Hi, my blood test results are considered normal. Had one in April and one in November, with the following results. Could it still be a thyroid issue, and if not, what else causes weight gain, (looking heavily pregnant) and not being able to lose it, despite doing weight training and aerobic exercise for half an hour each 5 days a week, plus sticking to a 1000 calory or less diet, plus tiredness. Is it worth trying a private GP?
April (medichecks test): November (medichecks):
TSH 3.28 3.77
Free thyroxine 13.3 14.3
Total thyroxine 81.5 Wasn't included
Free T3 4.02 5.42
Thyroglobulin antibodies < 10 13.6
TPOab 34.9 30.2
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No, those results are not 'normal' - they're in-range, but too low in the range for FT4/3, and the TSH is too high. You are hypo with a TSH over 3. However, the NHS likes it to go to 10 before they will diagnose! And that is why your doctor isn't taking your symptoms seriously.
But, I think we can safely say you have Hashi's, with TPO antibodies that high, even though they aren't over-range. Antibodies fluctuate so just because they were that level at the time of the blood draw, doesn't mean they will be next week. They could be a lot higher.
Hashi's is an autoimmune disease where the immune system slowly destroys the thyroid. So, at some point, the TSH will go higher.
In the meantime, if I were you, I would exercise less and eat more! 1000 calories is not enough, and all that exercise - as you have found out - is not going to make you lose weight. In fact, it could even make you put it on! Low-calorie diets and excess exercise have a negative effect on the conversion of T4 to T3, making you more hypo, and therefore more likely to gain weight. Just gentle walking or swimming until all this is sorted out.
Going to see a private doctor is always a huge gamble - unless you know someone in the same situation who has found someone to help. Private doctors rarely have any extra education, they're just NHS-trained doctors that cost a lot of money.
Does the NHS also wait until TSH is 10 if the hypo is bad enough to cause knock on problems? If the hypo is bad enough for someone to have thrush in their oesophagus and the TSH is 9, will they still not treat?
(I'm curious, because my hypo symptoms had been dismissed as all in my mind as I had a beautiful TSH (1.2? 1.3?) in about May. By July I had the same symptoms but also thrush in my oesophagus, which triggered further testing (by a new doctor). Normal healthy people don't get that - it's seen with serious illness like cancer - or - in hypothyroidism. I don't recall what the TSH was, and it was probably done in the afternoon anyway, but I rather think it was lower than 10.)
It depends very much on the doctor. They are supposed to use their intuition, but a lot of them either don't have any, or are scared to use it. So many of them take the guidelines as rigid rules - it makes like easier for them. But, also, they know next to nothing about symptoms, they just go by the TSH.
I wonder why just about everyone except GPs see to know about symptoms. Almost like a conspiracy. I suppose the best thing would be to find a GP with a thyroid issue themselves. This is all so depressing as you feel helpless, just sitting waiting for your blood results to get bad enough for them to do something, but meanwhile your body goes to wrack and ruin.
It's all to do with their education. GPs, in general medicine, spend about one afternoon on the whole endocrine system. So, you can imagine how little they learn about the thyroid. They learn nothing about symptoms, nutrition or antibodies.
However, when a doctor goes on to be a specialist, he often learns how the thyroid affects his special part of the body. All except endos. They only learn about diabetes. All in all, thyroid is the Cinderella of the medical educational system. And, we have Big Pharma to thank for that!
I must say that my GP (here in Aus) is very good with thyroid and also seems willing to listen and to ignore TSH if other numbers are good and it seems warranted. Also happy to continue to prescribe NDT for me. Orders FT3 and FT4 routinely (though I think T3 and T4 are discontinued now and they only do the frees) and RT3 when I asked for it, antibodies on occasion though not routinely. I have never had only a TSH done since the original diagnosis.
There are exceptions, of course. But, this is a UK based forum, so I mainly talk about UK doctors - and French ones. I know nothing about the situation in other countries.
Testing rT3 is a waste of time and money - it's an expensive test - because it doesn't give you any useful information. So your level comes back high? What does that mean? And what are you going to do about it? It's often hard to know why it's high, because the test doesn't tell you what's wrong.
Yes, that's true. And there is variation between doctors, and some English trained doctors here too. I've only had GPs run my diagnosis/treatment so can't comment on endos.
For me the RT3 cost about $100/GBP60. It's the one thyroid test I have to pay for out of pocket - all the rest is covered once you're a thyroid patient - and the GP can run them all. For me, it was worth every cent and more, as it showed up abnormal (high, out of range), and it rounded out the picture with my other test results - I was very unwell, and it was abnormal. That indicated that I'm converting poorly and suggested a need for a bit more T3 in my treatment regimen. Which was done and I feel significantly better now. But if the test doesn't inform a change in meds, then probably not worth it. I'm curious now about what that number is - I imagine it has come down since I'm much less symptomatic, though still very hard to lose weight - but not curious enough to pay for it out of pocket again!!
But you don't need an rT3 test to 'show' that you're converting badly, you just compare your FT4 with your FT3, and that shows it far more clearly. A high rT3 can be caused by many, many things, like high cortisol, or low ferritin, or infection, or low-calories diets. It doesn't automatically mean that you are converting badly. And it doesn't cause symptoms. It's the cause of the high rT3 that causes the symptoms, not the rT3 itself. rT3 is inert, and only stays in the body for a couple of hours before it is converted into T3. So, you could have found out that you needed a bit more T3 without spending all that money.
It's hard for me to tell. I'm on NDT and my FT4 barely ever scrapes into range, and my FT3 wasn't more than about mid range. (When I had that blood test I was on NDT and a titch of T4 at a total of about 90ish T4 and about 15mcg of T3. Then my FT4 was really low in range.) Does that tell you anything? I couldn't make much of it. FT4 is lower now that I'm on only NDT. At present the likely cause of the RT3 was that I was trying to lose weight.
I'm not sure we know enough as yet to say that RT3 is entirely inert - the body has receptors for it so it must have a purpose in the right amounts. But I completely agree that it doesn't look like it competes for T3 receptors, though you hear that a lot. I'm also not sure about the symptom thing, I'm not sure we have enough information.
I was happy to have it done, and I think it was useful in my case as it rounded out the picture. I'd do it again in the same circumstances. But not routinely and not now.
No, you can't tell how well you convert when taking NDT, but conversion isn't the most important thing when taking NDT. And the rT3 test would be of even less help!
So, you were taking NDT + levo + T3, if I've understood correctly? Why didn't you just increase your NDT? I don't understand the necessity to add both levo and T3.
FT4 usually is low when taking T3 in any form, so that doesn't tell you anything.
At present the likely cause of the RT3 was that I was trying to lose weight.
So, you're on a low-calorie diet? That would cause high rT3, and probably won't help you lose weight, anyway. Hypo weight isn't caused by too many calories. It's caused by low T3 causing low metabolism and water retention.
I'm not sure we know enough as yet to say that RT3 is entirely inert - the body has receptors for it so it must have a purpose in the right amounts.
Yes, it has a purpose in that it acts as a safety valve for the body under extreme circumstances, when the body needs to conserve energy. Under those circumstances, T4 is converted to more rT3 than T3 (normally it would be equal amounts). And does so without wasting the component parts or the T4 that isn't used to make T3. Every time T4 converts to T3, the atoms of iodine are released and recycled. rT3 is quickly converted to T2, and the T2 to T1, and the iodine recycled. And, it's possible that that is why there are receptors, so that the rT3 can go into the cells to be converted. However, no-one really knows what happens to rT3 in the cells, nor what it does. But most people are agreed that it is inert.
If you were in another country, I believe you'd be diagnosed with hypothyroidism also taking into account your symptoms. Also many countries diagnose/treat when TSH goes above 3. In the UK, for some unknown reason, they've decided that 10 is the lucky number, whilst ignoring disabling symptoms.
Don't diet at present as it is not 'food' which is causing weight gain but is a clinical symptom of hypothyroidism, due to your metabolism being so low/slow.
All blood tests for thyroid hormones have to be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between last dose of levothyroxine and the test and take afterwards.
The aim is a TSH of 1 or lower and you need increases every six weeks of 25mcg of levothyroxine until the TSH lowers and you feel well. The Free T4 and Free T3 (rarely tested) should be towards the upper part of the ranges.
Ask GP to test B12, Vit D, iron, ferritin and folate - everything has to be optimal.
Thanks, my GP made it clear she doesn't believe me and is not interested. She got quite shouty and annoyed with me and was not taking in what I said. She gave me a blood form for caeliac disease and suggested it was bloating, which I am not even going to bother with as it's clearly not that. I have ordered a blood test which includes B12, etc from an online company, the same as I did in the first place as they would never have checked anything beyond TSH. She did however give me a referral to an endocrinologist when I said I would not be happy about someone talking to me about stress and leaving it at that, but said she doubted they would do anything as my bloods were perfectly normal. The soonest appointment seems to be almost five months away. I hope I'm not the size of a house by then and that they will actually listen, but not too confident at the moment.
They seem to be unaware what a job thyroid hormones do, our brain and heart need the most T3 and no wonder so many complain of 'brain fog' etc plus the myriad of other symptoms they may have. Unfortunately those at the 'top of the tree' seem to insist that the TSH has to reach 10 before we're diagnosed. In other countries it is 3+.
I actually took two of those pages to the GP, but she was too busy insisting that the blood test was normal so that was that to look at them properly. At the end, she said very brusquely, "are you taking those?" To which I should have replied "actually, it would be nice if you read them", but by then I was annoyed by her annoyance and just wanted to leave.
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FT4 is lower now that I'm on only NDT. At present the likely cause of the RT3 was that I was trying to lose weight.
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