I am just back from the latest visit to GP, my first time seeing a different (recommended) GP in the practice. She was much more understanding of my symptoms than the previous doc, however on pressing for opinion on my thyroid results I'm not so sure this is heading anywhere better than my previous ill fated attempts to figure this out. She is still favouring post viral fatigue syndrome. At least she didn't put it down to wear & tear due to my grand old age of 49, like the last one!
I would appreciate any comments on the following that I've been told now, as I'm still finding my way with this stuff and my natural respect for the medical profession (although diminishing) always leads me to think I'm wrong, they're right.
I posted these results previously and got some great help with them. Now I've quizzed another doc - am I being fobbed off?
First thing to mention - she did start by saying private tests may not be reliable - set my alarm bells ringing! Showed her my Medichecks report and she gave me the following comments:
- "if this was causing an issue then T4 & T3 would be low" - so I pointed out T3 result below and asked about possible Central Hyothyroidism (as suggested by Seaside Susie ) and got the response below re T3.
TOTAL THYROXINE(T4) 71.1 nmol/L 59.00 - 154.00
FREE T3 3.18 pmol/L 3.10 - 6.80
- "this is normal" - I queried this as 0.08 within range seemed to be a small margin to base this on, but didn't get an answer.
I was happy with my previous antibodies test ruling this out. However GP agreed to rerun my thyroid tests and vitamin / mineral tests again on fasting bloods. She also agreed that she would have prescribed a loading dose for Vit D rather than the standard dose I was given. So I will source my own and get going with that after the tests.
Susie mentioned an iron panel in relation to the ferritin result - what should I be looking to see if they have tested along with serum ferritin? I got the following from Medichecks;
I know I'm sort of asking for answers before I get the next set of results, but the way our practice operates I will get a phone consultation when the results come back before I've seen the paper copies. Just think it will pay to be prepared for the call.
I'm getting to the point where I feel like giving up pursuing through my GP and just making my own decisions based on my own research. No wonder folk end up visiting "quack" natural therapists for health conditions - starting to think they can't do much worse job than GPs who wont admit they don't know everything.
At least she did give me something to take to my employer advising reduced hours, and did seem to understand that I am trying to deal with this whilst travelling to work, holding down a full time job and caring for my immobile mother, who is my rock :).
Any thoughts / advice would be very much appreciated.
Thanks
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Om289
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No, it is not normal to have an FT4 under-range and an FT3 at the bottom of the range, and her reason for saying it was normal, was pure gibberish. She didn't really say anything!
I would say most definitely Central hypo, but then, I've probably had more experience looking at labs than she! And, I know from experience that your low FT3 is causing your symptoms.
As for self-treating, that's all well and good, BUT if you do have a problem with your pituitary, other hormones - like HGH - are also going to be low and causing problems. The pituitary doesn't just produce TSH. So, you really need to have those hormones tested, too. A pituitary failure could affect your adrenals. But, doctors fail to see how these things are all inter-connected. Do you think there's any chance she will refer you to an endo to get these other hormones checked out?
So glad you said that greygoose. It sounded like nonsense to me, just with a smile this time! I take what you said about self-treating. I was just venting. I feel so frustrated that I do everything in supposed to to stay healthy and just because they can't tell me to 1) lose weight, 2) stop smoking or 3) cut down on alcohol, they manage to come up with some other platitude. She asked me if I thought I might be depressed. Said no, I knew how that felt and that I am too angry and have too much fight to be depressed 🤣.
If the next tests come back as "normal" I will ask for referral to an endo. Honestly not sure how that will go down, or what they are like in this area. But you don't get if you don't ask.
Thanks for the pointers on Central hypo, I will get a bit more informed on that before my next round.
It can be difficult putting all of these pieces together, so appreciate advice on how to approach it all. Sometimes it seems so much to sort out it's overwhelming.
But we already know that her thyroid hormones are very low, so she's not getting anything much to use. It's there, in the blood, the amount she's got, but the pituitary isn't reacting as it should to those low levels. I really don't think vitamins would help her pituitary if it's been damaged or has some sort of benign tumour.
Yes, of course, we always need to keep our nutrients optimal. But we don't want people running away with the idea that nutrients have a direct effect on TSH.
I agree that it looks like you suffer from central hypothyroidism. How you persuade your doctor that this is the case, I'm not sure.
Getting tested as early in the morning as possible having fasted (except for water) for 8 hours or so, might help. But what I suspect will happen is that the lab will refuse to do either or both of Free T4 and Free T3. If it isn't very long since your last TSH test they may refuse to do that too. I'm guessing that you aren't on meds.
I was happy with my previous antibodies test ruling this out.
I'm not sure what you are referring to here. What has been ruled out? Central hypothyroidism is not caused by antibodies (to the best of my knowledge), it is caused by damage to the pituitary and/or the hypothalamus in the brain. It can be caused by head injuries, accidents, tumours, disease, severe bleeding during childbirth, and probably various other things I don't know about. Sometimes, I'm sure, the cause of poor functioning of the pituitary/hypothalamus might never be found.
The one thing you want to avoid is the "post-viral fatigue" diagnosis. Next thing you know, you'll be diagnosed with CFS or medically unexplained symptoms or persistent physical symptoms or functional disorder or somatic symptom disorder or bodily stress syndrome or bodily distress disorder and that is a disaster. (I've probably missed a few of the "official" euphemisms the NHS applies these days - there are so many of them.) All these things mean roughly the same thing to doctors - the patient is a time waster with mental health problems. With any of those on your notes no doctor will ever take you seriously again and they will resist doing any tests or investigations for the rest of your life.
You really need to do something about these results :
Your folate needs to be raised to mid-range. Your vitamin D needs to be raised to 100 - 150 nmol/L. Your ferritin is too low, and if your serum iron is low too then you need to supplement iron. If you read SeasideSusie 's posts you'll find lots of info on what to supplement and what co-factors are required to be taken with vitamin D.
For more info on your iron status, this is the best test :
I am well wary of being labelled with a euphemism as I've spent years helping my mother deal with this (different illnesses). She did try to go down that road as being a possible conclusion later on if nothing shows up -in her opinion- but im not going to accept that if it is suggested.
Sorry my mention of antibodies was a bit woolly. What I meant was that my test showed them to be in range so doesn't look like Hashimoto's etc.
I will look at the iron test link you've attached and get that arranged. It's dawning on me that what the docs accept as acceptable is not the optimal levels on all of these things that are required for good health - how naive ive been.
Also told to accept that i might not be able time i things at the same pace for a while??? I've given that idea 3 mths and think that should be enough for that idea. Also declined her kind offer of depression diagnosis.
Was wondering if now would be a good time to request a copy of my medical notes? Or do you think that might be antagonistic at this point? Would it be better to wait until further tests done and discussed? What do you think?
If you were to request a copy of all your GP notes of all types in any format i.e. paper or electronic or scans etc you would currently pay £50 for it.
If you wait for 25th May you can't be charged at all. See this post from DJR1, our resident expert on our rights to access our own records :
You can never fully rule out Hashi's. For one, because antibodies fluctuate all the time, and for two, not all Hashi's people develop high antibodies. But even if they were positive, that wouldn't rule out the low TSH. You would have to consider having Hashi's and Central hypo at the same time. Which is a possibility, of course.
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) and got the response below re T3.
Hyper or Hypo..not sure anymore!!!
Worrying new Thyroid results from Medicheck
FT3 low in range. How do I help GP understand this could be the cause of some of my symptoms?
Improving T4 to T3 conversion 
