Hi im new here. I have all symptoms of underactive thyroid. Fatigue, aches and pains, depression, feeling cold, bad memory. All my blood tests come back as normal so I was diagnosed with cfs but I have my doubts. Decided to do my own tests which I have posted below. Just wondering what others think. Really appreciate some help interpreting my blood test results. Am I right to suspect my thyroid isn't normal like they say?
TSH: 2.12 0.27-4.20
FT: 13.7 12.00 - 22.00
T4: 76.9 59 - 154
T3: 3.8 3.10 - 6.80
Thyroglobulin antibody:
<10 0.00 - 115.00
Thyroid peroxidase antibody:
1.3. 0.00 - 34.00
Active b12: 74.900 25.10 - 165
Folate: 4.44 2.91 - 50
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bragglinz
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It would be difficult for your doctors to find anything to suggest your thyroid was compromised- yes FT4 and FT3 are on lowish end of ranges, but TSH is in the lower half of range. In GB doctors wait till TSH is at 10, even though some countries realise over 3 can be hypothyroid. Neither do you appear to have raised thyroid autoimmune antibodies or Hashimoto's disease. You have had two of the usual 4 Vit/ min tests members suggest for helping support good thyroid, and general, health: folate and B12. For thyroid disease folate is recommended to be halfway up the range, say 27 plus, and B12 nearer the top of range. What about your ferritin and VitD? It may be low vit/ mins that are giving you some symptoms. I am diagnosed with fibromyalgia (along with hypothyroidism and diabetes) and various doctors ruled out other ailments with blood tests and various scans, so I can appreciate how some diagnosis seem like 'dead ends'; I recommend you look further into your vits/ mins as feeling proactive in your own health improves your well being. Perhaps other members will have other suggestions for you to follow.
There's no reason to suspect there's anything wrong with your thyroid as your antibodies are low and your TSH is not elevated.
I am seeing this so often nowadays. Your fT3 and fT4 are low normal and your TSH is not elevated, your TSH really should be high with both thyroid hormones being low. Your pituitary is failing to produce enough thyroid hormone. This can happen in 'secondary hypothyroidism' when there is a physical problem with the pituitary but in these cases the TSH is much lower.
Sometimes the hypothalamic pituitary thyroid axis is 'down-regulated' and so insufficient TSH is secreted. This can occur after a period of hyperthyroidism which is less likely in your case unless you can remember a period when you were hyperactive and perhaps sweating easily. It can also occur in patients with depression or people on restrictive calorie diets. Whatever the cause you need thyroid hormone to correct it. It may not be possible but I would push your doctor very hard for a trial of thyroid hormone, more than 25 mcg levothyroxine daily.
I've just had an telephone appointment with a gp in London who says based off my symptoms he thinks a trial of t3 would be a good idea. But wants to see my results first. I wouldn't even consider going to my local gp because of how much they have upset me in the past asking when asking for for various tests etc. Is t3 on its own OK or do you think I need t4.
My axis is down-regulated because I needed very high hormone levels for many years. I've found that although I can be OK on about 125 mcg levothyroxine it doesn't sort out my cognitive problems. This makes sense because the brain usually takes in mainly T4 and converts it to T3. TSH stimulates conversion of T4 to T3 in the thyroid and in brown fat. I also believe it does so in the brain but I can't find conclusive evidence. So, with an abnormally low TSH you get brain hypothyroidism.
I find I do best on 50 mcg levothyroxine plus 20 or 30 mcg liothyronine. Increasing the levothyroxine above 50 mcg doesn't make any difference, so it makes sense not to take it. I feel it is a good idea to have some L-T4 just to deliver more stable hormone levels and there's always a chance that T4 has a role we are not aware of. Taking 20 or 30 mcg L-T3 puts your fT3 above normal levels, I assume this is needed because we have reduced brain T4 to T3 conversion and so the brain needs these higher serum fT3 levels. (The brain controls its T3 levels by varying the rate of T4 to T3 conversion and I believe the brain has higher T3 levels than serum). The flip side is that some tissues such as the heart do not rely much on T4 to T3 conversion, these organs take most of their T3 from the serum.
Consequently if serum fT3 levels are high the heart may be overstimulated and put at risk. We should be aware of this risk but not exaggerate it. In any event there isn't much choice if you want a normal life. Get better and use your increased energy to exercise and enjoy life.
Sorry if the above gets too technical. To answer your question I would try levothyroxine first but if you find your fT3 going low whilst fT4 is below 20 I would start adding some L-T3. It's great that this doctor has offered L-T3 I would definitely go with them.
Do you suffer from depression or are you on a strict diet? I only ask because it would be useful to tackle these at the same time (not with drugs).
Depresssion can reduce the amount of TSH you produce and lead to the production of TSH isoforms with reduced bioactivity. TSH is not one molecule but a group of very large molecules 'isoforms'. These are all detected by the immunoassay (blood test) but they can vary in bioactivity.
Theres' a Catch 22. Although depression can lower TSH and hence thyroid hormones, hypothyroidism can cause depression. So, you have a bit of a vicious circle. Sometimes depression does not respond to antidepressants until the patient is given T3.
From a treatment point of view I would still try levothyroxine initially and if doesn't work then introduce some liothyronine. This all assumes you can find a doctor who is willing to prescribe. If you are seeing a psychologist you could look into asking them to consider T3 treatment as it has been shown to be helpful in 'refractory depression'.
Your FT3 is below range and FT4 is low in range and you would expect TSH to be higher with such low frees. It makes me wonder whether there is something preventing your thyroid hormone working effectively. Are you taking any other medications or have you any coexisting conditions (CFS excepted)?? Something isn't quite right.
No not taking any other medication. Not officially diagnosed with anything else apart from the cfs. Forgot to add my ferritin come back as on the low side 16.3 range being 13 to 150 so Ive just started taking optiferrin. C. Not had vit d levels checked yet.
Getting your ferritin to a good level, around mid-range or 70 could make all the difference. Thyroid hormone seems to work synergistically with iron and other vitamins. If vit D is also low then that will contribute to your thyroid struggling. Before starting levothyroxine trial I would correct these deficiencies and retest thyroid levels after a few months of having good ferritin and vitamin D levels.
Did your GP do a full iron panel based on low ferritin results and if so what was your iron level?
Ask doc if you would benefit from a full iron panel. If you're going to get vitamin D done, they could be tested at the same time. If you want doc to test for vitamin D then take a list of symptoms and if you never get out into the sun, work 9-5, never see the light of day and never go abroad for sunshine then tell GP that too.
CFS is not a condition, it's a name given to a range of symptoms that GP's can't attribute to a specific cause. There are probably underlying causes for the symptoms that can be sorted out. Could be nutritional/vitamin/mineral deficienies so definitly worth ruling out.
Always a good idea to request a copy of your test results from GP as they usually just say you are fine anyway, however, by having your own copies you will be in more control. It is not just being in range that is important like Drs think, but whereabouts in the ranges you are. NHS ranges are very wide and unreasonably so. Especially for vitamins.
Sorry I'm a bit new to all of this. What is central hypothyroid. I've heard it mentioned in other posts with similar results to mine but I'm unsure what the difference is.
Central hypothyroidsm is when the pituitary is not producing sufficient hormones, including TSH. This is split into secondary hypothryoidism where the fault lies with the pituitary and tertiary hypothyroidism where the problem is with the hypothalamus. So, 123 1. thyroid 2. pituitary 3. hypothalamus.
You might want GP to test B12 and folate before starting supplements.
Supplementing a good quality daily vitamin B complex, one with folate in not folic acid, might be of benefit
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results
Eating liver or liver pate once a week should help improve ferritin
Your vitamins are likely low because Thyroid hormones are low. But having low vitamins makes Thyroid hormones low. It's a vicious circle. Breaking it by improving vitamins is first step.
rfu - I'm not sure you annd I disagree! Central (secondary or tertiary) hypothyroidism is usually associated with a very low TSH along with low levels of other pituitary hormones. It is usually caused by an adenoma or trauma to the head. In a down-regulated axis the TSH is abnormally low but other pituitary hormones are usually normal. In both cases there is insufficient TSH and where the axis is down-regulated the TSH isoforms usually have reduced bioactivity.
So perhaps we are saying the same thing, there is too little TSH from the pituitary? Central hypothyroidism and a down-regulated axis have a different aetiology and effects on other pituitary hormone. In both cases some T3 medication is probably needed although I would always suggest levothyroxine in the early stages because it is cheaper, gives more stable doses and it is much easier to interpret blood test results.
Yes, that's something that intrigues me, why some patients seem to need NDT rather than a levo / lio combination. A blinded trial of patients receiving NDT or levo / lio delivering the same fT3 / fT4 is needed to show whether there is something in the NDT or it's simply a case of getting a higher dose frm the NDT. Unfortunately doctors who favour NDT have never done such a trial which would be simple and cheap. I'd fully endorse using NDT if levo or lio do not work.
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