BH results in - advice welcome

Hi, have just had results. Apart from raised CRP it's all looking fine and dandy (NB I've not been diagnosed as hypo, but as having ME).

CRP 4.6 (<3.0)

Ferritin 109.8 (20-150)

FT4 15.59  (12-22)

FT3 4.17 (3.1-6.8)

TSH 2.38 (0.27-4.20)

Reverse T3 18 (10-24)

T4 total 92.7 (64.5-142)

Anti-thyroidperoxidase abs 12.2 (<34)

Anti-thyroglobulin 10 (<115)

Vit D 119 (<25 deficient)

Vit B12 621 (<140 deficient)

Serum folate 10.9 (10.4-42.4)

Any help with interpretation would be great.

Many thanks,

Amandak

13 Replies

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  • Which supplements are you taking ? 

  • None apart from 1000iu Vit D and magnesium (currently on a train so can't give dosage details).

  • Thyroid results could be better - in as much as the TSH is on the cusp of displaying Hypo.  FT4 and FT3 low in range.  I am not a medic but could it be Central Hypothyroidism rather than Primary ?  it is something I have read here on the forum.  Maybe the Pituitary Gland is not functioning optimally.  Someone who knows better than I - will be along shortly to give better advice.....

  • Thank you Marz for your help and kindness. I've just asked BH about the units of measurement for the FT3 and rT3 so I can work out the ratio. 

    Others have mentioned central hypothyroidism in the recent past and I've been advised to have cortisol tests. However, I have also been informed by the BH doctor that in pituitary probs the FT3 and FT4 are usually below range and the TSH is either below range or very low in range. My results don't fit with this so it's an unusual picture. Other lab results that normally indicate pituitary problems, such as LH and FSH are also in range.

    A bit of a mystery!

  • Your CRP is too high, (but not dramatically high so doctors wouldn't pay attention to it) suggesting you have inflammation or infection somewhere. The problem is it doesn't tell you where. I suspect, although I have no proof, that the commonest site for inflammation would be somewhere in the gut.

    labtestsonline.org.uk/under...

    If your gut is inflamed it could be caused by coeliac disease or a gluten intolerance. Many of us on here have been tested for coeliac disease and it has come back negative. Despite that many of us get benefits from giving it up 100% - a lifestyle change, not a diet.

    There are lots of other possibilities of course - you could have an allergy or intolerance to some other food. Some people give up dairy or lactose and it helps. I don't know anything about how people track down allergens or other things they have an intolerance to.

    Do you take lots of antacids? Acid blockers?

  • Ferritin 109.8 (20-150) - This is fine, don't take any iron supplements. Be aware though that your serum iron can be lower than desirable despite the good ferritin because the body stores iron in ferritin when inflammation or infection occurs. See this link for an explanation : irondisorders.org/anemia-of...

    Vit D 119 (<25 deficient) - This is fine. If you've been taking vitamin D supplements drop your dose to a maintenance level.

    Vit B12 621 (<140 deficient) - This is not bad at all, compared to many B12 levels I've seen. However the pernicious anaemia society recommends a level of 1000 to avoid any deficiency symptoms and to help us feel well. You could, if you were worried about it, take 1000mcg methylcobalamin per day. Many of us use Jarrow Formulas or Solgar methylcobalamin. Once you've taken B12, your level will probably end up over the reference range. B12 isn't poisonous, so don't worry about it. Your body gets rid of excess B12 in urine. Once your level is over 1000, you could probably dose just a couple of times a week to maintain a good level. But you'd have to try it and see.

    Serum folate 10.9 (10.4-42.4) - this is too low, I think (this is my personal opinion) that it needs to be in the top quarter of the range. If you get your B12 level up it is a good idea to keep the other B vitamins at good levels as well, including methylfolate. Taking a good quality B Complex is well worth doing. There are different forms of some of the B vitamins and some are more easily absorbed than others. I use Thorne Research Basic B Complex which I buy from Amazon. Do some research into "activated B vitamins". There are plenty of products to choose from.

  • Only just seen this and your previous reply. No not taking antacids etc. Usually B12 levels (when tested through NHS) are well beyond the upper range and rising. Agree that folate levels are rock bottom so may be worth taking supplements as you suggest.

    CRP may be temporary as at the time of the blood draw I was feeling pretty awful but no discernible virus.

    Thanks for your help.

  • Anti-thyroidperoxidase abs 12.2 (<34)

    Anti-thyroglobulin 10 (<115)

    The above levels suggest you don't have autoimmune thyroid disease - so no Hashimoto's to worry about for now. But, it is possible you have it and it is going through a quiet phase right now.

    FT4 15.59  (12-22)

    FT3 4.17 (3.1-6.8)

    TSH 2.38 (0.27-4.20)

    Reverse T3 18 (10-24)

    T4 total 92.7 (64.5-142)

    Your Free T4 is about 36% of the way through the reference range. Your Free T3 is about 29% of the way through the reference range. Neither of these are good. Many people with hypo problems feel at their best when Free T4 is in the top quarter of the reference range, and Free T3 should be in the upper half of the range or even the upper third. But everyone needs to find the levels that work for them.

    Your TSH is higher than desirable for a healthy person, but it isn't high enough for you because it isn't raising your Free T4 and Free T3 enough to make you feel well.

    Doctors believe that the pituitary works perfectly or it doesn't work at all. There are no grey areas for them. I think many of us would dispute that. I'm sure that people can have poorly performing pituitary glands without having outright failure. So your body is producing TSH but it isn't producing enough for you to feel well. I think you have almost no chance of getting a diagnosis of central hypothyroidism, sadly. You'll probably just get told the levels you have are "normal for you".

    There are lots of other ways that thyroid function can go wrong. Read this post from another forum. I found it fascinating. But if you want to follow it up you're on your own I'm afraid.

    forums.phoenixrising.me/ind...

    Good luck.

  • Thank you humanbean, you have confirmed my suspicions, that I'm falling through the net of the usual diagnoses. In fact, my profile is typical for people with ME, as identified by Dr Sarah Myhill who thinks that the majority of ME patients have pituitary problems (typified by low FT4, FT3 and low normal or subnormal TSH and occasionally higher TSH). She also sees ME as a mitochondrial disorder so it may be worth me having tests relating to this.

    I could also go down the Lyme route as well. But it is all very expensive!

    One day the mystery may be solved. Meanwhile I'll continue in the grey nether regions and accept that I probably won't have full health this side of heaven!

    Amandak

  • Treating yourself with thyroid meds might be a worthwhile experiment. You would probably only need a low dose. The potential problem with this is that you might struggle to get things back to the way they are now. For example, I spent several months un-medicated after my first stint on T3. My TSH never rose as high as it did before treatment meaning that my chances of getting help from the medical fraternity were even lower than before.

    I was one of the people who fell into the gaps of thyroid treatment. I have never had positive antibodies. I was told my thyroid was "borderline" in the early 1990s. I was first offered 25mcg levo in 2013 after almost going on my knees and begging. (I was diagnosed with sub-clinical hypothyroidism and officially I needed no treatment.) I did very badly indeed on it. After being fobbed off for so many years I wasn't prepared to just leave things as they were, and I started finding out about buying my own meds and getting my own blood tests. I've tried higher doses of levo, T3 alone, and NDT alone. I've switched from one to the other as circumstances demanded. I recently switched to NDT after spending 13 months on T3.

    I'm much better than I used to be but improvement has been slow. When you fall through the cracks with medical treatment you have to fix yourself or continue suffering. I chose to fix myself as much as I possibly could.

  • Hi Humanbean, would it be poss to point me in the direction of a scientific paper/webpage which provides the info about FT4 and FT3 needing to be in the upper part of the range (as you've specified). I'm having trouble persuading my OH of these facts as he is using standard deviation to calculate and therefore is quite happy with my thyroid results. This means that I'm having an uphill struggle with him as well as the medics!!

    I'm grateful for all your advice and support. Incidentally, the Vit B supplements you recommended are due to arrive today so I look forward to trying them out. I'm concluding I may have an absorption problem as I have high B12 levels and we eat loads of folate-rich foods.

    Thanks again,

    AmandaK

  • That's actually a very difficult question.

    The people who come to these forums are those who can't get a diagnosis and those who have a diagnosis and treatment but still have symptoms. It is estimated that the people who do poorly on standard thyroid treatment or who can't get a diagnosis using standard thyroid testing make up about 15% of the total who have hypothyroidism. (Estimates vary, naturally.)

    If someone get a diagnosis and treatment and feels perfectly well on it then they would have no need to come here. They are the people who will do well with TSH anywhere in the reference range. They probably rarely, if ever, get their Free T4 and Free T3 measured, but if they did they would probably be in the reference range.

    The research by conventional researchers will cater for the 85% who fit the normal reference ranges and do well on the usual treatment.

    So, finding research papers which back up the 15% who don't do well is almost impossible.

    The suggestions that people need Free T4 and Free T3 in the upper quarter, third, or half of the range comes, as far as I know, from patient experience on patient forums.

    There is an article from Pulse Online (a website for doctors) that was written by Dr Toft that suggests Free T4 can be high in range without causing problems. Louise Warvill (who works for Thyroid UK) can send you a copy of the Dr Toft article as an attachment via email (not private message). Her email address is louise.warvill@thyroiduk.org

    This might be of interest - it has some more quotes from Dr Toft :

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

    Some more articles :

    mercola.com/article/hypothy...

    tiredthyroid.com/optimal-la...

    If you want to see the distribution of normal TSH in a healthy population see this graph :

    web.archive.org/web/2004060...

    The information to generate that graph came from this paper - see the numbers in the right hand half of table 3 :

    eje-online.org/content/143/...

    Another interesting article :

    health.howstuffworks.com/hu...

    And finally, have you seen this :

    forums.phoenixrising.me/ind...

    One of these days I'll buy the book that post is based on. :)

    Doctors claim that measuring TSH level tells them everything they need to know about the thyroid. Based on that link above, I think they don't know what they are talking about.

  • T3 is the active hormone which controls your metabolism so the Free T3 result is the most important. T4 is a storage hormone and needs to be converted to T3 to become active, so the T4 result is less important.

    It is unusual that you have ME symptoms with your free T3 levels, but they could be caused by thyroid hormone resistance (impaired sensitivity to thyroid hormone). This is a genetic condition which means that the body needs high levels of T3 to function normally. 

    Dr Lowe found that 90% of fibromyalgia sufferers had thyroid problems and it is likely that many ME sufferers also have thyroid problems.  

    I can point you to a book on this if interested.  

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