Thyroid Blood Test Help Please

[Flatdanny]

I’ve been trying to get to the bottom of hypothyroid symptoms for a while now and have had a bunch of bloods done in the past both privately and via GP....

Along with possible thyroid issues am also investigating low testosterone. I suspect I may have a problem with both. But as low T and hypothyroid symptoms are very similar it’s a little tricky to say the least getting to the bottom of the problem.

Symptoms include:

- Severe brain fog, fatigue, poor memory, joint pain, low labido.

TSH: Aug 2016 = 2.48mU/L - Dec 2017 = 3.07mU/L - Jan 2018 = 4.20mU/L

FT3: Aug 2016 = 5.02pmol/L - Jan 2018 = 5.91pmol/L

FT4: Aug 2016 = 16.49pmol/L - Dec 2017 = 16.50pmol/L - Jan 2018 = 13.50pmol/L

RT3: Jan 2018 = 15.00ng/dl

RT3 Ratio: 25.65

* The elevated TSH in Jan 2018 was because I did iodine replenishment in December.

Could do with some help interpreting these results so any pointers would be a great help. Thanks in advance (;

——

Latest update... Would appreciate come advice on these bloods. For the past 6 months or so I’ve been on testosterone replacement therapy and been struggling to dial in a dose that works for me. All in all been feeling awful which I suspect is partly due to thyroid struggling. The TRT I’m sure has increased the thyroid issue which I understand if common if there’s an underlying thyroid issue. I think I need to address the thyroid problem otherwise I’m not going to see any benefits with my TRT.

If you look at the thyroid bloods over time to me it looks like there’s defo an issue with T3 conversion.

I might be wrong but the way I see it is that my TSH is slowly increasing telling me to increase FT4 which it is doing. But even with higher FT4, FT3 is dropping. And with a FT3 ratio being on the low side would point towards FT4>FT3 conversion issue.

[Clutter]

Flatdanny,

I hope you've stopped taking iodine. As you can see iodine has depressed FT4 and elevated TSH.

Your rising TSH in Dec 2017 indicates your thyroid is struggling to produce T4 and T3 hormone which are currently good. NHS won't diagnose hypothyroidism until TSH is over range or FT4 below range. You could supplement 100mcg - 200mcg selenium to help support your thyroid.

Arrange your next thyroid function test early in the morning when TSH is highest and fast (water only) as TSH drops after eating and drinking.

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

It may be worth asking your GP to check ferritin, vitamin D, B12 and folate. Low iron and vitD deficiency cause joint pain as well as low thyroid.

[Flatdanny in reply to Clutter]

Thanks for the quick reply Clutter, very much appreciated... Yes I stopped iodine a while back and have been taking 200mcg of selenium a day. I tested iodine replenishment because of my low body temperatures (not getting above 97.3 in morning and never getting to 98.4 by late afternoon) * Iodine replenishment did not help raise temperature in the end.

My b12 and vit D is good as I’ve been supplementing for a while and had good blood results.

I realise getting a diognosis via NHS is unlikely which is no surprise. So I am happy to self medicate if need be. There no way I’m going to sit back and hope the NHS will sort this. I’d rather be proactive.

So with TSH high and lowish FT4 could I test taking some low dose T3 to see if it’s any help? I know many people have hypo symptoms even when they have seemingly ‘normal’ thyroid bloods.

[Clutter in reply to Flatdanny]

Flatdanny,

You haven't posted lab ref ranges so I can't tell whether FT4 is low or not. In range 12-22 FT4 16.5 is good, just shy of halfway through range, and FT3 5.91 is very good in range 3.1 - 6.8.

So, I'm wondering why you want to trial T3 instead of Levothyroxine? Whatever you do will mean you won't get a NHS diagnosis and if you decided you wanted NHS treatment you would almost certainly have to stop self medicating to 'prove' your hypothyroidism.

[Flatdanny in reply to Clutter]

Apologies for not putting the lab ref ranges. Here they are -

TSH = 0.27-4.20 mU/L

FT4 = 12.00-22.00 pmol/L

FT3 = 3.10-6.80 pmol/L

RT3 = 10.00-24.00 ng/dl

Well I think you do have a point about self medicating. Might be sensible to hold off considering any medication till I see my NHS endo again. I saw him the end last month about the low T and thyroid blood results. He wanted to do more bloods in March and then come back and see him in April. I think best to hold off doing anything till then. In the mean time I can deal with the low T and see if the symptoms get better.

I was considering following the Wilsons T3 protocol. Do you think that’s not a good way to go about it?

[Clutter in reply to Flatdanny]

Flatdanny,

Wilson's Temperature Syndrome is not medically recognised. Dr. Denis Wilson was struck off after a female patient died of a heart attack after following his high T3 protocol.

[Flatdanny in reply to Clutter]

I see... thanks for the heads up.

[Flatdanny in reply to Clutter]

One question if you don’t mind Clutter...

Is there a standard protocol for a newly diagnosed hypothyroid patient? Or would the meds vary depending on bloods?

[Clutter in reply to Flatdanny]

Flatdanny,

Dose depends on bloods. NICE recommends initiating dose 50-100mcg or 25mcg for patients >50 or anyone with heart disease.

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

[Flatdanny in reply to Clutter]

Do they ever go straight in with T3? Or is that a no no?

[Clutter in reply to Flatdanny]

Flatdanny,

NHS used to for thyCa patients in between thyroidectomy and RAI because T3's shorter half life meant patients needn't be off meds for so long. Thyrogen is available in the UK for raising TSH now so I'm not sure if T3 is still prescribed.

T3 is supposed to be initiated by endocrinologists so T3 is rarely initiated by GPs.

A month's dose of Levothyroxine costs <£3 whereas a month's dose of T3 typically costs £258+ so a lot of NHS CCGs and health authorities have banned prescribing of T3.

[Flatdanny in reply to Clutter]

I see, so it comes down to the cost of the meds essentially. I totally understand the NHS is struggling and theres not a lot of money to go around. But £258+ seems crazy expensive for T3 considering it can be sourced for about £20 for 100 x 25mcg pills in other EU countries.

[Clutter in reply to Flatdanny]

Flatdanny,

It didn't always, but it does now.

bbc.co.uk/news/amp/business...

gov.uk/government/news/drug...

[Flatdanny in reply to Clutter]

That’s just shocking.

[Clutter in reply to Flatdanny]

Flatdanny,

Innit, though! It's not just happening with T3. Carbimazole has shot up in price so that may mean hyperthyroid patients are pressured to have RAI instead of remain on Carbimazole. Hydrocortisone too and epilepsy drugs.

DoH and NHS procurement is hopeless. As the world's largest health organisation you would think NHS would be able to negotiate decent prices.

[Flatdanny in reply to Clutter]

I’m not sure how to tag users on this forum so will post this message a few times. Hope that’s okay.

——-

Latest update... Would appreciate come advice on these bloods. For the past 6 months or so I’ve been on testosterone replacement therapy and been struggling to dial in a dose that works for me. All in all been feeling awful which I suspect is partly due to thyroid struggling. The TRT I’m sure has increased the thyroid issue which I understand if common if there’s an underlying thyroid issue. I think I need to address the thyroid problem otherwise I’m not going to see any benefits with my TRT.

If you look at the thyroid bloods over time to me it looks like there’s defo an issue with T3 conversion.

I might be wrong but the way I see it is that my TSH is slowly increasing telling me to increase FT4 which it is doing. But even with higher FT4, FT3 is dropping. And with a FT3 ratio being on the low side would point towards FT4>FT3 conversion issue.

Trying to upload images of my thyroid chart but having issue.... here’s a link to the image in Dropbox. Hope it’s allowed? If not I can remove this post (:

dropbox.com/s/vl5b49mdglsex...

[SlowDragon Administrator]

Have you tested Thyroid antibodies?

Essential to also test vitamin D, folate, ferritin and B12

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

Private tests are available

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

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fastingL This gives highest TSH and most consistent results

[Flatdanny in reply to SlowDragon]

Thank you for the reply and info SlowDragon.... I’ve not done thyroid antibodies yet but have just received a thyroid plus test kit from medichecks, so will get that tested. I always go in the morning but not always fasted, so thanks for the tip, will go fasted next time (;

I had these tested in Jan 2018 -

Folate = 19.8ug/L >3.00ug/L

Ferritin = 168ug/L 15.00-300.00ug/L

B12 = 991ng/L 180.00-900.00ng/L (I’ve been taking a b12 Supplement)

Just been checking my blood results and can’t see vitamin d anywhere. So maybe that’s not been tested. But I’ve been taking a high strength d3 Supplement for a while now so that should be good.

[Joanie17 in reply to Flatdanny]

Hi Flatdanny you really need to be very careful taking all these supplements without being under the care of a Docter, it is very dangerous to take Folate with a true vitamin B12 reading and visa versa also the Thyroid is a very volatile glan and can be easily thrown off balance by certain vitamins and minerals my advice would be to stop self-medicating or at least ask your Dr for advice before you take anything and also keep a record and show him/her a list of everything you are taking when you next visit, Vitamin D is a fat soluable vitamin and can easily build up in the system and do not forget along with these vitamins you will be getting some through your diet and that needs to be counted in for your daily allowance please be careful or you will end up over vitamised and very ill.

[Flatdanny in reply to Joanie17]

Thanks for the advice Joanne, I have only supplemented b12 because I was deficient and the doctor advised I take a supplement. I am taking the selenium as I was advised to do so because I was taking iodine before. I always tell my doctor about any supplements or meds I take to keep them in the loop and get advice.

[Joanie17 in reply to SlowDragon]

Hi I am just wondering how they can do proper Thyroid test with a finger pick test? I always had a clotted blood sample taken in order to get a true reading of Thyroid readings.

[SlowDragon Administrator in reply to Joanie17]

I gave up with finger prick when they changed to new lances

Before that I had no trouble

I pay the extra for a blood draw at local private hospital.

[JS33]

When first diagnosed I tried Iodine and my antibodies and general suffering went through the roof.

[Flatdanny in reply to JS33]

That’s interesting... I’ve actually been very ill since Christmas but think it’s a bug. Still I’ve stopped supplementation now and am taking selenium.

I wanted to start with iodine first to se if things got better. Now I’ve ruled out iodine deficiency I can investigate other causes. Thanks for your input JS33 (;

[JS33 in reply to Flatdanny]

I used selenium , think it helped lower the antibodies a little.

[SlowDragon Administrator in reply to JS33]

If you have raised antibodies then seriously consider trying strictly gluten free diet

If you'd antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

Essential to test vitamin D, folate, ferritin and B12.

Always get actual results and ranges. Post results when you have them, members can advise

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

Persistent low vitamins with supplements suggests coeliac disease or gluten intolerance

gluten.org/resources/health...

[Flatdanny in reply to SlowDragon]

Totally forgot to add that I already have an autoimmune disease (scleroderma) which I’ve had since 17... I’m 43 now. I also had issues for years with IBS and tested for food tollarance issues. Then changed my diet and IBS cleared up.

[SlowDragon Administrator in reply to Flatdanny]

So are you absolutely strictly gluten free?

[Flatdanny in reply to SlowDragon]

Not gluten free at all actually. Just gave up dairy and any processed foods and my stomach got better.

[SlowDragon Administrator in reply to JS33]

Iodine is definitely not recommended with Hashimoto's

thyroidpharmacist.com/artic...

drknews.com/iodine-and-hash...

[Flatdanny in reply to SlowDragon]

I’m not sure how to tag users on this forum so will post this message a few times. Hope that’s okay.

——-

Latest update... Would appreciate come advice on these bloods. For the past 6 months or so I’ve been on testosterone replacement therapy and been struggling to dial in a dose that works for me. All in all been feeling awful which I suspect is partly due to thyroid struggling. The TRT I’m sure has increased the thyroid issue which I understand if common if there’s an underlying thyroid issue. I think I need to address the thyroid problem otherwise I’m not going to see any benefits with my TRT.

If you look at the thyroid bloods over time to me it looks like there’s defo an issue with T3 conversion.

I might be wrong but the way I see it is that my TSH is slowly increasing telling me to increase FT4 which it is doing. But even with higher FT4, FT3 is dropping. And with a FT3 ratio being on the low side would point towards FT4>FT3 conversion issue.

Trying to upload images of my thyroid chart but having issue.... here’s a link to the image in Dropbox. Hope it’s allowed? If not I can remove this post (:

dropbox.com/s/vl5b49mdglsex...

[SlowDragon Administrator in reply to Flatdanny]

Suggest you put up a new post

I can't see the images in drop box (on an iPad)

Can only add one image within one post

[Flatdanny in reply to SlowDragon]

Okay thanks, will create a new post. It’s a shame we cant post more than one image. I have about four I wanted to post.

[Flatdanny]

Quick update as I found out I did actually have thyroid antibodies tested recently -

SE Thyroid Peroxidase Ab Con: Dec 2017 = 9.4U/ml

Ref Ranges...

SE Thyroid Peroxidase Ab Con = <35.00U/ml

So I assume those are Okay numbers?