What tests to do next?

[Ninatz]

Hi,

I am not diagnosed but something is just not right!

I had some blood tests done in December and was told to come back after 3 months or so if symptoms persist.

So what test should I get this time? What should I ask for?

Blood tests from December:

Tsh 1.55 (0.25-5)

T4 free 13.67 (9-20)

T3 free 3.67 (4-8.3)

Ferritin 36.81 (25-280)

Cholesterol LDL 2.74 (<2.59)

cholesterol HDL 0.69 (1.04-1.56)

Cholesterol Total 3.85 (<5.20)

I got iron tablets and multivitamins given in December.

Nothing was said about the low T3

Symptoms:

Days i feel tired and can't get through a day without a nap which is not my usual behaviour.

Muscle pain (some days worse than others). Mainly thighs and upper arms. I sometimes have to take pain killers for this.

Occasional headaches - I have never suffered from headaches.

Sore breasts - comes and goes. sometimes feels like when the milk runs to when breastfeeding!

Puffy face.

Severe diarrhoea

No weight loss no matter what I do (exercise or diet)

I am a yoga teacher and consider myself fairly active physically.

I am 42, female, mother of 4 (2 children staying home), teaching yoga 5 x weekly + personal practice, squash x 2 weekly, studying, and engaged in the local community.

Thanks for your help!

Have a great day!

[shaws]

I am sorry you are feeling so bad but, unfortunately, if you are in the UK, doctors have been told not to prescribe/diagnose hypothyroidism until the TSH is 10. As far as I know the BTA don't acknowledge any clinical symptoms and doctors follow the instructions. I doubt your doctor knows much about the function of T3 in our bloodstream. Yours is low. List of clinical symptoms below. Before blood tests were introduced, we were diagnosed upon clinical symptoms only and given a trial of thyroid hormones.

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/diagno...

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

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

We have labs which do private blood tests which can be done but I doubt GP will prescribe.

This is an excerpt regarding the Free T4 and Free T3:

FT4 = FREE T4

Thyroid hormones not bound to proteins. FT4 lowers when the thyroid is struggling.

The approx. reference range for this test is 10 to 24

FT3 = FREE T3

T4 converts to T3 and is the only thyroid hormone actually used by the body's cells.

The approx. reference range for Free T3 is 4 to 8.3

Blood tests should be the very earliest, fasting (you can drink water) and if on hormones allow 24 hours gap between last dose and test and take afterwards.

I am not medically qualified but think that if patient's bloods don't 'fit' they may be diagnosed with fibromyalgia or chronic fatigue.

[Ninatz in reply to shaws]

Hi

Thanks for your answer.

I am not in UK but in Tanzania. I am seeing a private doctor although she's not an endocrinologist. No reliable endocrinologist around here - if need be I will have to travel out of country to be evaluated.

My current GP is willing to have the discussion about what to test next.

[shaws in reply to Ninatz]

Sometimes doctors are better than Endocrinologists I believe if they have knowledge.

As the doctor increases levothyroxine about every six weeks, your FT4 and FT3 whould increase and you should begin to feel better. The aim is a TSH of 1 or lower and some of us need it suppressed. FT4 and FT3 should be towards the top of the range. You can go by how 'you feel' i.e. good pulse rate and reasonable temp. Usually both are low before begin diagnosed.

Also test Vitamin B12, Vit D, iron, ferritin and folate. We are usually deficient and that can also cause symptoms.

[Clutter]

Ninatz,

It would be useful to have TSH, FT4 and FT3 repeated plus vitamin D and B12 and folate as diarrhoea may be causing vitamin deficiencies. Also tisssue transglutaminase to rule out coeliac disease which may be causing diarrhoea and a full blood count to see whether infection is indicated. If sever diarrhoea continues you should be referred to gastroenterology for investigation.

[Ninatz]

thank you Clutter.

I will check for coeliac as well!