Possibility of Hypo diagnosis based solely on symptoms and poor T4 to T3 conversion?

Hi all just a quick question. Is it possible to get a diagnosis of hypothyroid based just on hypo symptoms and poor T4 to T3 conversion? I have many hypothyroid symptoms, both mum and sister are hypo and have a history of hyperparathyroidism. The most recent bloods I had for thyroid all show in range-the only thing that shows at the lower end of the range is T3- MyT4 is right at the top of the range. I believe I have been misdiagnosed with M.E. I have the following questions.

1.Is it possible to be diagnosed hypothyroid with a normal even optimal TSH, and T4 , T3 “in range” based on symptoms alone?

2.Could I ask for a trial of medication?

(T3/NDT?)

3. Would you self medicate with these results even if the doc refuses to accept them?

4. .If yes to self medicating , Would you try NDT? Or just T3 on it’s own?

Any advice, words of wisdom, or how to broach this with my GP (appointment Monday) would be gratefully received.

Latest blood result below: waiting for 24 urine thyroid to come back.

TSH 1.06 REf range: 0.27 - 4.20 IU/L

T4 Total 130.8 64.5 - 142.0 nmol/L

Free T4 21.58 12 - 22 pmol/L

Free T3 4.25 3.1 - 6.8 pmol/L

17 Replies

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  • Tickeyland,

    Your TSH is low-normal, FT4 top of range and FT3 mid-range. Results are euthyroid (normal) and don't indicate poor conversion or thyroid dysfunction. You can request a trial of Levothyroxine but I think there is zero chance of persuading an NHS or private doctor that your symptoms are thyroidal or that you should be prescribed Levothyroxine.

    I would not self medicate Levothyroxine, NDT or T3 with those results.

    Have you had calcium, vitamin D and parathyroid hormone tested to rule out hyper parathyroidism?

    It is worth having ferritin, vitamin D, B12 and folate tested as low/deficient symptoms can mimic hypothyroid symptoms.

  • Although your FT3 is low in the range, I doubt that you will find a doctor to give you a diagnosis of hypothyroidism. And I personally would be very wary of self medicating. Medicating will suppress your normal thyroid production, and no matter what anyone says, the supplements are never as good as the real thing. It will also mask the symptoms so the real cause may take much longer to find.

    You could ask for tests for B12, Vitamin D, folate and ferritin. All these need to be optimal for good conversion. Deficiency of these show very similar symptoms to hypothyroidism.

    ME is a diagnosis of desperation, although it does, of course, genuinely occur post virally in a few people. Most of those recover within two years. It is different to hypothyroidism, with the intolerance of exercise being much more marked. In hypo patients they are just exhausted, with or without exercise. My ex had ME, and is fully recovered. His thyroid was and is normal. I am hypo. Because I lived with him I know the difference!

  • Have you had your antibodies tested?

  • Hi all,I have antibodies tested-all clear, have had Vit D, ferretin tested - all ok -Vit B12 was the only one that was slightly low in the range (but was still in range). The only blood test that was out of range was CRP- it was 7 at last blood test (range less than 5). I know I'm grasping at straws- I can't accept M.E as a diagnosis. I'm just trying to get to the bottom of why I feel like this.

  • Tickeyland,

    You need to use the green Reply button otherwise members will not know you have responded.

    GPs will say results within range are fine. Best to post the results and ranges and members will advise whether they are optimal or whether you might benefit from supplementing.

  • Could it be low cortisol?

  • Hi Josiemum, I thought it might be that too. I had a 24 hour saliva test done which showed the exact opposite- high out of range cortisol all day.

    Reference Range (nmol/L)

    Sample 1 Post Awakening 34.49 H range: 7.45-32.56

    Sample 2 (+ 4 - 5 Hours) 16.26 H range: 2.76-11.31

    Sample 3 (+ 4 - 5 Hours) 16.82 H range: 1.38-7.45

    Sample 4 (Prior to Sleep) 5.70 H 0.83-3.86

    Sum cortisol 73.3

    DHEA mean 0.93, DHEA :Cortisol ratio 0.033

    DHEA sample 1 :1.14 (range 0.25-2.22)

    DHEA sample 2: 0.71 (" ")

  • The symptoms of high cortisol seem to be the same as the symptoms of low cortisol, and hypothyroidism:

    mindbodygreen.com/0-9527/10...

    The Adrenal Reset Summit has some excellent interviews. I particularly recommend Niki Gravrix on Day 5:

    adrenalresetsummit.com/event/

  • The "was still in rage" means practically nothing. Take time and post the numbers with ranges. Tens of thousands of members here have come to know what is really optimum

  • These are my results to date:

    Thyroid bloods:

    TSH 1.06 REf range: 0.27 - 4.20 IU/L

    T4 Total 130.8 64.5 - 142.0 nmol/L

    Free T4 21.58 12 - 22 pmol/L

    Free T3 4.25 3.1 - 6.8 pmol/L

    CRP H 6.40 <5.0 mg/L

    Ferritin 88.9 20 - 150 ug/L

    Anti-Thyroidperoxidase abs 8.5 <34 kIU/L

    Anti-Thyroglobulin Abs 11.3 <115 kU/L

    Vitamins

    Vitamin B12 374 Deficient <140 pmol/L

    Insufficient 140 - 250

    Consider reducing dose >725

    Serum Folate 29.29 10.4 - 42.4 nmol/L

    Vitamin D Total Vitamin D :

    137.4 nmol/L ADEQUATE

    (range greater than 50)

    (25-hydroxyvitamin D 3

    134.6 nmol/L

    25-hydroxyvitamin D 2

    2.8 nmol/L)

    CORTISOL 24 HOUR SALIVA

    Reference Range (nmol/L)

    Sample 1 Post Awakening 34.49 H range: 7.45-32.56

    Sample 2 (+ 4 - 5 Hours) 16.26 H range: 2.76-11.31

    Sample 3 (+ 4 - 5 Hours) 16.82 H range: 1.38-7.45

    Sample 4 (Prior to Sleep) 5.70 H 0.83-3.86

    Sum cortisol 73.3

    DHEA mean 0.93, DHEA :Cortisol ratio 0.033

    DHEA sample 1 :1.14 (range 0.25-2.22)

    DHEA sample 2: 0.71 (" ")

    Many thanks

  • If I were you I would have the above complete data in a new post. Anything older than some twelve hours seems to get little attention :-(

    - - -

    Overall impression: FT3 in proportion to FT4 low, cortisol high, B12 lowish, the others fine. But posting again might give valuable comments

  • B12 is too low and something is causing inflammation - CRP.

  • Since you have high inflammation and high cortisol (cortisol being an anti-inflammatory) you could have high reverse T3 giving you symptoms of low T3, although your thyroid results look normal. My results in the past were very similar to yours and I have high reverse T3. Reverse T3 competes with T3 to get into your cells, so it blocks and therefore negates the effects of T3. Search online for high reverse T3 or reverse T3 dominance. Many things can cause high reverse T3. Check out this link for more information drhagmeyer.com/restore-your...

  • Thank you for that Guthoo, can i ask you if you managed to remedy this and what you did. My vitamin levels are in range the only one that seems a bit low is Vit B12 -have been supplementing this for the last month or so).

  • When there is more than one close family member with thyroid issues there is a possibility of a genetic thyroid condition. I have been researching this for about ten years: Impaired Sensitivity to Thyroid Hormone (more often known as Thyroid Hormone Resistance).

    With it the thyroid blood test results can be low, normal or high. It causes symptoms similar to hypothyroid. The symptoms can start as mild and become worse with age of as a result of infections or stress.

  • Thankyou Sandy 12-do doctors recognise this impaired sensitivity? Do you know the best ways to treat it? I should also say on the history front that I had hyperparathyroidism 10 years ago and subsequently had a parathyroidectomy. My calcium levels are well within range at 2.3 (range 2.1-2.6), but parathyroid bloods haven't been checked since 2008. Got doctors tonight so will ask if he will check PTh levels again.

  • Impaired Sensitivity to Thyroid Hormone (ISTH) is a term which describes a number of genetic defects which interfere with the working of thyroid hormones and cause symptoms similar to hypothyroidism. It is a recognised medical condition although many doctors have not heard of it. Some doctors may however be aware of it under another name such as Thyroid Hormone Resistance or Resistance to Thyroid Hormone. Those doctors who are aware of the condition view it as extremely rare (1 in 50,000) and associated with severe disability. It is therefore not something to consider as a possibility when they see a patient with hypothyroid symptoms but normal thyroid blood tests. They are instead likely to give a diagnosis of fibromyalgia, Chronic Fatigue Syndrome, ME or depression.

    I have sent a personal message with more info.

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