Thyroid results, looks like T3 issues - any advice gratefully received!

Hi,

I'm in my mid 30s and have been struggling with total fatigue for the last couple of years. Had a family history of thyroid issues, and a major illness which seemed to cause it, but the NHS testing of TSH and free T4 came back within range so nothing happened. Eventually got so frustrated I ordered some private blood tests and it's flagged up some other issues:

Bloods:

Total T4: 5.6 (5.0 - 10.8 ug/dL) *

Free T4: 1.2 (0.7 - 2.5 ng/dL)

Free T3: 1.8 (2.5 - 6.5 pg/mL) **

TSH: 1.7 (0.5 - 3.0 uU/mL)

TPOab: 8 (0 - 150 IU/mL)

TGB: 24.1 (3-40, optimal 3-10 ng/mL) *

Vitamin D, 25-OH, D2: <4 ( <4 ng/ml)

Vitamin D, 25-OH, D3: 37 (32-100 ng/ml) (80-250 nmol/L) *

Vitamin D, 25-OH, Total: 37 (32-100 ng/mL) *

Urine:

Iodine/Cr: 157 (100 - 1100 ug/g Cr) (100-300 optimal)

Bromine/Cr: 2246 (893 - 5696 ug/g Cr) (5-95% range)

Selenium/Cr: 88 (27 - 175 ug/g Cr) (50-175 optimal)

Arsenic/Cr: 129 (3.3 - 138 ug/g Cr) (5-95% range) *

Creatinine (Urine) 0.99 (0.3 - 3.0 mg/mL)

I wonder why Total T4 would be low when TSH is normal (does my brain not realise there isn't enough in circulation?) And very low T3 looks worrying! Any advice gratefully received.

Cheers,

Mark

21 Replies

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  • I should add, I'm not on any thyroid medication, and haven't had any formal hypothyroid diagnosis, although I guess these results suggests that might be the case...?

  • Mockendo, Low-normal TSH with low FT4 and below range FT3 indicates secondary hypothyroidism (hypopituitarism). The thyroid gland is usually healthy but without adequate TSH stimulation from the pituitary gland it can't produce sufficient T4 for conversion to the active hormone T3 and it is lack of T3 which causes hypothyroid symptoms. Treatment is Levothyroxine to replace low thyroid hormone but you should be referred to an endocrinologist for investigation into the pituitary dysfunction which can also affect sex and growth hormones too.

    cks.nice.org.uk/hypothyroid...

    patient.co.uk/doctor/hypopi...

    patient.co.uk/doctor/pituit...

    Your negative TPO and Tg antibodies rule out autoimmune thyroid disease (Hashimoto's).

    Your vitD is very low. Optimal is 75-200. Supplement vitD3 softgel capsules or spray, 5,000iu daily and retest at the end of September.

  • Mockendo, you need an endocrinologist who is willing to check all the pituitary function. There could be other hormones affected as well. i've got the same thing. When TSH was 3.45 (back in 1986) and T3 was low, ft4 was lousy.......but that guy wouldn't prescribe anything. Maybe you'll be more fortunate.

    Then a few months later another doctor noticed a goitre.......

    Some of us have really gone through the mill. I'm wishing and hoping that your path to health is smoother.

  • Mark, I agree with the previous two posts. Ask for a referral to an endocrinologist who has expertise in this area (not just diabetes). Your comment "and a major illness which seemed to cause it" fits in. It's possible the illness has reduced your pituitary output. It's best to get an overall assessment of pituitary function. Don't let a doctor just prescribe levothyroxine, ask for everything to be checked out.

    I'm assuming the blood tests were done by an accredited lab, the only other possibility is that the results are wrong as the numbers are quite unusual and total T4 isn't usually measured.

    ........... I've just read your other post. I would get your doctor to test for TSH, fT3, fT4 as it is quite likely that the finger prick tests don't work. Thyroid hormones are very difficult to assay due to the incredibly low concentrations in the blood. If you look at this chart upload.wikimedia.org/wikipe... you can see that the thyroid hormones are at the extreem LHS of the concentration range. (if you click on the chart it is enlarged). Thus it is a challenge to get good results even with a test tube of blood, let alone a few spots.

    I would get a conventional blood test done and if the above numbers are confirmed then ask for an endocrinologist as mentioned earlier. If you do see an endocrinologist they will want to draw blood anyway. I'm afraid it can't be avoided.

  • I just came across this paper on PubMed and thought it might be worth a look: ncbi.nlm.nih.gov/pubmed/127...

    "OBJECTIVE: Symptoms of hypothyroidism in adults can be mistaken for medical and psychiatric diseases, as well as for general signs of ageing such as weakness, lethargy and fatigue. The incidence of hypothyroidism is many-fold higher in adults than in newborn children. The latter have been routinely screened for the condition using filter paper dried blood spots (DBS) for nearly three decades but this cost-effective screening technique has only recently been applied to adults. This study was undertaken to show that DBS testing in adults and older children is an accurate way to screen for hypothyroidism.

    RESULTS: The correlation coefficient for 118 matched serum and DBS (Dried Blood Spots) specimens was 0.99.

    CONCLUSIONS: Individuals can be screened for hypothyroidism by collecting finger stick DBS specimens "

    If I'm reading it right then it says that bloodspot tests correlate 99% with serum tests, so should be as accurate as serum tests.

    Cheers.

  • This is interesting, I will read the full paper when I get a chance.

    I would not assume your finger prick test is accurate, even if it is capable of giving accurate results in a laboratory environment it may not do so in the real world.

    If you look at the full paper (it's on open access, click on the blue box) you will see that all the authors work for Neo Gen Screening. This is not independent research.

    I'm not saying your blood test results are inaccurate but they do need to be verified as they present quite unusal results.

  • Jim, interesting point. And I see from the full text that the 0.99 correlation co-efficient applies to TSH that goes right up to 300mU/L. For the normal stuff (which they review in 0-20mU/L range) the co-efficient is 0.88 - still good but not 100%.

    I assume that lab testing of any sort, whether serum or finger prick, will have a margin of error. So no two samples will be measured identically, and we should treat bloods as a guide rather than absolute fact?

  • This paper refers to screening, you have to be careful when screening is mentioned. Usually it is a sort of pre-test, just to see if it's worth investigating further. An example is bowel cancer screening which gives a number of false positives and occasionally a false negative. However, it is a simple and economic way of screening people for further testing and picking up cancers before they get too advanced.

    I've only skimmed the paper but it seems that the accuracy they are reporting is based on how many patients are correctly determined to be within the TSH reference interval. It doesn't seem to be reporting the accuracy of the individual test values. The lower the TSH the more precise the assay has to be. So the blood spot assay handles the high values shown in Figure 1 quite well. If you look at figure 2 a number of the TSH values determined by the serum assay were close to zero yet the DBS assay shows some of them having a TSH of about 2.0. If you draw your own line through grid references 1,1 2,2 10,10 etc you will get a better idea of how the individual results are quite different. I think they have based their accuracy figures on how many results they have correctly determined to be above or below 4.0 mU/L. This is quite different to the accuracy of the individual figures.

    I believe serum thyroid function tests are accurate to around 5% or 7% depending upon which hormone is measured.

    This study only looks at TSH, there will be a different level of accuracy for fT3 and fT4.

  • As you put the good advice above in motion, as well as supplementing D3 it will be as well to take a good Adrenal supplement - your Adrenal glands are almost certain to be exhausted from the stress your body has been under through the illness you mention and its aftermath which you are now experiencing. And a good quality multi-vitamin+minerals can do nothing but good.

    Hope you find the answers you need very soon.

  • Hi Mock, I'm surprised you are standing. I'll post a video if you can take time to watch as it is more authoritative but in a nutshell your adrenal gland is stressed and telling the pituitary NOT to send out TSH because your body simply cannot handle a higher metabolism (energy). Ive never seen urine results as no one seems to do it but the fact that your iodine is so low and your bromine (toxin) is so high, I would think that is where your trouble lies. The video will explain that bromines interfere with what your thyroid really needs (iodine) because they are both halides and picked up by the same carriers but instead of iodine, it is carrying bromide. Your thyroid tries to use it but it cannot. Bromides are found everywhere but the video will also explain. I would definitely consider taking iodine as it will flush out bromides but the dose is still controversial and I wouldn't attempt to advise.

    You also need massive doses of D3.

  • Thanks for that video Heloise! That was very informative--and I learned a lot. I have "things" suppressing my thyroid-and I need to work on!

  • Pettals actually posted one of his videos and I have looked up many others on YouTube. He has a whole series about thyroid that are excellent. You must watch the one about neuropathy as well. You will learn a lot and he's amusing, too:)

  • This is a post from Mockendo as a reply to all of us.

    A few other thoughts:

    - Got my adrenal (24h saliva cortisol) results back, and the 4 samples were bang in the middle of range. No problem apparently. Glucose, insulin, hsCRP and Hemoglobin A1C all fine too.

    - I'm curious if there's any issues with the finger prick tests? I know that Blue Horizon are recommended by Thyroid UK, and are used by loads of the private hospitals in the UK, and they do finger prick home-testing. I'd have thought if there was any issues they wouldn't be approving them? I used ZRT labs who are the US equivalent, and liked them because they added a few other things (like vitamin D and metals) to the tests. I actually had TSH tested with two separate samples (ordered together but processed separately) and the results came back identical, so there's some comfort there! I'm sure there'll be a pubmed paper comparing serum to blood spot but don't have the details to hand...

    - I'm keen to explore the iodine/bromine connection. Although looking at the lab results, it suggests i'm pretty much in the middle of where I need to be for them, iodine is suggested as 100-300 optimally. Although perhaps urine isn't too accurate a gauge for these things? Again any advice appreciated.

    - I do have one mutation in my DIO2 gene, which I've read slows the conversion from T4 to T3. There's a paper suggesting people with this gene need a bit of a boost from T3 (press.endocrine.org/doi/ful...

    So it seems like there might be a couple of things going on here:

    a) Low Total T4 - sounds like the feedback mechanism isn't working too well, because otherwise the pituitary should be shouting for more thyroid hormone and TSH should be higher. But it's not...

    b) I should have mentioned, TGB is Thyroglobulin, not the antibody test. It seems that because thyroglobulin is held in the thyroid gland, then too much of this floating about in the blood is a sign that it's leaking out a bit. Which is a sign that the TGB isn't using iodine properly to create the T4/T3. Or at least that's my understanding but it's a bit complex!

    Maybe iodine would help for both (a) and (b).

    c) The ratio of T3/T4 looks odd - there's a normal amount of free T4, but way too low free T3. Might be the DIO gene, or something else? I think selenium can help this conversion? (not too much, not too little, sounds like the three bears...)

    I'm organising an Endo appointment, but want to try and get this straight in my head so I know what the conversation should be like!

    Bit of a monster post, but there's a lot going on in my head ;-)

    Again, any thoughts or advice gratefully received.

  • Many thanks everyone!

    A few other thoughts:

    - Got my adrenal (24h saliva cortisol) results back, and the 4 samples were bang in the middle of range. No problem apparently. Glucose, insulin, hsCRP and Hemoglobin A1C all fine too.

    - I'm curious if there's any issues with the finger prick tests? I know that Blue Horizon are recommended by Thyroid UK, and are used by loads of the private hospitals in the UK, and they do finger prick home-testing. I'd have thought if there was any issues they wouldn't be approving them? I used ZRT labs who are the US equivalent, and liked them because they added a few other things (like vitamin D and metals) to the tests. I actually had TSH tested with two separate samples (ordered together but processed separately) and the results came back identical, so there's some comfort there! I'm sure there'll be a pubmed paper comparing serum to blood spot but don't have the details to hand...

    - I'm keen to explore the iodine/bromine connection. Although looking at the lab results, it suggests i'm pretty much in the middle of where I need to be for them, iodine is suggested as 100-300 optimally. Although perhaps urine isn't too accurate a gauge for these things? Again any advice appreciated.

    - I do have one mutation in my DIO2 gene, which I've read slows the conversion from T4 to T3. There's a paper suggesting people with this gene need a bit of a boost from T3 (http://press.endocrine.org/doi/full/10.1210/jc.2008-1301)

    So it seems like there might be a couple of things going on here:

    a) Low Total T4 - sounds like the feedback mechanism isn't working too well, because otherwise the pituitary should be shouting for more thyroid hormone and TSH should be higher. But it's not...

    b) I should have mentioned, TGB is Thyroglobulin, not the antibody test. It seems that because thyroglobulin is held in the thyroid gland, then too much of this floating about in the blood is a sign that it's leaking out a bit. Which is a sign that the TGB isn't using iodine properly to create the T4/T3. Or at least that's my understanding but it's a bit complex!

    Maybe iodine would help for both (a) and (b).

    c) The ratio of T3/T4 looks odd - there's a normal amount of free T4, but way too low free T3. Might be the DIO gene, or something else? I think selenium can help this conversion? (not too much, not too little, sounds like the three bears...)

    I'm organising an Endo appointment, but want to try and get this straight in my head so I know what the conversation should be like!

    Bit of a monster post, but there's a lot going on in my head ;-)

    Again, any thoughts or advice gratefully received.

  • Mock, you are a great student and you will be advising us pretty soon. One thing though, I'm not sure anyone is going to read this because it is not a reply to anyone. I only saw it because I was notified that I had a response in this thread from sister-earth.

    The urine test is the best one I've read for iodine. I don't think you should have any bromine at all, that's why it was alarming to me. I'm going to check that out.

    You've done a beautiful job so quickly of putting facts together so I think I am going to cut and paste your eloquent post as a reply to everyone and see if that works. Otherwise you are going to have to put it as a new post using "Write a post" link to do it.

  • People have reported the fingerprick test is fine at least for thyroid and probably others as well.

    The video by Dr. Clark is directed mostly to females but Dr. Bergman notes that estrogens from pesticides on any foods that are not organic are prevalent. They find Round-Up (herbicide) in the blood of the general population. So even men are eligible I'm afraid.

  • Heloise and everyone else, many thanks - very useful info, much appreciated.

    On the TSH feedback question, do we know which thyroid hormone specifically impacts the hypothalamus/pituitary... I'm wondering if it responds mainly to Total T4, Free T4, or Free T3? That might help pin down where the poor feedback mechanism lies.

    The halogens (chlorine, fluorine, bromine v iodine) is an interesting one. I used to swim twice a week, so perhaps excess chlorine here, and lots of bread in the past (bromine). I've corrected the error of my ways though, and cut out gluten & bread for the last couple of years!

    The T4 -> T3 conversion is still puzzling, especially with normal cortisol levels. I read somewhere that T4 is normally converted to T3 and reverse T3 in a 50:50 ratio, but sometimes this level shifts, with less T3 and more rT3. This slows down the body in an attempt to heal or hibernate (e.g. through the winter). Any idea what causes that shift? Without the rT3 in my blood test I don't know for sure this is the case, but might be worth considering...

    Thanks!

  • MArk, if you can watch the video I posted in the link of a previous healthunlocked thread right beneath my first post, he explains much of what you need to know.

    Here is to find the ratio of Rt3 to Ft3 which is 20:

    stopthethyroidmadness.com/r...

    I think that is the way the adrenal gland uses cortisol to restrain thyroid hormone.

    The hypothalamus is a sensory gland, it stores stress and when it is overloaded starts the fight or flight mechanism. For a short time you can tolerate higher blood pressure, rapid heart, etc. all the things your body does to aid in your survival but chronically

    it is a killer. Remaining in that state is a problem many people have.

    I like this paper on deiodinases although it's fairly technical but describes the transport system of the hormone if you locate the paragraphs involved.

    nahypothyroidism.org/deiodi...

  • Both the hypothalamus and pituitary use fT3 for feedback, it's the active hormone.

    More is known about the pituitary. The pituitary uses type-2 deiodinase (D2) to convert T4 to T3 so both free serum T3 and T4 are used by the pituitary to regulate TSH in a negative feedback mechanism. Unlike peripheral tissues the pitutary D2 does not repond to other factors like high hormone levels (not stictly true, it is much less affected). This is what one would expect, the pituitary sees the serum hormone levels like it is, so that it can respond in an accurate manner. Peripheral tissues do however respond to hyperthyroid conditions by e.g. reducing deiodinase. And vice-versa in hypothyroid conditions.

    The hypothalamus responds to certain external influences such as starvation or depression when it reduces the quantity and quality of TSH.

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