This is all very new to me so I was hoping someone might be able to help me understand my results a little better as my GP seems reluctant to entertain the idea that there might be something wrong with my thyroid due to normal TSH.
Quick background: I have constantly low energy (going up the stairs requires way too much effort for a 21 year old), I'm always tired and weak, constipated, dry skin and very depressed. I am also, however, underweight and struggle to put weight on. I went to the doctor's and had TSH and FT4 tested:
FT4 14.7 [12-22]
TSH 2.39 [0.3-4.2]
My B12, folate, ferritin are all in the middle of the reference range, Vit D right at the bottom of ref range. All my blood counts were way below ref.
Doctor said I was fine and evidently fit as a fiddle... Not happy with this I went and got myself tested with Genova labs:
T4 - 72 [58-161]
TSH - 1.55 [0.4-4]
FT4 - 12.7 [11.5-22.7]
FT3 - 3 [2.8-6.5]
RT3 - 0.29 [0.14-0.54]
Thyroglobulin <20 [<40]
TPO - <10 [<35]
So, the good, the bad and the ugly? My interpretation of this would be hypo (is being underweight ever seen?) I'm a little confused as to why my FT4, T4 and FT3 would be low but my TSH is normal.
The good news is that your thyroglobulin and thyroid peroxidase (TPO) antibodies are negative so you don't have autoimmune thyroid disease.
FT4 and FT3 are low in range although your TSH 1.55 is 'euthyroid'. Sometimes the thyroid gland is perfectly healthy but lack of TSH stimulation can mean that you aren't producing sufficient TSH to stimulate thyroid hormone. Ask your GP to consider secondary hypothyroidism and run pituitary function tests to rule out pituitary dysfunction.
It is more common for weight gain to be experienced when hypothyroid but some people do have weight loss and difficulty in maintaining weight.
B12 is optimal at the top of range so supplement 1,000mcg methylcobalamin sublingual lozenges, spray or patches if your B12 is <500 and take a B complex vitamin to keep the other B vits balanced.
Vitamin D is optimal 75-200, most are happy with it around 100. If you say what your vitD level is I will advise how much to supplement.
Ferritin and folate are optimal half way through range.
Conormdrew, 56 isn't too bad, supplement around 3,000iu daily or 20,000iu weekly and levels should improve in around 8 weeks. You'll need to supplement Oct-Apr when ultraviolet is too low to stimulate vitD.
Very sorry to hear about your symptoms, especially at such an early age. I thought it was bad enough when I was diagnosed with my first condition at 35 but the good news is you are being proactive.
I have many of your symptoms with an underactive thyroid, but in 2012 I suffered from an adrenal crash. In a way it was a good thing as it forced the medical profession to drill further down to make sure they were treating the correct condition. It turned out that I was cortisol deficient and for years I had staggered on until my adrenals gave up. I am now managing it far better with cortisol medication as and when needed now that my adrenals have been given some respite so maybe you need to research this and see of the symptoms match yours
I wish you well, have courage and conviction when you are dealing with this as you are young and deserve to be out causing mayhem
Chablis, thank you for the encouraging words. It's certainly all a tad daunting but knowing there are people out there going through the same thing and supporting one another is honestly a huge sigh of relief. I'll try and get my cortisol levels checked as my stress has been through the roof the last five years, I seem to be going on a crash course on the body's inner workings all of a sudden! I hope you're able to find relief from your symptoms as well and we can all do a little mischief causing.
All good advice above. Do get your thyroid checked again in a year. Sooner if your symptoms get worse. I was around your age when my thyroid started failing and I had several years of "normal" thyroid results before finally being diagnosed. It is worth keeping an eye on things just in case. Hopefully the vitamin D will help.
You say all your blood counts were low. Do you have the actual results? That may well be contributing to your symptoms. I wonder what the cause is. Sometimes it can be low iron but your ferritin is well within range. I'm surprised your doctor hasn't flagged up your low blood counts :/
I think I'm going to see if I can get my GP changed, we've had our differences in the past and I'm not convinced he's particularly interested in medicine. I was told they were 'a little low' but nothing seems to have come out of it. I'll need to do some chasing up.
Haemoglobin 123 [135-180]
Red blood cell count 4.1 [4.5-6.5]
Haematocrit 0.4 [0.4-0.55]
White blood cell count 4.3 [4-11]
My understanding was that this is likely to be a side effect of hypothyroidism, could it be the other way around? It probably explains why my limbs have turned to deadweights!
It could be low iron. Although your ferritin is good, that could be due to inflammation. A full iron panel would be helpful but my first thought when hearing about a low blood count is low iron. I was thrown by your ferritin being ok but that can be falsely high due to inflammation. Low iron would certainly explain some of your symptoms. Iron is also required for your body to use thyroid hormones properly.
Is it possible eating an iron heavy meal the night before the test could have just falsely risen the result? I eat a lot of iron rich foods but I suppose inflammation would block the absorption.
Can I throw out a wild card and ask about iodine? The importance of it seems undeniable and due to not being on the average diet it seems highly likely that I would be deficient. From what I can tell I'm likely only getting around 40-50mcg a day with the rda being at 150mcg. I also consume a large amount of goitrogenic foods. Any thoughts?
Iodine is a tricky one. Increasing your iodine intake can be beneficial if you are deficient but it can also be harmful. Increasing your iodine intake when you don't have a deficiency can down regulate conversion of t4 to the active t3. It can also cause problems in some people with autoimmune conditions. If you are going to try supplementing with iodine, go slowly and carefully and see what happens. If you benefit, keep with it. If you feel worse, stop it.
Ok, thank you Carolyn. I can see that it's clearly not something to approach lightly and I'll make sure I start very low and slow with all it's concomitant vitamins and minerals. And of course I'll follow up on the words of advice you've all given me today.
I wish you good learning.... and it is a steep curve but you are going to find as you already have, doctors have little knowledge in treating this condition. Putting you on antidepressant has already interfered with your thyroid function like most chemical formulations will. Many people are here simply because they have been fouled up by modern medicine even denying the age old proven remedy of natural dessicated hormone.
Personally I'd only boost with iodine through something like ferriglobin and diet.
A relative is a researcher in iodine. There are deficiencies in some age groups in the uk but it's easy to address through diet. Yogurt, milk, fish.
What is your ferritin level?
I'm a strange one in that I loose weight easily - but I've now been given the disgnosis of hypermobility syndrome. My muscles are easily hit / easily deconditioned. i think its a collagen thing, but the big thing has been that my ferritin level was causing awful symptoms at 55 which is not seen as bad. CFS style symptoms accompany hms, and its a down wards cycle as the less I do the worse it gets. I was actually struggling greatly with a Tsh of 2.5 compounded with low iron.
It could be that you have these tendencies - in which case boosting vit d and possibly iron if appropriate (can be done through diet) and some very gentle graded exersise such as swimming?
Just a different perspective as its not always just about the blood. Constipation can also be due to weak muscles (ask gp about helping this if you try iron). Look into different types of fibre - insoluble and soluble. I can't remeber which one caused me trouble but switching to porridge made with water (plus honey and Cocoa!!) helped a lot. I was given a type of bulking laxative to retrain my bowels too.
Your description of yourself describes me at 21 greatly even after my thyroid was corrected. I'm afraid it's been learning that diet and exersise can boost greatly.
It's possible you're a bit CFS? But do look at hypermobility syndrome too.
It's really tough, you do have my sympathies.
For me depression is always linked to how physically capable I am.
haggis, that is why this condition has so many symptoms....from anything involved in metabolism....which is everything. I hope you will watch the longer video below since he is even more specific but along those lines.
The thing about CFS/ hms/ any kind of weakness eveb simply recovering from a bad flu bug I s we increasingly avoid doing things. And mood massively affects this too! Annoyingly. And fitness Abd strenght levels very quickly deteriorate. There's a really difficult balance between Pushing yourself gently and then making sure you are resting to recover.
Getting my bloods right has been half of the battle but the rest is very much down to me. But I'm 38 and done this several times so I know I can get there (competing in martial arts, cycling etc. Can't do at momrnt though!)
So definitely discuss other issues with gp including hypermobility as it really can impact on people especially as you age. Are you getting any kind of support for your mood too?
Thank you haggisplant. My ferritin was 225 [30-400]. Unfortunately I can't tolerate dairy or eggs and I don't eat grains so the only place I would be getting iodine is from fish. I eat about 3-500g a week but even that spread over 7 days is a mere 50mcg a day. My diet is otherwise very good and I eat literally no processed foods whatsoever. This does mean my intake of goitrogenic foods like turnip, swede and brassicas is generally very high though.
I do try and do gentle exercise like swimming and cycling and as for my mood, well, that's a difficult one. I find it hard to be happy and unhealthy, it doesn't quite add up for me especially having watched all my friends move on with life and head off to uni etc. I have had counseling for two years and cbt for 6 months but still a cloud over my head. I'm currently taking 1g vitamin C a day and planning to slowly increase. Thanks for the advice, I'll add it to the list of avenues to explore! Best of luck with your health.
I'm glad you're getting support for your mood though yes I recignise the cloud not shifting. Have you been offered ads? I'm sorry youre in this situation. It's hard seeing others , peers, doing so well and finding things easy. It might not feel like it now but what you're experiencing does have the potential to end up being positive - you will be learning coping strategies which will end up giving you huge strenght and wisdom.
I don't regognise the ref range for ferritin - mine didn't go so high as that.
So maybe try the iodine as that sounds reasonable considering your diet. But do be careful. Selenium is the other one to look at too.
Hms is a cruelly deceptive thing. You can look slim and healthy but be really suffering with fatigue. Rheumatology is the route for this.
I also questioned the iron rich meal question - I think it's possible but also your iron is affected by menstruation.
In terms of fatigue and exercise - I've had to (reluctantly) start pilates. I prefer yoga but I've finally been convinced I have to do pilates. So far, at a dedicated pilates centre, two of the teachers ive met were on the floor with fatigue and illness before they started. One had CFS.
The issue with hms - another avenue to look at - is your muscles have to work so much harder to keep yourself going. I can do short bursts of things like cycle or swim but standing and walkimg can tire me. Pilates is a very very fine tuning work out for all the tiny muscles inside. I now have the pain associated with hms but at your age It was just being skinny and finding things really hard.
the only other thing I learnt is that 'hit' training had a big impact on me - short fast exercise to raise heart rate, effectively exercise the heart muscle. Skipping did this for me (not great for hms though!) First time I could only do 5-10 skips. Gradually trying 2-3 times a week I extended it. Then I found other exercise easier eg swimming. Abd gradually everything increased including energy levels and muscle strenght.
I'm just throwing suggestions your way on the off chance it helps in any way. X
I was on anti depressants for a year or so but they weren't for me. I'm managing though and thankfully I've got really fantastic support from family and close friends that know more about how I'm feeling.
I think I can safely say menstruation shouldn't be an issue for me, all things considered! Thank you for all the suggestions though, it's good to leave no stone unturned and I've definitely got a lot to consider.
Hi Conor, After twenty years of searching to figure out my own thyroid problems, I do believe this man is getting it right. He and others know that the dysfunction of many organs are just natural reactions to a problem that may not exist in the organ itself. We have to have a holistic view because there are several organs involved in our metabolism. Since you are on the edge, you may be able to avoid a lifelong problem. It could be as simple as going gluten free. There are many websites like Stop The Thyroid Madness Now that explain the condition and treat the condition but not as much to avoiding the condition.
Thank you very much for linking that, I'll watch it shortly. I'm actually already gluten free and have been for a number of years but I definitely see medicine with a holistic view. I'm going to try a more natural approach before attempting any medications as I honestly feel iodine could be a big player in how I'm feeling.
That is wonderful Conor. I think this is the age of enlightenment for patients, however, NOT for doctors in general. I find they don't look at new research and go by what they have been taught from thirty years ago. It is too late for some of us but not for you but the world has become so toxic I don't even know if YOU can succeed. I am watching many of Dr. Bergman's videos, I followed askwaltstoll.com for ten years until his death (he was a disillusioned brilliant doctor) and also this functional neurologist which I posted above. He sees 24 reasons why you could have low thyroid.
Glucose is a huge problem for the adrenals as you will see and cortisol reacting to stress is another.
Iodine will flush out other halides like bromine and flouride and chlorine. We've had lots of discussions here but still controversial. I was going to take Iodoral which is made up of both iodine and iodide. But I think the dose might be too high. There is a 1 mg. size.
I wouldn't be unduly worried about your results, though as you have noted they are towards the lower end of the scale. It might be worth getting your iodine and magnesium levels checked out. Over and above that I would recommend that you look at food intolerances such as wheat and dairy. The normal western diet tends to be too high in both these categories. Make sure you drink between 1 1/2 litres to 2 litres of mineral water (pH 7.3 or above) daily. Switching to organic produce, and ensuring you eat a varied diet including a high percentage of fresh fruit and vegetables and reducing your exposure to electromagnetic fields should help increase your energy levels. Cut out sugar and processed foods, alcohol, coffee & other caffeinated beverages, tobacco and associated products such as wacky baccy. Don't use ordinary table salt for cooking or adding to food as this is devoid of the natural minerals and trace elements that aid its digestion (such as iodine and magnesium) instead switch to natural sea salt.
Hey LilFlower, thanks for the advice. For various other reasons I've actually been paleo for over a year now! I'm leaning towards the idea of iodine deficiency purely based on the fact that, other than fish, which isn't a huge source anyway, I don't eat anything that would contain iodine. I also eat a lot of foods that interfere with iodine absorption. I'm currently supplementing with magnesium glycinate. Either way, I'll get all my levels checked before making rash decisions.
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