Could my thyroid really be the problem?

[katmell]

I think I posted this in the wrong section so posting again here! I wrote on here last week for advice on GP blood tests that were TSH level is 4.91 (range 0.35-5.50) T4 is 9.2 (range 7.86-14.41). My GP put me on 25mg thyroxine to see if it'd help my symptoms even though he thinks it's depression causing it, and I've since paid for private tests to get a clearer picture.

I've just got the results back but I'm really not sure what to make of them. I'm guessing I don't have an autoimmune reason for feeling like this?? I've had other tests done for vitamins d, b's, ferritin etc and they're all either high or above range but my symptoms are awful and pretty classic of hypo including high cholesterol which I've never had before. If anyone can help shed some light I'd really appreciate it.

These are the private results:

TOTAL THYROXINE(T4) 63nmol/L (59 - 154)

THYROID STIMULATING HORMONE 4.01mIU/L (0.27 - 4.2)

FREE THYROXINE 13.8pmol/l (12.0 - 22.0)

FREE T3 3.4pmol/L (3.1 - 6.8)

Thyroglobulin Antibody<10.0IU/mL 0-115

Thyroid Peroxidase Antibodies<9.0IU/mL 0 - 34

[Judithdalston]

Unfortunately a dose of 25 mcg levo is very unlikely to make much difference re improvement, and might infact make you feel worse. How long were you on levothyroxin, 6-8 weeks? 25 mcg levothyroxin is a starter dose for very young, elderly or those with heart problems- should have been 50 mcg. Are you getting blood drawn at same time early morning say 8-9 am, without food, and no levothyroxin for 24 hrs before? Ideally should get yourTSH down to 1 or below, eventually to get FT3 to halfway plus thru range ie 5+. You might be Hashimoto's but just getting tests when antibodies low, unfortunately their behaviour is unpredictable. You are lucky the doctor has given you levothyroxin, but continue pressing for increase to you feel ok.

[katmell in reply to Judithdalston]

I've only been on it just over a week and didn't take it for 2 days before i had the recent private blood tests done (all early am and fasting). My GP wants to test me again in 6 weeks at which point i'll ask him to increase the dose. I know he won't be keen though as he thinks its depression causing these symptoms. I am certain it isn't (I'm a psychologist so do know what I'm talking about) and think it's actually these symptoms that have made me depressed.

Unfortunately, I've been on sertraline since these symptoms started last year. I feel I should have been more assertive about it all as all my GP has done is keep upping the sertraline (which has had no effect!) and I'm almost at the maximum. This is despite being pregnant when it started and now breastfeeding. I wish I'd pushed for thyroid investigations sooner rather than take a drug that carries risks to unborn babies and has had no positive impact on my mood or physical symptoms.

It would mean so much to come across a GP willing to have a two-way holistic focussed discussion

[greygoose in reply to katmell]

You tested too soon - should wait six weeks - and you were off your levo for too long. So, those labs are worthless.

[katmell in reply to greygoose]

It was just to test for antibodies and T3 as my GP wouldn’t do that. So I stopped Levo for 2 day’s to see what T3 levels were without treatment. I’m getting tested again in 5 or so weeks to see what 25mg a day of levo until then has does to my levels

[Judithdalston in reply to katmell]

So on 25 mcg for a few days, then off, then test? So the test really is more like what you were like before taking levo, tho could be slightly compromised by some T4 is system?

[jimh111]

Both your fT3 and fT4 are low normal with a normal TSH. Usually when both hormones are lowish the TSH jumps up. It suggests your pituitary is underperforming , not really central or secondary hypothyroidism which occurs when there is a pituatary problem but a milder form. Have you had a recent head trauma? This can sometimes cause TSH to be low, also depression and strict dieting. Whatever the cause it would make sense to give you sufficient levothyroxine to bring your fT4 up to around 18 or 20 and see if your fT3 gets to around 5.0 where it should be.

[Portia1974]

Hi Katmell

So these are almost Identical to my results!! My (NEW) GP has diagnosed hypothyroidism on the basis of them. However from everything I have learnt, read, been advised etc this particular combo (FT4 & FT3 low in range but TSH that is not as high as it should be given how low the FT4 & FT3 are) is suggestive of Central Hypothyroidism rather than Primary hypothyroidism. That is that the thyroid gland itself is not the primary issue. Rather that the problem could potentially lie in the "central command center" for the thyroid. And that is either the pituitary or the hypothalmus. Even though you are low in FT3, your thyroid is not getting the message to produce more hormone because the message (The TSH) isn't strong enough from the pituitary. Suggesting pituitary function is sluggish/suppressed in some way.

This is my "thyroid newbie" way of explaining what I have only learnt recently and there will be others more knowledgeable than me who will hopefully give you some input. Suggest a quick google on Central Hypothyroidism in the meantime.

Something obviously going on with those antibodies too but have no knowledge in that regard I'm afraid.

I'm fortunate in that I now have a very "holistic" GP who is willing to look at the overall picture and not just the bloods. Because any other GP I've seen looks at TSH and if it's in range it's fine. I now realise that results going back to at least 2010 suggest a thyroid issue despite being told it was all "fine".

Are there other GPs at your practice? Is there another practice you can move to? The one I am at now is about a 15min drive away compared to the 5 min walk of the crap one. But thank god I made the change. I found out about it through recommendations from local friends. Are you maybe able to ask about and see if others could recommend a better GP either in your current practice or a different one?

[katmell in reply to Portia1974]

Hi Portia1974, oooh so your GP has given a diagnosis of hypothyroid. Have they prescribed anything? Has it helped?!

I’d be more than willing to change GP and surgery. Tricky thing is knowing who/where to change to though. I think I’ll see what my current GP suggests when I see him again in around 4-5 and what if any change I’ve had in bloods and symptoms at that point.

Thanks for the info on central hypothyroidism - I’ll have a read

[Portia1974 in reply to katmell]

Yep been prescribed Levothyroxine 50mcg. Only 2nd tablet today. TBH I feel worse today. But am hoping that's either coincidence (surely just two tablets can't have such a quick reaction) OR as I've read many times on here, initially you feel worse before you feel better. One thing I can tell you as we have such similar results...you're not imagining it. Somethings out of kilter.

Good luck!

[Nanaedake]

Check the sertraline leaflet, could it impact thyroid hormone and consequently cause reduced function?

Are you female and of menopausal age because if so, have you excluded calcium deficiency? It doesn't always show in blood tests but can cause depressive symptoms. Do you eat calcium rich foods at every meal? You mention some vitamins are above range but you don't want fat soluble vitamins to be above range. Have you checked?

Did GP do HBA1C test?

[katmell in reply to Nanaedake]

Hi Nanaedake, yep I checked the sertraline but actually these symptoms preceded me taking that. I was prescribed that after this started as they thought these physical symptoms were caused by depression. I maintain depression has been caused by the way I feel physically which on some days feels like being trapped in an exhausted body with a numb brain! Quite a constrast to what I used to be like (Pilates at 6.30am most days, cycling 6 hrs a week, able to clean my house, walk my son to school, socialise, be happy, be productive in my job).

All my vitamins and mineral levels are good - I’ve been taking supplements for over a year and had ferritin intravenously last year (it was v v low) after I thought it could be that and before I’d realised just how many hypo symptoms I’ve had for some time.

[Nanaedake]

I think it's likely your depressive symptoms were caused by your low nutrient levels but that now your symptoms are being caused by the sertreline.

ncbi.nlm.nih.gov/pubmed/250...

This report makes me think there could be a connection between calcium deficiency and SSRI's.

I have no medical experience but If I had your results I would not jump to the conclusion my symptoms were thyroid related because you have no thyoid antibodies and your low vitamin levels were likely the cause of depressive symptoms while the sertreline will now be affecting thyroid function and contributing to continuing symptoms.

If it were me, I would increase intake of calcium rich foods at every meal and get off the SSRI's with advice from GP about how to go about it.

This article suggests a link between low calcium and anxiety.

tranquilitylabs.com/calcium...

whittington.nhs.uk/document...

ncbi.nlm.nih.gov/pubmed/825...

Your low nutrient levels are likely to go hand in hand with gut dysfunction. Approx 70% of your immune system resides in your gut and more people are thinking there is a connection between gut function and the brain - I think it's the vagus nerve that connects the two - so I would improve gut function with pro-biotics or home made kefir using organic whole milk which will also improve calcium absorption. See what happens with making those changes.