A little advice re: blood test if possible?

[wendybee]

Hi all,

I've popped over here from the PAS forum as I've recently had my Thyroid Function Test results back.

A little background info, it was discovered that I didn't have the intrinsic factor when I was about 10 years old so had PA. Nothing was ever mentioned about it after that. I have always been tested for Thyroid issues whenever I visit the doctor with any complaint due to family history. My Mum has underactive, my Nan overactive.

About 5 years ago I was experiencing pins and needles, napping daily, memory loss but had blood tests and everything was 'normal'. I spoke to my GP and mentioned about PA and she said that my B12 was a little low (162, low lab range was 160!) So started loading doses.

Fast forward to now (I'm 31), I have B12 injections every 8 weeks due to the neuro symptoms. However this doesn't seem to be holding me and Is effecting me at work.

My current GP (not as good) asked for Throid Fucntion Test to be done and my results are as follows:

Serum TSH: 1.76 (0.3 - 4.8)

Free T3: 4.9 (4.2 - 6.9)

Free T4: 9.5 (7.7 - 20.6)

Just for reference - Serum B12: 559 (145 - 914)

(I read on the Thyroid UK page that T4 lower range was 10)

Antibodies weren't checked unfortunately.

Please can someone advise if the test results are in fact normal? I have an appointment with my GP on Monday and was initially going to ask for my B12 injections more frequently (or begin to look into self injecting), I am armed with the NICE guidelines etc. However I wasn't sure if it would be worth brining up my results with him?

Any advice/reassurance would be greatly appreciated.

Thanks so much in advance,

Wendy

[greygoose]

Hmmmm… Difficult one. Your TSH would be classed as 'very good' but any GP. However, your FT4/3 are very low. I'm not a GP - nor any other sort of doctor - but that looks suspiciously like Central hypo, to me.

Central hypo is when the problem is with the pituitary (Secondary hypo) or the hypothalamus (Tertiary hypo) rather than the thyroid itself (Primary hypo). For whatever reason, the pituitary cannot produce enough TSH to stimulate the thyroid to make more hormone. Have you ever had a serious bang on the head? Or excessive bleeding? Do you have any hypo symptoms?

[wendybee in reply to greygoose]

Hi, thank you so much for your reply. Any help is invaluable right now. I will have a read up on central hypo over the weekend.

I haven't had any head trauma or excessive bleeding. Although my GP did ask if I had banged my head or had any serious infection recently. Never would have thought that it would be linked.

I have a lot of hypo symptoms but have always assumed that they were due to Pernicious Anemia as the symptoms can be so similar. My current issues are constantly cold, freezing hands and feet, but this has always been an issue!

Poor memory & concerntration, mainly forgetting simple words or people's names.

Hearing - struggling when out in a group.

Blurred vision- have been referred to hospital via Specsavers, though I'm too sure why. Specsavers also did a hearing test for me and said there were issues but I was too young for any type of referral or treatment? I guess they have guidelines!

Shaking/trembling hands, I would usually put this down to being hungry or needing a cuppa but it's starting to happen more frequently.

Also often feeling as though I'm drunk which is very unsettling.

I have tried to list these symptoms to my GP but he made it abundantly clear that it was "one issue per appointment" and didn't want to listen. I am taking my Mum with me on Monday (feels silly saying that at 31) in the hope that she will take in some of the information I don't.

Once again, thank you so much!

[greygoose in reply to wendybee]

You're welcome.

I can relate to all your symptoms. And, that's the problem with hypo, the symptoms are non-specific and can all be explained away by 'something else'. But, when you have a whole bunch of them… Are you more likely to have 24 diseases with one symptom each? Or one disease with 24 symptoms. That's what doctors should ask themselves. But, they know nothing about symptoms, and prefer to treat each one as a separate disease!

[wendybee in reply to greygoose]

Oh yes! That's exactly right. My response to him saying "one issue per appointment" blah blah blah was that I would hope that they symptoms would be related. His response to that was "That's for me to decided" I dread to think what my facial expression was like upon hearing that!

It seems that if the symptoms don't relate to anything on their QOF register then they are not fussed about diagnosing.

Fingers crossed for Monday or I may be seeking a new surgery!

[greygoose in reply to wendybee]

Sounds full of himself, doesn't he! Has he never heard that the only expert on any disease is the patient him/herself?

He should take a tip from William Osler MDCM, who said “Just listen to your patient, he is telling you the diagnosis.”

I think I might have replied something rather sharp and to the point, had he said that to me. lol

[SeasideSusie Remembering]

wendybee

(I read on the Thyroid UK page that T4 lower range was 10)

What you read on the ThyroidUK page was:

FT4 = FREE T4

Thyroid hormones not bound to proteins. FT4 lowers when the thyroid is struggling.

The approx. reference range for this test is 10 to 24

Ranges vary from lab to lab, so it doesn't matter what you read, it's the range that comes with your result from the lab that did your test that is the only one you can use.

Free T4: 9.5 (7.7 - 20.6)

Your FT4 is 13.9% through it's range, which is low. Your FT3 is also very low in range.

It's possible that your results might indicate Central Hypothyroidism, as Greygoose has said. This can be indicated by a low, normal or slightly elevated TSH and a low FT4. Whether "low FT4" actually means low in range or below range I don't know, but it's worth pursuing.

Your GP can look at BMJ Best Practice for information - here is something you can read without needing to be subscribed bestpractice.bmj.com/topics... and another article which explains it ncbi.nlm.nih.gov/pmc/articl... You could do some more research, print out anything that may help and show your GP.

As Central Hypothyroidism isn't as common as Primary Hypothyroidism it's likely that your GP hasn't come across it before. You may need to be referred to an endocrinologist. If so then please make absolutely sure that it is a thyroid specialist that you see. Most endos are diabetes specialists and know little about the thyroid gland (they like to think they do and very often end up making us much more unwell that we were before seeing them). You can email Dionne at ThyroidUK

[e-mail]

for the list of thyroid friendly endos. Then ask on the forum for feedback on any that you can get to. Then if your GP refers you, make sure it is to one recommended here. It's no guarantee that they will understand Central Hypothyroidism but it's better than seeing a diabetes specialist. You could also ask on the forum if anyone has been successful in getting a diagnosis of Central Hypothyroidism, possibly in your area which you'll have to mention of course.

[wendybee in reply to SeasideSusie]

Thank you so much. All this is a great help.

I have a feeling my GP will be rolling his eyes when I produce all this information - but oh well!

I'll print some bits off from the BMJ and have a good scout trough.

Thanks again, this has all been very helpful!