Who is suffering with quite bad anxiety, depression and O.C.D. The blood test was done at 6pm in the evening. Their thyroid results came back as...
TSH 3.74 (0.3 to 5.0)
T4 8.9 (7.9 to 16.0)
Doctor would not do T3. I know I would be very ill on these results but their doctor is saying all normal.
Thank you xX
Katherine
If you friend can get a very early appointment for another test, definitely no later than 9am, and fast from the evening meal the night before (just delay breakfast on the day of the test, and drink water only until after the blood draw) that may send her TSH over range which would help. She could then be pushing for a diagnosis of Subclinical Hypothyroidism which is where the TSH is between 4 and 10 and with symptoms.
With her current results, I would say she could possibly push for investigation into Central Hypothyroidism. This is where the problem lies with the hypothalamus or the pituitary rather than a problem with the thyroid gland. With Central Hypothyroidism the TSH can be low, normal or slightly raised, and the FT4 will be low.
TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). In Primary Hypothyroidism the TSH will be high. If there is enough hormone then there's no need for the pituitary to send the message to the thyroid so TSH remains low.
However, with Central Hypothyroidism the signal isn't getting through for whatever reason. It could be due to a problem with the pituitary (Secondary Hypothyroidism) or the hypothalamus (Tertiary Hypothyroidism).
Her 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 the GP.
As Central Hypothyroidism isn't as common as Primary Hypothyroidism it's likely that her GP hasn't come across it before. She may need to be referred to an endocrinologist. If so then please make absolutely sure that it is a thyroid specialist. 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
tukadmin@thyroiduk.org
for the list of thyroid friendly endos. Then ask on the forum for feedback on any that she can get to. Then if her GP refers her, 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.
Awww! thank you SeasideSusie I am going to print this all out and give it to her and the link. I hope you don't mind xX
If in the UK, it seems very barbaric to me that doctors seem to have been advised not to be prescribed thyroid hormones until the TSH reaches 10.
The following is from Thyroiduk.org.uk
thyroiduk.org.uk/tuk/testin...
Your friend can get a private blood test if she can afford it. They are home pin-prick tests and you are aware that an early a.m. blood draw is preferable which she can do at home and should be well-hydrated a couple of days before blood draw. Just in case I will give a link and there are several home pin-prick test labs.
thyroiduk.org.uk/tuk/testin...
Even if TSH is not high enough 'for diagnosis', if thyroid antibodies are present she should be prescribed levothyroxine.
How can a T4 of 8.9 (7.9 to 16.0) provide sufficient T3.
T4 is an inactive hormone and has to convert to T3. T3 being the only active thyroid hormone.
It is particularly to be deprecated because in the past ten years we have seen the TSH ranges generally reduce at the top end. That is, we used to see lots of range topping out about 6.00, now few (if any) do.
I cannot help but conclude that the gap between 6.00 and 10.00 is smaller than the gap between 4.50 and 10.00. With the consequence that 10.00 is effectively a higher level now than it was. If you see what I mean!
(All this depends on why the ranges have tightened. At least a part has been more rigorous exclusion of anyone with thyroid issues from the process of setting ranges.)
Thank you for your reply Shaws I don't think she would be in a position to pay privately :0/ she is working all hours just to make ends meet for her and her toddler. Her thyroid antibodies were not tested and her doctor does not seem sympathetic to her anxiety, tiredness and fatigue (she has to be in bed every night at 9pm) just to get a little energy (she is 41). All her doctor will prescribe her is anti-depressants, these have not really made much difference to her anxiety. Her doctor prescribed anti-depressants with out any testing of her thyroid, B12, iron, folate etc. I was the one that said to her go and get these tested. She did ask if she could have a trial of levothyroxine but her doctor said no your thyroid is normal. She did not test for T3.
If she can't afford full testing privately perhaps she could just test thyroid antibodies
Or push another GP to test
Same with vitamin D - or only £29 postal kit
Essential to test thyroid hormones early as possible in morning and fasting to get highest TsH
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