Help to interpret bloods please?

[ziggyguitar]

Hi, I suffer from waves of extreme fatigue and considering different causes. I tend to feel crippling fatigue for a few weeks and then I'm fine for anything from a few weeks to a couple of months, then it's back again.

My GP said my thyroid levels just need 'watching' but because my TSH levels were fine than there was no need for medication. I asked for the results but really cannot make head nor tail of it:

Serum TSH level 2.31 mU/L 0.30 4.20mU/L

Serum free T4 level 10 pmol/L 12.00 - 22.00pmol/L

Can anyone explain what it means or tell me if there is any need for concern? I understand healthy levels vary from one country to another (I am in the UK). If this were the case then what would be my next step?

[SeasideSusie Remembering]

ziggyguitar

TSH (Thyroid Stimulating Hormone) 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. If not enough thyroid hormone then the TSH will be high. If there is enough hormone then TSH remains low.

Free T4 (free thyroxine) is a measure of the thyroid hormone circulating freely in your body.

In a normal healthy person, TSH would be probably no more than 2, and FT4 would be probably mid range or above.

Unfortunately no-one knows where their levels lie when healthy because they're not tested.

Your results show your TSH in a reasonable place, but maybe a touch high for a normal healthy person.

Your FT4 is below range, this means that there is very little thyroid hormone circulating for your body to use. Basically you are hypothyroid. Unfortunately, doctors in the UK are told not to diagnose and treat until TSH reaches 10, although there can be exceptions.

Two things spring to mind

1) You say you fluctuate between crippling fatigue and feeling fine. This suggests that you could possibly have autoimmune thyroid disease which is where thyroid antibodies can be raised and the antibodies attack the thyroid and gradually destroy it. Test results and symptoms fluctuate with the antibody attacks.

I think it's extremely important that you get your antibodies tested. There are two types

Thyroid Peroxidase (TPO) which your GP may be able to get tested.

Thyroglobulin (TG) which your GP is unlikely to be able to get tested, this is usually done by an endocrinologist.

These tests can be done privately. If you are considering this, then I would suggest you do a full thyroid/vitamin panel with either

Medichecks - Thyroid Check Ultravit medichecks.com/thyroid-func... (20% discount using MED99 if used before end of October on any test not on special offer)

or

Blue Horizon - Thyroid Check Plus Eleven bluehorizonmedicals.co.uk/t... (sometimes a pop up discount appears, today there is oct15 for 15%)

2) You could be looking at Central Hypothyroidism and you should ask your GP to look into this.

Central Hypothyroidism

This is diagnosed when TSH is low, normal or minimally elevated, with a low FT4. Your TSH is normal and your FT4 is obviously low because it's below range.

With Central Hypothyroidism the signal (TSH) isn't getting through for whatever reason so your thyroid isn't being stimulated to produce thyroid hormone so FT4 will be low. It could be due to a problem with the pituitary (Secondary Hypothyroidism) or the hypothalamus (Tertiary Hypothyroidism).

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... (Look at Summary and click on Read More)

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

[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.

**

One more thing

My GP said my thyroid levels just need 'watching' but because my TSH levels were fine than there was no need for medication

Please ask your GP to explain what he thinks is "fine" about FT4 being below range.

[ziggyguitar in reply to SeasideSusie]

Thank you so much for your reply, that is so helpful and has given me something to go back to the GP with. I really appreciate the time you took to reply, thanks again.

[SeasideSusie Remembering in reply to ziggyguitar]

Good luck. Please come back and let us know how it goes.

[AlleneMarie]

My level was 14 when I started taking Levothyroxine one year ago. Normal is one and a half to 5. I think you can Google what healthy levels are. It is confusing because the high numbers mean it's low. Your brain sends out signals telling your body to produce more T3 and 4 I believe but if your thyroid isn't working right then it won't make what your body needs hence levothyroxine. I am itching all over. I get up every hour or two when I'm home and look for bugs on my body on my furniture but they are not there. I have rashes in different places like right now on my chest above my breast. It itches like crazy but if I scratch it it just itches more. My skin is so sensitive that if string or a piece of lint moves across it well it feels like a bug is crawling on me. I'm taking two levo thyroxine pills every morning at the same time on an empty stomach and waiting for my numbers to go back down. Is it worth putting up with the side effects to have energy? Is there any other way? Has anyone tried that 40 something dollars thyroid vitamin stuff that is supposed to naturally give you all the things your thyroid needs to start working right? It's a mixture of vitamins and other things I will get back on here after I read it again and explain.??? I have no damn energy right now. I went to the cardio doc this morning because I thought maybe my heart was in bad shape. It doesn't look like it. I read somebody else's text about getting different things checked out. Why don't doctors tell you that you might feel heart palpitations, exhaustion, sleep problems, extreme itching Etc.? My memory has got so bad I can't even remember words that I know that are on the tip of my brain but I can't see them 4 five or ten minutes sometimes at all. Please reply anyone. Thank you

[SeasideSusie Remembering in reply to AlleneMarie]

AlleneMarie

Please start your own thread for your own question/problem, it will then be at the top of the forum page and be seen, and replied to, by members. It also means that ziggyguitar's thread will stay on topic.

[AlleneMarie in reply to SeasideSusie]

, sorry I m not to versed on form for this platform. New on smartphone. So exhausted have to sleep. I will fix later

[eeng in reply to AlleneMarie]

It does sound as though you could be undermedicated. Does taking antihistamine pills (the type you would use for hayfever maybe) help with the itching? I'm sure someone will help when you start a new thread.