Thyroid UK
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Could my Thyroid just be starving?

Hi all! So I posted previously here:

healthunlocked.com/thyroidu...

Numerous comments suggested Hashimotos based on the bloods I posted. So I did a medichecks full thyroid panel including antibodies. Here are the results:

TSH *4.73 mIU/L 0.27 - 4.20

FREE T4 *11.800 pmol/L 12.00 - 22.00

FREE T3 3.61 pmol/L 3.10 - 6.80

TG AB <10 IU/mL 0.00 - 115.00

TPO <9.0 IU/mL 0.00 - 34

As you can see, not autoimmune. But thanks to you guys am starting, to understand a little of what is going on. I'm beginning to wonder, because I've been struggling with ferritin/iron for so long (see previous post here):

healthunlocked.com/thyroidu...

Could it be possible, that because "the thyroid needs iron" that once my Iron is addressed....the thyroid will fall back into line? Has my thyroid literally been starved of iron and is now starting to struggle as a result?

It sounds too simple...but I've felt for a while that Iron is the "jenga" piece that restores the tower. If that makes sense, lol!

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My instinct is “no”. Don’t get me wrong - iron helps - is vital in fact - in you being able to convert T4 to T3. But I don’t think rectifying your iron levels will necessarily fix your thyroid issues.

Yes, hypothyroidism is mainly caused by Hashi’s - but not exclusively so. Some can be a genetic tendency. Plus of course, negative antibody tests don’t always mean you haven’t got Hashi’s. They’re not conclusive, I’m afraid.

I had a read through your last post and was struck by the waking up gasping for breath thing. Have you ever had a sleep study? Has anyone considered sleep apnoea?

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Hi Jazzw, sleep study has been mentioned in the past with regard to my epilepsy. But the episodes I described are not every night...but some nights. And even if it were sleep apnoea, is that not more of symptom than a cause?

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Ah well, that’s an interesting question. :)

It all gets a bit chicken and egg, doesn’t it? Not sleeping very well is known to have an awful effect on health - very stressful. So does the stress cause the symptom or the symptom cause the stress? Answers on a postcard... :)

Your thyroid results look a lot like mine did, in medicated. I felt awful. And my blood tests never show antibodies either.

I guess there’s no harm in giving it a whirl. You do seem quite anaemic. I’m just not sure if I can figure out why having low iron would make TSH high. If your high TSH was making FT4 higher, then it would make sense - it would be about converting more T4 to T3. But your FT4 is low - so even though your thyroid is being screamed at by the TSH, it still can’t make much thyroxine. That suggests your thyroid is failing.

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I know it's a puzzle isn't it😂 so as in, if iron is so crucial to a well functioning thyroid, if you starve it if iron for a prolonged period (ie are deficient for a long period...anemia or no) then it would become a poorly functioning thyroid would it not? A poorly (under)functioning thyroid triggers the pituitary gland to release TSH to try and nudge this sleepy thyroid awake. This is my understanding of the process. If I ind a way to give the thyroid what it needs (iron) I'm wondering....

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I edited my post while you were writing. :)

I’d agree - except if your high TSH was all about making FT4 higher, then it would make sense - it would be about your thyroid recognising it needs to raise T4 so that it could make more T3. But your FT4 is low - so even though your thyroid is being screamed at by the TSH, it still can’t make much thyroxine. That suggests your thyroid is failing, rather than it being about iron.

But I don’t know. :) I’m only guessing and your guess could be better than mine!

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Ah okay, interesting! I can see the thinking. I am literally still processing g all of this so that viewpoint/angle is really helpful. Thank you so much!

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All I can tell you is that most anorexics end up hypo, but it is not reversible.

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I am very far from anorexic 😂 ALWAYS hungry and it's a fight not to give in tbh. I've always found though, the more tired I am, the more hungry I am, and the less energy I have to make that meal from scratch. But I try!

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No, I never said you were anorexic, that wasn't the point. You were talking about your thyroid being 'starving', and asking if raising your ferritin could bring it back to life. Perhaps I should have phrased it differently - how about : when hypothyroidism is caused by anorexia, it's irreversible. Meaning that even if your hypo is caused by your low iron, optimising it is unlikely to revive your thyroid. But, that's just a theory, on my part.

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No I know it was just a hypothetical. I was just making light. But that is roughly what I was getting at. If "starving" my thyroid of iron has caused it to suffer and become less than optimal , in your view that's irreversible? This is all hypothesising and musing but I'm fine with that. Helps me get my head around it all.

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I don't suppose anyone really knows. There's so little research been done into things like that.

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OK, in which case I'll file that under "may be worth a try" 😊 :) Thank you again.

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It's not just that it's 'worth a try', you need your nutrient levels optimal, anyway.

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Yes, I'm fully aware of that. Thank you. Have lived with it for the last few years. I know how important it is. I have a haematology appt in August and am hoping for an infusion as this has gone on too long.

This thyroid thing though is a new thing. I'm just trying to figure out the chicken and egg thing. Iron deficiency predates any weirdness in my thyroid results by several years. Sooooooo....

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By extension, greygoose, makes you wonder if everyone who’s ever been on a diet of 1,000 cals or less for a length of time is likely to “give themselves” hypothyroidism. I have - and maybe I did. Which is so ironic. Soooo desperate to lose weight, I may have messed up my ability to ever make that easy...

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Except that if you were that desperate to lose weight, you probably already were hypo.

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Ha, very true. Although I’m still fat and can’t shift it. :(

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Ugh! 2 stone in the last 18months (1 of those in the last 3 months alone 😟) The weight just adds to the sluggishness. How have your energy levels reacted to treatment?

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I have more energy in general (but if I overdo it, it can lay me low for days). So I’ve learned the very boring art of pacing myself.

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There’s conflicting science on iron induced low Free t4 with no thyroid problem, some studies suggest it will fix your problem, others would suggest if it was from iron deficiency your TSH should be normal. Your TSH is high-normal.

I would get an ultrasound done to rule out Hashimotos as a minority will have normal antibodies but also Hashimotos.

thyroid.org/patient-thyroid...

I’ve had similar labs, normal TPOab and TGab, normal ultrasound, high-normal TSH with low normal FT4/FT3. But your FT4/FT3 are much lower in fact! Recent studies suggest central hypothyroidism can present with low, normal or even slightly elevated TSH. So your TSH wouldn’t be fully bioactive, it would be much higher given your low FT4/FT3. Fair enough to say there’s a malfunction in the hypothalamus and/or pituitary (often indistinguishable) so your thyroid is not being properly stimulated to produce adequate thyroid hormones.

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Thank you Andyb1205! So that would be central hypothyroidism? Greygoose, I think, referred to in on a previous post. I don't really know where to go with this. Don't think my gp will refer me on the basis of these bloods will he? I'm anticipating another fob off but I know I'm going to HAVE to go and see him if only to have it on my record that I did. Also not sure whether to push for a trial of Levo yet (even though I feel like he'll as am also PA (ABneg), iron deficient and low on vit D and folate). Would you say more info needed before deciding on a course of action?

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You can definitely talk to your doctor about a plan, get started on supplements for your vitamin deficiencies. I’m not qualified to answer if that would be sufficient to raise your thyroid hormones.

Otherwise, your FT4 is below range which is indicative of hypothyroidism. If not primary, then it must be central hypothyroidism. You may require a referral to an Endo to check the rest of your pituitary, that would be good. You should discuss with your doctor on a course of action soon, to wait until your vitamins are up before starting levothyroxine or to begin a trial now.

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Thanks Andyb1205. Appreciate your casting your eye over it all.

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No problem. Your GP may be unfamiliar with central hypothyroidism but your labs show a pretty clear cut case even by conventional guidelines.

Refer to page 28 here.

btf-thyroid.org/images/docu...

“The biochemical diagnosis of secondary hypothyroidism necessitates the use of a combination of TSH with FT4. Plasma TSH can be low, within or mildly above the reference range in these patients but combined with a low thyroid hormone measurement is suggestive of secondary hypothyroidism.”

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Gosh...so you think it's as clear cut as that? It's interesting because, I was diagnosed with epilepsy at 13. A time when my pituitary gland would have been highly active...makes me wonder.

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Assuming it’s not from the vitamin deficiencies themselves, then yes it would be a clear cut case I’m afraid. The good news is that the doctors would have to follow their own conventional and conservative guidelines. But you still may have to put up a fight because most doctors are next to clueless when it comes to the thyroid, they may write you off as “fine” for having in range TSH.

I had an idiot doctor tell me once that I’m fine because the TSH is what matters. That my T4 is barely in range but still not bad, and T3 is only a bit below range. Whole point of TSH is to present a mirror image of the T4/T3, and given the complexity of the thyroid the mirror is often cracked!

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Can we assume that it's not because of the vits though? I mean it's prolonged. 4 years + of borderline or deficient iron and folate and at one point severe vit D and b12 deficiency.

Also...What do you mean by :

"The doctors would have to follow their own conventional and conservative guidelines." ??

Sorry to be pain. You don't have to answer. You're probably wishing you never responded in the first place now, lol!

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No no not all I don’t mind! Thyroid patients are often neglected because of outdated guidelines that doctor have to follow. But your results would indicate a classic case of central/secondary hypothyroidism, low, normal, or slightly elevated TSH with low Free T4. So a doctor can’t refuse to follow their own guidelines.

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