Elevated TSH, T4 low, T3 normal

My partners blood tests came back with having elevated TSH (6 mIU/l - range is 0.27 to 4.2). Based on this the doctor referred her to a nuclear medicine specialist but the earliest appointment is in July.

We went back yesterday to see if she could be put on Levothyroxin in the meantime, but he wouldn´t prescribe it because her T4 levels were only slightly below the accepted range (Free T4 is 8.9 ng/l - range is 9.3 to 17) and T3 was normal (3.10 ng/l - range is 2.21 to 4.43

One of the main symptoms she is experiencing is extreme nausea mornings and after eating. We assumed, after researching on the internet and seeing that the rest of her blood tests results were in the normal range, that these symptoms were also down to the hypothyroidism, but the doctor stated that the nausea wasn´t and prescribed her Metoclopramid for the nausea.

From what I´ve read T4 should optimally be in the middle-upper range. I also strongly believe that the doctor should have prescribed the Levothyroxin at least at a minimum dose to get the ball rolling before her appointment in July. From what I can tell just about every outcome leads to Levothyroxin being prescribed.

I would really like to hear what others in the community think. Am I being overzealous here?

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14 Replies

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  • No you're definitely not being overzealous lol. Unfortunately docs won't normally treat hypo until the tsh reaches 10 so many people often have to wait a long time feeling crappy until then. Her T4 levels are really low! Yes, hypothyroidism doesn't usually cause vomiting but it affects everything and might be making any of her hormone levels unbalanced.

    Blood glucose level problems can cause vomiting and nausea - hypoglycemia and hyperglycemia so might be worth getting a cheap blood glucose testing pack from the pharmacy and check if these are okay at the times she is vomiting. Maybe even cortisol levels which would be effected by glucose levels or thyroid levels? These are both some things that can cause nausea and can be affected in the mornings and after food specifically??

    Does she have any other digestive issues and are her nutritional levels low? (might be worth posting her results if you have them as often what docs say is normal often isn't - VIT D, Vit B12, ferritin and folate) - Reflux/stomach acid issues could cause nausea and coeliacs would cause vomiting after eating but blood test for coeliacs is unreliable and can only be ruled out by endoscopy which still doesn't rule out gluten intolerance. If you get no further with doc, you could try a gluten free diet for three months.

    She might have issues/allergies to other food groups - an elimination diet will help work out any other intolerances - not sure how likely this would cause nausea in the morning before eating mind you.

    Other here might be able to help give better suggestions for things you can test and rule out but hope you figure it soon :-)

  • If you can't get anywhere with the docs, you can pay for your own tests using medichecks or blue horizon. Medichecks for example has cortisol saliva tests on offer at the moment for £59?

  • hi, i have the test results but he won't prescribe her anything because her t4 is only slightly out of range

  • Yes, this is usual as mentioned. You could maybe do thyroid antibody tests to see if she is likely to get worse in regards to her thyroid but not much you can do about getting the NHS to prescribe. Maybe positive antibodies would persuade some of them???

    I meant the other tests (Vit B12, iron, Vit D and folate) as many with thyroid issues are deficient in these and can effect thyroid function and might help a little in the meantime if resolved.

  • Hi - yes she is hypothyroid and should be treated. I believe I read somewhere here that a "borderline" tsh as defined by nice or maybe bta should be treated if eitheeither ft4 or ft3 is below range or with positive antibodies but I can't provide a link sorry. Nausea could also be caused by good intolerance which is very common with hypo. Personally I react badly to both gluten and dairy. I didn't realise the extent of this until I had been off both for several months and then had them accidentally. Maybe try searching in box at top right for bta guidelines.

    Btw it is very common for GPs to not have much knowledge and hence delay diagnosis & treatment. Could your wife see a different one?

    Good luck

    Gillian

  • I am nauseous too especially in the morning, it is accompanied with very low temperature. Eating always help me.

    I have been extremely nauseous after eating as well in the past , but B12 , K2 and vitamin D helped with that.

    I am not medicated either , but based on test results heading hypo.

  • Hi. Are there any other symptom other than nausea? If you look on thyroid uk website's list, and you can tick several of the symptoms, then it's worth writing to GP, listing all symptoms and asking for "a trial" of levo. If it's in writing, they seem to take more notice - well in my experience.....

  • Hi,

    yes, she has pretty much all of the classic symptoms listed for hypothyroid, which was kinda why I´d hoped the doctor would have been willing to start her on the L-Thyroxin in the run up to her appointment with the specialist (Nuclear Medicine) in July. We actually went with a list of symptoms written down. All of her blood results except for the TSH & FT4 (and Uric acid - although we knew already about this) came back ok.

  • I agree with Clutter - try another GP.

  • Ask for both TPO & TG thyroid antibodies to be tested, plus vitamin D, folate, B12 & ferritin

    If GP is difficult then you can get private tests

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

    Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven- same tests, just different companies- £99 DIY finger prick test or option to pay extra to get private blood draw. They both often run money off offers

    If she has high antibodies then this is autoimmune thyroid, (Hashimoto's) and its recommended, if patient has symptoms, even with "normal" TSY, FT3 & FT4 to consider starting treatment

    Low vitamins are common with Hashimoto's, but can cause symptoms in their own right too

    If it is Hashimoto's then very likely she would find benefit changing to gluten free diet

    Does she suffer from any gut symptoms- acid reflux, reaction to dairy or gluten? Etc

  • That's ridiculous. I have a diagnosis of hypo with a lower TSH than your partner's and T4 just below range. Once they both are out of range then my understanding is that is enough for a diagnosis. It's when the T4 is in range that they wait for TSH to go over 10.

    Can you see another doctor? Can you ask for a "trial" of levo?

  • Della_De,

    Please ask your partner to see another GP at the practice because she is overtly hypothyroid and should be prescribed Levothyroxine to raise her FT4 level.

    NICE CKS states:

    Hypothyroidism - Summary

    Hypothyroidism is the clinical result of impaired production of thyroid hormones (thyroxine [T4] and tri-iodothyronine [T3]). Thyroid hormones are released from the thyroid gland when it is stimulated by thyroid-stimulating hormone (TSH) from the anterior pituitary.

    Primary hypothyroidism (95% of cases) occurs when the thyroid gland is unable to produce thyroid hormones because of iodine deficiency or an abnormality within the gland itself. It is categorized as:

    Overt hypothyroidism (OH) — TSH levels are above the normal reference range (usually above 10 mU/L) and free T4 is below the normal reference range.

    OH should be treated with levothyroxine (LT4) — all people who are stable on LT4 require at least annual measurement of serum TSH levels.

    cks.nice.org.uk/hypothyroid...

  • Hi della_de,

    I am wondering why your partner has been referred to Nuclear Medicine and not an Endocrinologist, do you know? Or does anyone else know why that might be? I'm imagining it's so that they can do a scan of the Thyroid, but with those blood results it seems clear that the thyroid isn't working properly, and I just wouldn't want you to wait for the scan then have to be referred to an endocrinologist and wait again, but I could be completely wrong, I don't know a huge amount about all this.

  • Just wanted to update this thread. We went to the Nuclear Medicine appointment yesterday. The doctor looked at her previous blood tests and performed an ultrasound scan. He stated that her thyroid gland was very small. I am not sure exactly what the significance of that is. Anyone know?

    They took another round of bloods and he prescribed 50mcg of Thyroxine, but we have to hang fire until he has the blood test results back (probably tomorrow)

    It seems we are finally on the right track, but he actually did nothing our GP couldn´t have done, which is frustrating to say the least.

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