T4 / TSH 'in NHS range', with previous antibodies

Hi

A quick backstory, was making great progress gym-wise in 2016, then I got uncharacteristically with 2/3 heavy colds towards the back end of 2016. I've had some major, major life events happen since Jan 2017, including recently losing my job and now I feel wiped out, totally unlike me, it's wreaking havoc on gym routine and my anxiety is up.

NHS GP ran a whole bunch of bloods last week, including basic NHS thyroid checks.

T4 15.5 (10-20)

TSH came back 3.4 (0.2-4)

I also had these Blue Horizon thyroid tests done in 2015

Free T4 15.3 (12-22)

Free T3 4.2 (3.1-6.8)

T4 Total 91.5 (64.5-142)

Anti-TPO 280

Anti Thyroglobulin 12.5 (<115)

B12 544

Ferritin 269

CRP 0.3 (<3.0)

Serum Folate 45.4 (10.4-42.4)

The GP feels my thyroid is normal, there are no more physical checks they can do and my tiredness/fatigue is due to mental (stress/anxiety/residue from previus depression) caused by recent events.

My interpretation is my TSH is on the high side, T4 is ok (unchanged since 2015), T3 was lower end in 2015, suggesting I am subclinical hypothyroid. I showed them the Anti-TPO marker from the private bloods and it didnt register.

Now I'm confused about the whole thing and whether its all just in my mind???

[greygoose]

No, you're not making it up. You have antibodies, and antibodies can cause symptoms. And your TSH is too high, but, not high enough to interest a doctor. They like a TSH to be much higher than that before they'll consider diagnosing!

But it will probably get higher, so, eventually, they should diagnose you. Just one thing, what time were these labs done? And were they both fasting?

More importantly, did they say nothing about that high ferritin? You haven't put a range - please, we always need ranges - but it looks very high.

[Hidden in reply to greygoose]

Both tests were done fasted 8.45, 9.45 AM

The GP didn't bother referring to the private bloods I had done at all.

The range for ferritin was 30 - 400

I have to be careful about how far I push this because they will start pinning it on my anxiety and past depression.

I've been trying the usual things recently, paleo diet, COQ10, selenium, even ashwaghanda for adrenal/thyroid re-balancing, but it seems to be the gym that kills me off. I crashed mentally and physcially after cardio on friday, and I'm struggling with the weights I used to do. Basically everything that was working last year to keep me in balance is having the opposite effect.

What other options do I have to improve things if the NHS aren't interested?

[greygoose in reply to Hidden]

Well, you shouldn't really be doing weights and cardio with such a low FT3. Exercise uses up your T3, and that's why you crash. If you give up the gym, your FT3 should rise, and you won't feel so bad. But, of course, if that anti TPO is over-range, it does mean you have Hashi's, so things are probably going to get worse.

Actually, it could be because of the Hashi's that everything was going so well last year. It starts of with a hyper swing, so your blood is flooded with thyroid hormones, giving you lots of energy and, if it doesn't make you feel bad, it makes you feel good. But, the high levels of hormone are only temporary, and when they're gone, you become hypo. But, that's only a guess, because I don't even know if you have Hashi's without seeing the range.

[Laundretta in reply to greygoose]

Hi I was diagnosed subclinical about a year ago but was symptomatic so I convinced my go to let me try Levo. Felt much better after a few weeks - but left with not being able to lose weight gained pre-diagnosis. And I’d rather eat! I’m being managed at tsh 2.4.

I have always been pretty fit and active, with cardio such as jogging, swimming, cycling etc. However, in last 2 months I’ve had a change up (attempt to lose the weight) I’m now doing more Hiit (spin and running) and some weights too as well as some basic cardio. The hiit and weights is great while I’m doing it, but it seems to wipe me out for 1-4 days - awful fatigue. So it makes sense what you say about using the t3 up. If I had a bigger t4 reserve (ie increase levo dose to manage at a lower tsh?) would this help?

[greygoose in reply to Laundretta]

It might do. But it depends how well you convert. Have you ever had your FT4 and FT3 tested at the same time?

With a TSH over 2, your FT3 is probably very low. The aim of thyroid hormone replacement is to achieve a TSH of 1 or under. You are definitely under-medicated, so you won't lose weight. You're just wearing yourself out for nothing.

[Laundretta in reply to greygoose]

Thanks for the super quick reply! Only had t4 tested once but that was before I was medicated. Never had a t3 test bcos the t4 was in range. It was 14.6 (12.0-22.0) and at that time tsh was 6.6 (0.27-4.2)

8 months ago tsh came down to 2.3 on 75mcg levo. 2 months ago tsh back up to 6.4, and dose increased to 100mcg. I had started with symptoms again before the test (general fatigue, foggy brain, slower resting heart rate, heavy periods, dry skin, weight management issues) but the proper fatigue after exercise is new with the new type of training, and other than my resting heart rate bombing to 40-ish when fatigued (it’s usually 50 ish) symptoms have abated with the new dose.

Blood test again next week - I’m going to request t3 and t4 but I’m betting the nhs won’t comply!

I haven’t lost weight, but I have managed to replace some fat with muscle with a higher protein diet. Progress is very very slow though.