Hashi's or not?

[Tiredjess]

Hi, I'm new here & was hoping someone could help with my blood results.

tsh: 0.72 mlu/L

Ft4: 11 pmol/L

Ft4:ft3 ratio: 2.1

T4: 77 nmol/L

Tpo antibodies: 31 iu/mL

All other results appear fairly mid range so I haven't included them.

Background: I've been feeling awful for years, but especially over the past year since the birth of my 3rd child. My main symptoms are brain fog, tiredness, irritability and weight gain, and these have not improved after a complete diet overhaul. I've been seeing a nutritionist since Sept. Over the past fortnight I've developed numbness in my hands/arms/lower legs and had a bad episode of hives all over back in Sept. I also suffer with allergies and recently I've discovered several food intolerances. Several family members have hypothyroidism & a host of autoimmune issues.

My Gp isn't interested in anything except my tsh in terms of my thyroid and more or less laughed at me when I suggested I might have Hashimoto's. I got the above result privately. Dr did however do more bloods yesterday including coeliacs & calcium. I've been Reading The Root Cause book & there it suggests tpo antibodies over 30 can mean Hashi's, and elsewhere online I've read anything above 15 & 20.

Since Sept I've been gluten and dairy free and didn't think I felt much better. However since Xmas day I've been eating gluten and dairy and feel even more appalling than normal so it must be making some difference, so I am back to it as of today.

The blood results were from early Dec when I was gluten and dairy free.

Does anyone have any advice for me with regard to those results, and how to get a Dr to take you seriously?

Sorry for the mega long post!

Thanks in advance,

Jess

[Clutter]

Tiredjess, What is the range for FT4 and antibodies (figures in brackets after results) and did you get a FT3 result?

[Tiredjess in reply to Clutter]

Thanks for responding Ft4 says 11.5-22.7 and tpo says under 35. One of my important questions really is; is this the definitive range or just the range that this particular lab uses. The Root Cause book seems to use a different range, as do lots of other online sources. Interested in what other people's results looked like...

My ft3 was 5.3.

Thanks

[Clutter in reply to Tiredjess]

Tiredjess, there is no definitive range. The result is aligned to the range the lab uses. Your result is <35 which means you are negative for Hashimoto's. My TPOab was 230 and <100 was negative and <160 equivocal.

It is possible that you previously had higher antibodies which reduced thanks to your gluten-free diet. It actually makes no difference to NHS whether antibodies are negative or positive because they don't treat Hashimoto's and Levothyroxine is prescribed for low thyroid hormone when TSH is over range or FT4 is below range.

Your TSH is low-normal but your FT4 is almost bottom of the range and I think your GP ought to consider secondary hypothyroidism due to isolated TSH deficiency or pituitary dysfunction, rather than primary hypothyroidism. FT3 5.3 is good but I would expect it to fall until FT4 is raised.

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

Vitamin and mineral levels can become low/deficient when thyroid levels are low and cause fatige and musculoskeletal pain and low mood similar to hypothyroid symptoms. Numbness in hands, arms, legs and feet can be due to B12 deficiency. Ask your GP to test ferritin, vitamin D, B12 and folate.

b12d.org/b12-signs-symptoms...

_______________________________________________________________________________

I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

[Tiredjess in reply to Clutter]

Thanks Clutter for your advice so far. It's so easy to get disheartened when the Gp isnt really interested. I should have some more blood tests results in a few days which I think included calcium and ferritin as well as another tsh. in secondary hypothyroidism would you expect tsh to reduce over time?

I can't remember if the dr is checking my b12 but I hope so. My ferritin levels go up and down all the time as I seem to not be able to keep them within range through diet alone.

You start to wonder if you are a giant hypochondriac when the Gp tells you everything is fine, but I know something strange is going on. I didn't use to feel this way!

Thanks X

[Clutter in reply to Tiredjess]

Tiredjess, Ferritin 11 and ferritin 300 are 'normal' in a range 11-300 but you'll probably feel very fatigued and achy if your ferritin is 11. Ferritin is optimal >100 through to halfway in range. You may need to supplement iron to optimise levels and once optimal supplement a lower maintenance dose. Take iron with 500mg-1,000mg vitamin C to aid absorption and minimise constipation.

TSH fluctuates throughout the day and night and for testing purposes it will be highest early in the morning and low during the afternoon. If your TSH has fluctuated it may be due to testing at different times of day. In primary hypothyroidism TSH rises when FT4 and FT3 are low, and drops when they're optimal. In secondary hypothyroidism (pituitary dysfunction) TSH doesn't rise in response to low FT4 and FT3 and without TSH stimulation the thyroid gland can't produce more T4 for conversion to T3 so I don't see why TSH should drop.

_________________________________________________________________

I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

[Tiredjess in reply to Clutter]

Ok thank you, I think I understand. So another tsh measurement really isn't very useful then? What would you suggest I do as my next step? My Gp isn't really interested in my thyroid issues as my tsh is within range. He is mostly just concerned with my numbness symptoms. The nutritionist I've been seeing believes my issues to be autoimmune and says diet will fix my symptoms. I don't know who to believe really. Would seeing an endocrinologist be a good idea in your opinion?

[Clutter in reply to Tiredjess]

Tiredjess, ask your GP to consider secondary hypothyroidism and show him the NICE link I posted. If he thinks it may be secondary hypothyroidism he should refer you to an endocrinologist.

A thyroid peroxidase antibody (TPOab) and thyroglobulin antibody (TgAb) test will show whether you have autoimmune thyroid disease (Hashimoto's). Your GP can order TPOab but you'll probably have to order a private thyroid test from Blue Horizon or Genova for TgAb.

thyroiduk.org.uk/tuk/testin...

___________________________________________________

I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

[Tiredjess]

My latest blood tests are normal according to gp. He didn't test ft4, despite me showing him my private blood result where ft4 is low (11, range 11.5+). He only did tsh, which again was the low end of normal. 2ish i think. Early morning with no breakfast. Ferritin was 71 and b12 Normal (can't remember score). He didn't do calcium. I give up. The spire need a Gp referral to do a thyroid test and I'm fed up of feeling like a hypochondriac when I go to see my gp. I will just accept that going to bed at 3.30 in the afternoon is normal.... 😡 So frustrating!