Here are this week’s results from a very dear friend of mine. As you can infer from these numbers, she is feeling extremely unwell, and although this must be seen in the context of complicated non-thyroidal illness including ileostomy and rapid transit, so likely malabsorption, we would very much welcome all input re t4/tsh, and folate/ferritin
GP input is described by my friend as being as much help as a chocolate teapot, a pattern we are familiar with,
Very many thanks, Ginny
Serum folate <2.0 ug/L range 3.9-26.8
“ ferritin 8.1 ug/L “ 13.0-150.0
“ free t4 3.8 pmol/L” 12.0-22.0
“ Tsh 2.73 miu/L “ 0.27-4.2
Thanks all!
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Ginny52
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If your friend's current doctor is ignoring these results, she should see another one as soon as possible.
Her Ferritin, being below range, suggests there may be iron deficiency anaemia, so she needs a full blood count and iron panel.
Her Folate, being below range, means folate deficiency. She needs B12 testing because B12 and Folate work together. She will need folic acid prescribing for the Folate deficiency but not before testing of B12 as folic acid masks signs of B12 deficiency. She should check for signs of B12 deficiency here
And if she has any then she should list them to discuss with her GP and be tested for B12 deficiency/pernicious anaemia.
As you suspect malabsorption, and that could be the reason for these results, what is being done about that?
FT4 is below range so there is likely very little FT3 either, and T3 is the active hormone that every cell in our body needs. She should suggest that she sees an endocrinologist or at the very least the GP discusses her FT4 result with one.
Her TSH is within range so this wouldn't get a diagnosis of primary hypothyroidism or subclinical hypothyroidism (TSH needs to be between 4-10 for subclinical). However, there is Central Hypothyroidism which is where the problem lies with the pituitary (Secondary Hypothyroidism) or the hypothalamus (Tertiary Hypothyroidism) and this is suggested by a low, normal or slightly elevated TSH and a low FT4. This is worth pursuing.
I'm not on my main PC where all my links are stored, I don't have them on my tablet., but if you see my reply in this thread there is information about Central Hypothyroidism including a couple of links that can be discussed with the GP
SS, thank you! She has been unlucky enough to get a gastro as bad as her gp, who has just told her that as long as she isn’t losing weight it makes no odds how short of vital nutrients she is. I wondered if absorption probs could have led to iodine deficiency, but gp says tsh would be low (?)
She has a genetic problem I have too, with a slight possibility of pituitary problem (empty sella), shouldn’t cause this xx, thanks ginny
Hi Ginny the poor lady is not going to be very well at all with these results.Her T4 is in her boots and everything else well below par.She can purchase some ferrous sulphate quite easily from a chemist as well as some B vitmains.I should imagine her B12 is really low too and she might benefit from some patches rather than something oral. Her GP is appaullingly neglectful.I would be good of she felt up to being able to make a formal complaint and maybe even consider legal advice.We are not overly impressed with the medical profession on this forum but some doctors stand out as being exceptionally uncaring and incompetant.As far as going forward she needs some thyriod hormones as soon as possible.There is a list of more helpful doctors available via the TUK website.( I think you have to email someone) or she may have to consider treating herself. She might be able to get treatment on NHS if she could be diagnosed as having a pituaritary problem that is driving the low thyroid hormones and unresponsive tsh and that I would think would be the best way to go if she is able to put up a bit of a fight with the NHS.If she does decide to persue NHS treatment it would be worth contacting the pituaritary foundation to ask about the best pituaritary services most local to her and then seeing another GP in her practice ( perhaps after complaining about the first)t to ask for a refferal. Poor lady.
Seeing the treatment she’s had recently makes me so angry for her I just can’t say in language fitting for a family forum!
She is 21and I hate seeing her dealing courageously with so little medical support. The complaint word suggested itself to me too, but I know the good sense here will buoy her up as it has always done for me- passing this straight on- thank you so much xx
The gp is unbelievable, and is so obviously overwhelmed by having to coordinate the care of a seriously unwell young person that she has thrown in the towel, leaving my friend not only to cope with her health problems but to organinise her care in our underfunded nhs as well. I find it hard to understand what they’re taking their money for! Thanks so much xx
She has annual Endo for adrenal insufficiency (steroids). I thought it would probably be best to ring his/her sec and try to blag an urgent appointment because there are so many factors at work here that he/she might have some kind of overview.
God what an indolent bunch they are! They have reduced her to near despair at the moment, and this is a woman who doesn’t despair easily!
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