Should I see my gp or an endo or who?

[charlie_brown]

Hi, I've been reading a little while and am dead impressed with the knowledge here. I'm not really sure of my next steps and I was wondering what you all recommended.

I've been working with a nutritionist to try and lose weight /have more energy and after getting nowhere with dieting, she sent me for some blood tests which clearly show I have very little T3 and an adequate amount of T4. She thinks I have a conversion problem and has given me a bunch of supplements. Which, are making me feel a bit better but still not amazing. Numbers below

Endocrinology

Thyroid Function Tests

Free T4 (15.2 11 - 26 pmol/L

l

TSH 1.78( 0.35 - 4.5 uU/mL

)

Free T3 3.7(3.9 - 6.8 pmol/L )▼

Immunology

Thy. Peroxidase abs. <10 (0 - 50 IU/mL)

For reference, I've been gluten +dairy free since Feb. I'm tired, so tired, have digestive issues, am dessicated like a lizard, my head is foggy, I can't remember stuff and I have a spare tire /Weight around the middle. And I am puffy like the michelin man. What a catch I am. Oh and my doctor says I have health anxiety and recommends counselling.

I'm taking:

Selenomethionine

TH207 complex (biocare.co.uk/th-207-60-cap...

Zinc, magnesium, methylated B vitamins, fish oils, ashwaganda and ginseng.

[bluebug]

I would expect your TSH to be under 1 and your free T4 to be in the top quarter of the range if you are optimally medicated on levo. Your results show neither of these. So you should first have a dose increase of levo. This your GP can do. There is a pulse article you can get from thyroid uk by emailing [e-mail] to show your GP and help convince them to do this.

Then and only then if this doesn't work to raise your free T3 you should then be asked to be referred to an endo - making sure the endo understands thyroid conditions to see if you can get T3. Be aware some endos won't give patients T3 so then you would need to self-medicate.

Alternatively you can self-medicate with either NDT, thryoidS or add T3 from the beginning. Some posters do this, do their own blood tests etc and refuse help from the NHS due to their uselessness.

[charlie_brown in reply to bluebug]

Thanks! Am not on any thyroid medication at all. I guess I'm not really sure what to do, my doctors are fairly useless.

[greygoose]

I take it you do not have a diagnosis of hypo, then? And you are not taking any thyroid hormone replacement?

It's true you do have a conversion problem. But I cannot see how anything much of what you are taking is going to help that. Some of it might even make things worse, like iodine and calcium. In fact, I think that TH207 complex is pretty awful! B vitamins might help, if you took enough of them, but taking just two B vits - one in massive quantities and the other a tiny dose - is not a good idea. You should take all the B vits together. And 8 mg magnesium is not going to get you anywhere - you need more like 350 mg.

Personally, I think the whole situation needs rethinking. And retesting. Vit d, vit B12, folate and ferritin are the main nutrients for conversion. They should be tested and you should just take what you need - which probably doesn't include calcium and iodine! Did she even test your iodine before recommending it?

If, as I get the impression - although you do not say in so many words - you are not on any thyroid hormone replacement, your labs suggest central hypothyroidism. This should be investigated by an endo. But very few doctors of any sort, have much understanding of central hypo, where the problem lies with the hypothalamus or the pituitary, not the thyroid gland - hence the iodine is not going to be of much help!

Has your doctor seen these results?

[charlie_brown in reply to greygoose]

Thanks, no, I haven't been to the doctor with these results yet, I wasn't sure what they would do given T4 and TSH are technically in range? I am not on any thyroid medication at all.

That's really interesting about more testing. So my strategy should be my NHS doc with these results and ask for the vit d, ferritin etc tests and I guess retest the thyroid.

Thank you for your help.

[greygoose in reply to charlie_brown]

Well, if you just ask him to retest the thyroid, he's probably only going to do the TSH, which will come back low, so he'll say there's nothing wrong with your thyroid. You need to implant the idea of central hypo, with the problem being the hypothalamus or the pituitary, so tests need to be done to check those, not just the TSH, because central hypo doesn't show up with just that. The TSH just diagnoses primary hypo, as it's called, where the problem is with the thyroid gland.

[charlie_brown in reply to greygoose]

I shall read up about central hypo and speak to him with some conviction. I've managed to book a appointment with a fair reasonable doctor so I am hopeful.

I am reasonably happy to go private if it will get this resolved, but is it going to be difficult to find a doctor who will look holistically at this? I'm so tired of being tired and fat. Thank you

[greygoose in reply to charlie_brown]

Yes, reading up on it is the best thing to do.

Who knows how doctors are going to react to anything thyroid. They thing that central hypo is terribly rare, so are reluctant to test for it, as a general rule.

[charlie_brown in reply to greygoose]

So I see, 1 in 80,000! That's crazy rare but the suggested treatment is levo so hopefully that will help. Thanks!

[greygoose in reply to charlie_brown]

Yes, but the trouble is getting diagnosed.

I'm not certain that it's as rare as that. We see quite a bit of it on here. But, if you never test for something, of course it appears to be rare!

[SimonA87 in reply to charlie_brown]

Have you checked both of the antibodies? I can only see Peroxidase in your results.

[charlie_brown in reply to SimonA87]

Those are the only results I have so I guess not. What is the other one called and I'll ask for that to be tested too. Thanks

[greygoose in reply to charlie_brown]

It's TG antibodies, but the NHS won't test for it.