Blood test results received today for my wife. On no medication, has plenty of classical thyroid type symptoms (hair loss, pains all over, fatigue, sleep disturbances, swollen/painful ankles, would gain weight except she eats maybe 1100 kcal per day, vertigo, eye and skin problems, IBS), but to my untrained eye the results don't show any really obvious clues.
Not obvious to me from above results what might be the problem, bu I'm no expert. However, what are her Ferritin, Iron, VitaminD, Folate and B12 levels like?
Sometimes LOW B12 can mimic Hypothyroidism.....very under diagnosed in the UK and elsewhere as Docs seem happy if is just inside the range. Usually around 180 - 800/900. People that know and understand B12 say that the result should be over 500 and to prevent cognitive decline - needs to be around a 1000.
The only results I see on here that are high are only high when people are supplementing - so if your wife is taking a B Complex containing B12 it may well skew the result. You will read in the link about how little of the B12 in the blood test is available at a cellular level where the B12 is needed.
Some Docs who think outside the box do say that Hypothyroidism should be considered when the TSH is over 2. If you go to the main Thyroid UK website - you will see a heading - Understanding Bloodtests. What time was the test done ? TSH at its highest in the morning....
Thanks for the links - in a way they were the initial reason for the more detailed testing. However, finding a doctor who might consider treating her with TSH just over 2 seems low probability. Any ideas?
additional blood results included as general reply. B12 looks mid range. There is added B complex in the porridge and bread she has, so perhaps this may skew results?
1100 kcal per day is not very much. What does this consist of? As, in what is her diet? If someone is consuming so little energy per day, then it has to be extremely nutrient dense and not just carbohydrates. There can be protein malnutrition and if she is not taking supplements, then easily deficient in B12, vitamin A, iron, etc. etc.
Porridge (no milk) and fruit for breakfast, typically slice of ham, lettuce, banana and slice of bread at lunch, small bowl of dry oatflakes or an oat biscuit in afternoon, meat/fish plus 3 or 4 veg and potato/quinoa/rice for dinner, small bowl porridge and some milk for supper. Mug of apple juice not included in the 1100 kcal. Plus two or three cups of weak tea, quite a bit of water. No ready meals or processed food apart from the ham and occasional sausage. Has osteoporosis, so takes calcium/vit D capsule daily, no other supplements.
Also consider SIBO (esp with so many carbs in the diet) and Candida overgrowth, which can also prevent absorption of vitamins and minerals and mimic hypo (or, some say, even cause it). Hydrogen breath test would tell you one way or the other.
Probably hard to use fat soluable vitamins on that diet, too.
I don't understand the need for oats all day long. Is this supposed to be helping with something? Eating carbs all day long just stimulates insulin production and results in blood glucose ups and downs.
In the British diet, milk is the number one source of dietary iodine. The thyroid gland needs this. She clearly can consume milk, so getting more in the diet is a good idea.
She'll need to take a good vitamin/mineral supplement to make up for what's missing on the diet.
If she has not had a full work up in regards to blood tests, it's a good place to start.
Thanks for the thoughts, and I'll get her to review her diet. I don't think it is the underlying problem, since she only reduced the intake last year when she decided she hated putting on weight, while the thyroid type symptoms date from much earlier, addi8ng a few more every year. She does have IBS, and is basically dairy intolerant, except that she seems to be able to tolerate carnation evaporated milk (perhaps the heat treatment changes it). Oats seem better for her than wheat. I didn't add in details of fats, etc, but they are there. Cholesterol levels were quite normal when tested earlier in the year.
Butterflyaug, I don't know what everyone is going on about here. For me the TSH is a tad too high, but should be higher because the FT3 is too low! It's not even mid-range, when it should be up the top of the range.
As for her diet... 1100 calories is barely enough to survive on. You need calories for all bodily functions - breathing, digesting, etc - but also for converting T4 to T3 (T4 is just a storage hormone and needs to be converted to T3 which is essential to every cell in the body). Calories aren't just about putting on weight!
Besides, hypo weight-gain is rarely about fat. It's usually water weight, so no amount of starving yourself is going to help that.
Now she has a decent level of T4 but it isn't getting converted to T3, so it's not surprising that she has hypo symptoms. This could be because she's not eating enough - not saying it is, but it could be, and the skimpy diet certainly isn't helping! Did you know that anorexics usually end up with thyroid problems?
And where is the fat in that diet??? No mention of butter or full fat milk, or olive oïl, or anything like that. I know fat is high in calories (but that's a red Herring anyway) but you don't get fat by eating fat because the body needs it! It needs cholesterol. The brain is mainly made of cholesterol (and it needs a large amount of T3!) and cholesterol is needed to make hormones.
So, I imagine that your doctor has said no action needed because the TSH is in range. They do that. Well, my advice to you is to improve her diet - more calories, more fat, more fruit and veg, and less carbs. Also make sure her iron, ferritin, B vits, magnesium and zinc are optimal. You could get iodine tested but I doubt that's a problem because her thyroid is making plenty of T4. Test it anyway.
See how it goes for a few months and if there's no improvement go back to the doc to repeat the tests - including the antibodies because one negative antibody test does not mean that there are no antibodies! It just means there were none at that particular moment. The numbers vary a lot.
Thanks Grey. The dietary element may be a partial red herring, since she has only really reduced her intake in the last year, while the symptoms have been around much longer (fibromyalgia for 20 years, vertigo for 8, eye problems for 7, skin problems and hair loss for at least 6, sleep disturbances for 5 or more etc). I accept that looking carefully at intake for some critical elements may be important too.
I didn't mention fats in the diet, but there is some. Plenty of oily fish, margarine on toast, olive oil in cooking. She doesn't weigh things, so I've no idea how accurate her estimate is - but she has managed to lose 6 pounds in a year while being quite sedentary, so there must be a fairly low intake.
You raise a really good point about the T4, TSH and T3 levels though. I wonder if we think of these the right way - while they might be "normal", if T4 is fairly high, then you would expect that TSH ought to be at the low end, rather than just in the "normal range". And if T4 is high, you'd think T3 should be too - unless the high TSH levels indicate that T3 conversion isn't that effective. So I think I'll have a look at what might impact T3 conversion.
Butterflyaug, forget the TSH, it is of no importance and absolutely doesn't tell you if your converting. If the T3 is high, the T4 should be around mid-range. A T4 higher in its range than the T3 in its means you're not converting.
I would also forget the margerine!!! Do you know, originally, margerine was invented to feed turkeys. The turkeys all died. So, they decided to market it to humans as a 'healthy' alternative to butter. It probably tastes a bit better now than it did then, but the poisonous ingrédients are still the same.
Avoid the label 'healthy' because it usually means they're desperate to sell it too you rather than something that is actually healthier.
Like butter. Butter is very healthy, it truly is. Is she trying to lower her cholesterol? There's no point. Cholesterol won't kill you. In fact, people with high cholesterol live longer than those with low cholesterol because the body needs it. Cholesterol has been turned into the bogey man by Big Pharma and Big Food. And they're making a mint out of your fear of it by selling statins and grotty margerine. Which doesn't even taste as nice as butter!
Besides, cholesterol is made in the liver and has little to do with what you eat. If it did depend on what you eat, mine would be sky high by now, instead of rock bottom. I eat all the things that are stuffed with cholesterol - cream, butter, avacados, eggs - but it doesn't do any good.
Also, eating fats doesn't make you fat. On the contrary. Those that eat a decent amount of fat lose weight far more quickly than those on a low-fat diet. I weighed myself today (squeal!) and I've lost 700 gms in two weeks. And that's on top of the 40+ I've lost over the last two years. And I've told you what I eat! But the thing is, I have good T3 levels, and that's what makes you lose weight, not low-fat this and that.
I've gone on a bit there, but the diet is not a red Herring! It's very important to eat nutritious foods and enough of them. A low calorie diet like hers is likely to make her more hypo, which will make her put on even more weight. You don't say how much she weighs, but she probably needs around 2000 calories at least. Actually, if she cuts the carbs a bit, gets plenty of fat, protien, fruit and veg, she doesn't even need to count calories. Calories are a red Herring for a hypo. lol
So, what impacts conversion. Well, not enough calories, for a start! You need calories for conversion just as you do for breathing, digesting and everything else. Even your brain needs calories to think with! And when it comes to handing out the calories, the poor old conversion is the last in line.
Also getting enough trace elements like selenium and zinc. Research those a bit. Hypos often need to take suppléments because they cannot absorb the nutrients from the food they eat. They tend to have low stomach acid, so digestion is often a problem.
So, go and buy her a pound of butter and tell her it's good to eat!
Thanks Grey. She is going to start on supplementing vitamins and minerals as a first step, so that's already a positive. Changing more will take time I think, but we'll see.
I posted the rest of her blood results as a general response in this post. I think Ferritin high but haemoglobin low implies she is getting iron, but something is causing it to stay locked up in Ferritin, leaving her somewhat anaemic. Any ideas?
Oh, I wish I knew! I have the same iron problem and nobody seems to know anything about it! I've tried doctors - but of course they have no idea! Just keep saying, your ferritin is good so your iron is good! I've tried asking questions of people on boards like this, but come to think of it, I've never posted it as an individual question. Try doing that and see if you get any results.
Good about the vitamins. But I don't think you ought to count on the vitamins in the bread etc because they probably aren't of very good quality. Besides, when you're hypo you have trouble absorbing nutrients from food, so need to up the dose by taking suppléments.
IMO thyroid function looks OK. Plenty of T4 & T3, normal antibodies.
1100 calories doesn't sound much, although the typical day you describe sounds more than 1100 to me, unless the portion sizes are tiny. Does she weigh/measure food or just guesstimate? Also the diet seems a bit crap; possibly lacking in protein and definitely good fats.
The weight gain could be water retention but if it is creeping up slowly all the time then it obviously can't all be water and body fat doesn't just appear out of thin air - the body can only store fat if you are eating more calories than you are burning up.
As others have said, consider B12, Folate, Iron, Vitamin D
No, her frees aren't good. The T4 is higher than the T3, which means she isn't converting properly. Her T3 is low enough and TSH high enough to cause problems.
And it most definately could all be water-weight that she's gaining. That's what happens when you're hypo, and calories in vs calories out doesn't mean anything anymore.
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