I have been told hormonal issue not thyroid, help please? - GP follow up from advice received here

[Nic_cooke]

Hello,

I posted last week and received some advice - Thank you. I had a thyroid lobectomy (one half) over 10 years ago following a benign lump. I haven't been on medication  since this operation and the only follow up I receive is yearly blood tests. I am female aged 34

I have been feeling rather unwell lately and it is having an impact on my daily life. My last result (March 2016) was T4 7.5 and TSH 2.31 I have had my Thyroid peroxidase antibody checked and this was <10 with no further action. 

A couple of years ago (July 2013) when checked my B12 and folate they were high and Ferritin was normal.

I have issues with my ovarian function and my serum FSH level is 10 within a range 2.00 - 8.00 (July 2015), however, the previous result was normal after a blood test following a holiday in Sept 2014?

I have been to see my GP this morning with Thyroid UK's signs and symptoms checklist. She advised as my TSH was 'normal' medication wouldn't be given. Can I ask, and forgive my understanding, the TSH result would become redundant anyhow if a dose of T4 was given to improve this output?

I am going to be having further blood tests before she decides on the next course of action (hopefully a referral to an endocrinologist), this includes B12/ Folate, FBC, Iron, FSH/LH - I need to have this blood test while on my period to give a true hormonal reading.

My GP has given me a prescription for 10mg of Citalopram as she says I have anxiety issues and this will help me to deal with my daily symptoms. She believes my symptoms are perimenopausal due to my ovarian function and heightened anxiety. I can't help but feel like I one begets the other, I'm in a vicious circle, etc etc.

Any advice would be much appreciated  

[Pixielula]

The advice given by most on here is to have your TSH done first thing in the morning on an empty stomach,  as the day goes on and you eat TSH levels fall. Sorry I can't be of more help...

[Roadrunnergreg]

Hi Nic, with reference to your TSH does the doctor realise it's a pituitary hormone telling the thyroid to produce FT4/3 if it's over 1 odds are your low on FT4/3 (personal experience) these are the hormones responsible for energy production IE FT4 the storage hormone to be converted mostly by the liver to FT3 the energy hormone. So if you don't know your FT4/3 levels how do you know if it's converting properly and if it's getting into the cells, you don't that's why you and your doctor/endo  need to know them, also if the T4 you've mentioned, is actually FT4 of 7.5 and in the uk the range being 12-22 tells your doctor your not even in range, that's why you feel unwell. As for nutrient tests try and add in zinc and copper too. With your ovarian issue etc I'd look at iodine levels, that may well be low and causing or partly causing the problem. If you decide to supplement with iodine, get Lugols from Amazon 5% or 12% start with one drop if it's 12% and put it where they take your blood from so the veins can pick it up. Plus be careful as it stains easily... Hope this helps you... Oh anxiety try magnesium oil, or Epsom salts baths, foot soaks, again in through the skin, transdermal delivery... 

[Clutter]

Nic_Cooke,

What is the T4 ref range (the figures in brackets after your T4 result).

[Nic_cooke in reply to Clutter]

The range has always been 9.00 - 23.00 on all of the print outs of my previous results and I've been sitting at 9 the last couple of years. I don't have a print out of the last one but the GP told me today they were in range because the range starts at 7. Why would this change? I despair - help?

[Clutter in reply to Nic_cooke]

Nic-cooke,

TSH >2 indicates your remaining thyroid is struggling to produce hormone.  FT4 7.5 in a T4 range >7.0 is very low indeed and one would expect higher TSH.  It may be worth asking your GP to consider secondary hypothyroidism due to pituitary dysfunction failing to raise TSH.

 cks.nice.org.uk/hypothyroid...

Make sure you request a follow up test within 6 months (sooner if symptoms become worse) because NHS will make a diagnosis of hypothyroidism when FT4 is below range even though TSH remains within range.

Ranges change when the lab uses new machinery to analyse results and revised population averages of results.

labtestsonline.org.uk/under...

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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.

[Nic_cooke in reply to Clutter]

Thank you, the links are extremely helpful. I'm sat here crying both with frustration and relief that I have somewhere to go. Again, all your help is much appreciated

[Clutter in reply to Nic_cooke]

Nic_Cooke,

Low-normal TSH means most doctors rule out primary hypothyroidism.  It can be a struggle to get a diagnosis of secondary hypothyroidism because many doctors just say it's rare and dismiss consideration.  You may end up seeing every doctor in your practice until you find one who agrees that secondary hypothyroidism is a possibility.