Friend needs help please

[Sespot]

Hello.

I am posting this for a friend from work who is really struggling and at a loss as to whom to get help from, sadly she had a non helpful response from the doctor she saw, he did however, request a thorough blood test.

She has very limited time to herself as she is a mum to lovely twin boys who are 3 and so i offered to post on her behalf, she has sent me as much info as she can plus the blood results.

I shall try and keep this brief and really hope you lovely people can advise.

She is in her 30s and has had a neck swelling/goitre for some years, recent months she has noticed the swelling getting bigger and even a colleague noticed it. She now has debilitating fatigue and at present cannot work which obviously she is very worried about. She is at present off sick. As well as fatigue she is anxious, emotional at times, confused, wiped out after activity, has had a swollen tongue since her 20s (doc not concerned) Beaus lines on nails. Problems with sleeping. Ongoing sore throat (comes and goes) Hair started falling out 5 years ago, stopped when pregnant.

My friend is very intelligent and pro active, she has as long as i have known her eaten healthily, she has therefore done research and has now cut out inflammatory foods, gluten and dairy.

She is now supplementing on B12, Ashwandga, Vit D. Selenium (now realised there is soya so going for the nut alternative) she has found the selenium to be helpful. Cutting out inflammatory foods etc. she is not as cold/shaky/freezing cold hands/feet, that has improved along with the swelling in her neck. It is less noticeable now.

My friend went to her doctor and he wasn't concerned about adrenals/thyroid, he thought it may be her parathyroid. Not concerned about the neck swelling either. The nurse who took her bloods said she should have it scanned. My friend explained how she viewed diet as important but the doctor was alarmingly dismissive, moreorless saying she should eat what she liked!

Here are some of her bloods;

25-OH Vit D

FT3 4.5 (4.3-6.8)

FT4 12.2 (7.7-15.1)

TSH 1.41 (0.34-5.6)

Prolactin 64 (57.5-561)

Ferritin 22 ug/L (11-307)

'Comment typed on the T4 was fatigue borderline T4, but I doubt this is the explanation - is the patient on any liver enzyme inducing drugs that can falsely lower FT4 - if not repeat test'

Calcium 2.26

Adjusted calcium 2.22 (2.20-2.60

She is hoping to get a follow up appointment soon, but in the meantime really needs some guidance/help. We would appreciate your comments/thoughts. She feels she has Graves/Hashimotos.

I had my thyroid removed due to cancer 2004 i can advise my friend to a point, but i suggested she could get more advise from here.

Much appreciated!!! Thank you!!!!

[Clutter]

Sespot,

TSH is low-normal, FT4 is around mid-range, and FT4 4.5 is usually good when range is 3.1 - 6.8. If range is as you typed it then FT3 is low. Your friend's Thyroid results are euthyroid (normal) and don't indicate hypothyroidism or hyperthyroidism.

To determine Hashimoto's or Graves it is necessary to have thyroid antibodies tested. GP may not be willing to test thyroid peroxidase antibodies as TSH is normal. Graves is not usually tested in primary care. Graves causes hyperthyroidism so there's no point in testing TSHRab.

You haven't added the vitD result or said how much vitD she is supplementing.

Calcium and prolactin are in normal range.

Ferritin is very low in range. Ferritin is optimal halfway through range. Your friend can raise ferritin by supplementing iron and taking 1,000mg vitamin C with each iron tablet to aid absorption and minimise constipation.

Apart from avoiding unfermented soy/soya, I agree with your friend's doctor, she should eat what she likes and just avoid foods which upset her.

[Sespot in reply to Clutter]

Many thanks for your help with this, i shall pass this on to her.

[lou-p-lou in reply to Clutter]

Hello ... I am the friend in question ... my name is Louise.

Sarah forwarded me your response ... a few details have got lost in translation so I’ve joined up to the site to respond in person. I’m just very busy generally and when my kids go to bed I’m completely shattered and ready for bed myself.

I had a blood test on the 31/10/17 my t4 was 7.6 with a range of 7.7-15.1

Doctor wasn’t concerned but my symptoms were unendurable... in a bid to find some relief I took to google and cut out inflammatory foods, gluten grains dairy soy. Also started taking 200mcg selenium.

Within two days my mental clarity came back somewhat and I was functioning better and felt safe to be in charge of the children but the debilitating fatigue was and is still present.

I took myself back to the doctors and had more bloods taken on the 06/11/17 this lot showed t4 had gone up to 12.2

... my question, could the increase in t4 be due to the dietary changes?

My t3 was 4.5 range 4.3-6.8

Also on my first blood test I had elevated white blood cells only one point over the top end of the scale which the Doctor wasn’t concerned about but I asked him today (different doctor) would white cells be up in the case of inflammation. He said they would but he’s pretty certain my problem is not thyroid related. He thinks I’ve got/had a disease/virus that is causing t4 to fluctuate. My tsh scores haven’t changed much between the two tests. He said they wouldn’t retest thyroid now for another 6 months.

I’m having more bloods again tomorrow to test for b12 - which I just started supplementing 3 days ago and I definitely have more colour today than I have had in 3 weeks. (Doctor doesn’t think b12 is low because there would be other markers in red cells to indicate a problem there)

Also being tested for Lyme disease, glandular fever and diabetes.

I may be putting 2&2 together and making 5 or more but I strongly believe my symptoms do reflect a thyroid disorder. I have had a swelling in my neck, basically the whole of my windpipe which has gone down SIGNIFICANTLY is now a 1/3 or more of the size than it was, since the dietary changes. I’ve had other symptoms, forgetful, tired, low energy, muscle weakness, leg cramp sensations, numb feelings in arms and hands, joint pains, increasingly anxious, nervous. Fluctuations in bowel habits/digestive issues/low stomach acid, hair falling out/thinning, nails breaking/splitting. Swollen tounge which has doubled in size the past three weeks. Beaus lines on most finger nails - (recent)

Never has any indication of a cause been found before despite numerous blood tests. Apart from the recent low t4.

Thanks in advance for your thoughts.

Kind regards

Louise.

[lou-p-lou in reply to lou-p-lou]

Forgot to mention vit D was 73 30-50 is considered low ....

I started supplementing fermented cod liver oil/k2 blend (blue ice brand) currently taking a tsp in the morning. It’s expensive but highly utilisable will work up to 2-3 tsp.

[Clutter in reply to lou-p-lou]

Hi Louise,

A virus can elevate TSH which means FT4 will drop, but your TSH hasn't changed. FT4 7.6 (7.7 - 15.1) was below range but FT4 12 is euthyroid (normal).

Ask your GP to test thyroid peroxidase and thyroglobulin antibodies at tomorrow's blood tests to rule out autoimmune thyroiditis (Hashimoto's).

TSH 1.41 is low-normal which rules out primary hypothyroidism but I think your GP should consider secondary hypothyroidism due to TSH deficiency if your FT4 goes low again. I think retesting in 3 months rather than 6 would be a good idea.

GP should look at the NICE CKS recommendation:

Secondary or central hypothyroidism is the result of insufficient production of bioactive TSH due to a pituitary or hypothalamic disorder.

Urgent referral to an endocrinologist should be arranged if:

Secondary hypothyroidism is suspected.

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

Unfortunately, supplementing B12 for the past few days will skew your B12 result. B12 is usually high when supplementing. Folate should be tested alongside B12. Numbness in hands and feet is often due to B12 or folate deficiency.

Joint pain is often due to vitamin D deficiency. Ask your GP to check and while he's at it to check ferritin (stored iron) too as hairloss may be due to low iron.

Hopefully your digestion will improve on the new diet.

Magnesium citrate, magnesium oil spray and Epsom salt baths are good for muscle cramp.