what should I do next?

hi all. 31 year old male. my blood tests nearly always show high tsh. from 3 to 7 yet top of range ft3 and ft4. my rt3 was high once and my shbg is top of range. vit d and b12 is good

i have lots of rhyroid symptoms. tried t4 and its almost like i took nothing at all

next step. go to private doc and look for thyroid hormone resistance? go and see dr peatfield? self medicate with armour or t3?

16 Replies

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  • I'm sorry you're not feeling too well. I think Dr P is unwell himself and not sure if he is consulting at present. 

    If you want to go private email louise.warvill@thyroiduk.org.uk and ask for her list of doctors. When you select a doctor(s) you can put his name on the Heading and ask for private messages to be sent to you of information about the doctor. We don't put info on the main forum.

  • Mic, 

    How long did you medicate Levothyroxine for & what dose ? 

    Initially It can takes up to 6 weeks to saturate the body which will only tolerate small increases at any one time. Thyroid tests should have been repeated after six weeks and the dose adjusted according to results as the goal of Levothyroxine is to restore the patient to euthyroid status and for many that would mean TSH around 1.0. Symptoms can lag behind good biochemistry by 6-8 weeks.

    Did you take your pill on an empty stomach with a glass of water, 1 hour before food, 2 hours before supplements and 4 hours before calcium, iron or vit D supplements ? Levothyroxine can bind to calcium, etc making its usage unavailable.

    People with thyroid issues often have vitamin deficiencies. Have you had Vit B12, vit D, folate and ferritin tested as optimum levels are required for good thyroid hormone synthesis ? 

    Sex hormones can become unbalanced through years of low thyroid hormone and compromised adrenal glands. The TSH level is variable but would become more so in the presence of Hashimotos. Have you been tested for thyroid antibodies ?  If you post any blood test results complete with ranges ( numbers in brackets) members will comment.

    You can email louise.warvill@thyroiduk.org.uk for a list of sympathetic endos/doctors that members have had positive experiences with.

    I hope you feel better soon.

  • thank you, I have only took t4 for one month and t3 for 2 months, I didn't realise it is such a long process, perhaps I should pick one and stick to it... t3 seems best due to my high rt3

    I don't have any antibodies and my vit d etc is good, here are some results from couple  years back, i dont have latest ones but they follow same pattern. if you want to see full bloodwork, my profile has my old posts

    healthunlocked.com/thyroidu...

    healthunlocked.com/thyroidu...

    healthunlocked.com/thyroidu...

    TSH - 6.33 [ 0.27 - 4.2 ]

    FT4 - 19.5 [ 12 - 22 ] 

    FT3 - 6.2 [ 3.1 - 6.8 ]

    another test

    -------------

    REVERSE T3 32.1 [ 9 - 35 ]

    FREE T3 4.9 [ 3.1 - 6.8 ]

    my first ever test

    ---------------------

    TSH- 4.11 [ 0.27-4.2 ] N

    FT3- 6.3 [ 3.1-6.8 ] N 

    Free Thyroxine-17.5 [ 12.0-22.0 ] N 

    Total T4- 134 [ 59-154 ] N 

    Thyroglobulin Antibody- 13.4 [ 0-115] N 

    Thyroid Peroxidase Antibodies- 10.5 [ 0-34] N

  • Mic, 

    There is obviously a problem as you have been chasing this for many years. Your blood work is impressive. 

    Your high TSH does not reflect your high T4 or T3 levels. This indicates a pituitary problem that is supplying too much TSH even though thyroid hormones are sufficient. This could be a tumor or possible hormone resistance. 

    Have you been referred to an endo ? Have you had an MRI to ascertain the presence of a pituitary adenoma ?

    Any problem within the endocrine system results in imbalances else where because it is joined by different feed back loops, meaning one problem will eventually show up further down the line.  

    Dr P is not a practising doctor any more so can not prescribe or refer. Ask your GP for a referral to an endo or choose one from the list detailed above. Self medicating thyroid hormones won't solve a pituitary problem and it could get worse.

    yourhormones.info/glands/pi...

  • Isn't thyroid resistance a rare condition? I see this happen a lot. I wasnt on thyroxine when I had blood tests. Would it make sense to take t3 and then re-test the blood test and see if it drops, if so, it would rule out thyroid resistance?

    I can of course ask for a referal to endo and get an MRI, but I guess thats a long process

  • mic, 

    The term "resistance' is used increasingly for a general resistance that may be seen in people medicating thyroid hormone replacement as often there is only a small margin in which meds will work efficiently. 

    This usually involves receptor resistance and I would consider it quite common. What is rare is the genetic abnormality seen in the beta receptor that prevents thyroid hormone being uptaken..

    Resistance involving the pituitary gland is also unusual but possible. I don't really know a lot about it but think it means the converted T3 that should negatively feedback  on the pituitary to decrease TSH secretion doesn't   .... OR  .. . the pituitary hormone TSH is resistant to thyroid hormone T4 so keeps encouraging more T4 when it is not necessary.

    I don't think yours is bad as read people with this condition often require beta blockers, etc as too much thyroid hormone has raised the metabolism too high. However, there is some problem as you feel crap and have other low//unbalanced readings so should have it investigated.

    If I was you and had been chasing for so long I would want it investigated properly. Self medicating will skew further results of what is really happening.

  • I may request a pituatary MRI. My prolactin is on high side too, just over range, but not in thousands, everything else is perfect apart from top of the range SHBG

    My HDL/LDL is sometimes bad too

  • mic, 

    Too little thyroid hormone can mean too much LDL cholesterol, in your bloodstream. The thyroid hormone helps the liver break down the cholesterol circulating in your blood and stimulates other enzymes needed to rid your body of triglycerides.

    Too much thyroid hormone does the reverse and variations go either way also messing up the ratio of  HDL/LDL.

    Cholesterol passes into many other hormones and T3 is responsible for the oxidative activity that governs the conversion of cholesterol so a variation in thyroid hormones results in variations right down the line.

  • Thanks, I think my next plan of action is either

    a/private endo and ask for pit MRI

    b/take thyroid meds and test bloods to see if TSH is suppressed, to rule out thyroid resistance

  • mic, 

    If you go private be aware that you will incure ALL costs unless a previous agreement is made with the consultant. 

    With a pre & post consultation, an MRI on my head last year cost me nearly £1000.00.

    Now I get my private endo to ask my GP to refer me for National Health tests (which yes, mean a long wait ! ).

    Good luck & hope you get to the bottom of your health problems.

  • I'm in the fortunate position of being able to afford it, but getting the right tests is crucial!

    Yes the wait is horrible, but maybe the consultant could write to my GP about any future meds I may need, and I can incur costs of MRI etc myself

  • mic,

    Just thinking re b)  ......  usually medicating thyroid meds will lower TSH as raising (or the correct levels of) thyroid hormones acts as a stop signal to the pituitary. 

    However, if you have pituitary resistance (or whatever it is called)  and you take thyroid hormone you will be increasing hormone that is already of a good level. Therefore making yourself HYPERTHYROID and the TSH will remain elevated because it's not taking any notice. 

    ...  just a thought ! ! .. 

  • so how would number 2 be ruled out?

  • mic, 

    Maybe you would have to have some T3 loading tests or something  ..  .. I don't know. That is why you would need to see a GOOD endo as most don't even like using T3.

    Also you said you have taken meds (albeit for a short time) and they had made no difference. This could mean peripheral tissue resistance as explained above  .... and to have both types of resistance would be very unlucky and require a very GOOD endo.

    You could repost the question with "pituitary resistance" in the title. Maybe another member who has suffered pituitary problems or had T3 loading tests would share their experience.

  • High TSH is probably due to your thyroid glands not functioning as well as they should. Hormone production between the pituitary gland and the thyroid glands is part of a feedback system. 

    When the thyroid glands are not functioning at optimal capacity, the pituitary gland produces more TSH to tell the thyroid glands to produce more thyroxine.

    I'm not a medical practitioner.

    If you were given thyroxine your TSH levels should drop. 

  • T3 is the active thyroid hormone which controls the metabolism and the symptoms. T4 is the storage form and is not active.

    With your free T3 level at the top of the normal range you are not hypothyroid. Also with good free T3 most people would have low TSH, not high. 

    Your blood tests however are a very strong indicator that you have thyroid hormone resistance, also known as impaired sensitivity to thyroid hormone. This is a genetic condition which requires very high levels of T3 in the body to compensate.     

    If there are other family members with ME, CFS, fibromyalgia, depression or thyroid issues this would further support this idea. 

    I will send you a personal message about a book on this.

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