite rather than direct weight gain but I had the weight gain problems before I started on that medication anyway.

    Last FBC - all normal except one of my liver function tests, though I have high serum folate, ferritin at the low end and my total white cells are at the low end 4.49 (4.0 to 11 I think it is). My cholesterol is also high. My symptoms are also indicative of B12 deficiency but again blood test in range - though as you all know on here those ranges don't mean anything!

    mp

  • Hi Melody,

    There's the condition 'post partum thyroiditis', but thyroid tests would generally be abnormal and it normally only lasts up to a year after childbirth... so I don't think it's that. Just a thought really.

    What does your doctor say about your low body temperature? That's quite intriguing.

    >I had the fatigue before I was on amitriptyline - this has helped me sleep better but still v. bad fatigue.

    OK, excellent that it's improved your sleep. Nortriptyline is a similar medication but you might feel less fatigued on nortriptyline. Can be useful to try both. If it doesn't suit you you can easily switch back.

    >As far as I am aware ami causes increased appetite rather than direct weight gain

    Yes, increased appetite is thought to be the major mechanism by which tricyclic antidepressants cause weight gain.

    >I have high serum folate, ferritin at the low end and my total white cells are at the low end 4.49 (4.0 to 11 I think it is). My cholesterol is also high.

    Serum folate, unlike red cell folate, reflects recent folate intake. A high reading could be caused by eating quite a lot of folate-containing foods in the days before the test. A WCC of 4.49 is fine. High cholesterol is exceptionally common in the general population, including a lot of healthy asymptomatic people who eat reasonable diets. It is therefore difficult to comment on that. It is not a specific sign of hypothyroidism.

    The importance of your slightly low ferritin level can be assessed by looking at your FBC. If your haemoglobin level, mean red cell volume, and other red cell parameters were all normal, this implies that your iron stores are adequate. If you have heavy periods, low dose ferrous sulphate may be useful to prevent deficiency.

    >My symptoms are also indicative of B12 deficiency but again blood test in range - though as you all know on here those ranges don't mean anything!

    For certain tests, the reference ranges are controversial. On the other hand, if the range really didn't mean anything at all the test would be pointless! It is true that the commonly quoted lower limit (200) for serum B12 is not always adequate, but I read in another post that your level was 480 (if I recall correctly). A study by Stabler and Allen revealed that levels above 350 were almost always adequate. It might be a good idea for labs to start using 350 as their lower limit rather than 200. Further tests for homocysteine and methylmalonic acid can be used to help identify deficiency in patients with borderline serum B12, but your results were not borderline.

    There are few doctors out there who will treat hypothyroid-like symptoms with thyroid hormones when blood tests are normal, but these doctors do exist. Would you be looking to try T3 therapy if a doctor would prescribe? You might have to go private. Perhaps you could see a different NHS consultant first for another opinion on the cause of your symptoms. Of course, most private consultants *are* NHS consultants as well but you tend to get a lot more time and input into your treatment if you go private.

    Kind regards,

    Bob

  • Thanks Bob

    I appreciate all your advice and for taking so much time to reply. Thank the lord for people like you and forums such as these.

    My previous B12 was 352 so borderline. Also, it is very much like TSH, you can't really put much faith in it. In other countries even at 472 I would be treated for B12 deficiency with my symptoms. It isn't just about how much B12 is floating around your blood it is more about how your body utilises it and, like the thyroid, there is a complicated pathway which can break down at various points. It's why I am struggling between whether I am b12 deficient or hypo or both.

    It is a minefield. I haven't bothered with further tests for homocysteine and methylmalonic acid, I was put off too much by the doctor. I am now self treating - it can't do any harm to my body (as opposed to not treating which can do masses of harm). I am going to see how I go on/feel once the effects kick in and then look into thyroid more/checking my B12 again by getting private tests done probably. I think you are right I may need to go down the private route and no doubt I will be back for advice on that. And yes, from what I have read about fibro and the thyroid I would probably be looking for T3 therapy. I think it is wise to see where the B12 takes me first, I will carry on keeping a note of my temperature and listing my symptoms whether they improve or get worse. What makes me so annoyed is that before all this technology and blood tests our doctors would simply look at our symptoms and trail us on whatever therapy they might think we need and if it didn't work try something else. Too much is put on the blood tests but yes of course I suppose they have to have something to go by - it's just often the symptoms and how a person is feeling go right out of the window just because we don't fit the ranges. I am sure many people on this forum and the B12 deficiency/PA can identify with that.

    Thanks again for your help Bob. MP x

  • Lately become aware of an active B12 test. Is that the type you took? I really don't know the difference myself.

  • Chiquitta posted this video today. thyroiduk.healthunlocked.co... It's the second one which explains your TSH problem.

    The liver is where T4 is converted to T3 so we probably all have liver problems.

    You can take sublingual B12 without worry of overdosing. I would supplement rather than stay on hold for your doctor to help you.

  • Thanks so much. Yes am now supplementing with sublingual B12 - like you say can't stay on hold anymore. Got to help myself! MP x

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