Hypothyroid? Help please 🙏

[Grundywhiffs01]

Hi everyone.

Firstly this forum has been a great help for me to understand, and self diagnose myself. I have had various blood test recently as I am on testosterone replacement therapy, and I noticed my thyroid levels were "off". I have also been feeling low, un energised, cold dry hands etc.

So my levels....

TSH - 4.4 (0.27-4.2)

Free T4 - 8.6 ( 12-22)

Free T3 - 4.5 (3.1-6.8)

Gp says everything is normal. Im considering self medication.

The only other level that looked poor, was ferritin - 41 (24-336).

Any and all advice welcome.

Thanks

[SeasideSusie Remembering]

Grundywhiffs01

TSH - 4.4 (0.27-4.2)

Free T4 - 8.6 ( 12-22)

Please go back to your GP and ask on what planet is an over range TSH and below range FT4 classed as normal.

From btf-thyroid.org/information...

"Test results outside the reference range

A high TSH level with a low FT4 level: hypothyroidism (under-active thyroid)"

Overt hypothyroidism is diagnosed when TSH reaches 10 and FT4 is below range.

Subclinical hypothyroidism is when TSH is above the reference range but below 10, and FT4 is within the reference range.

You have a mixture of over range TSH (but below 10) and below range FT4.

If your GP can't diagnose anything ask for a referral to an endocrinologist or at least ask your GP to ask for guidance from one.

Also ask for thyroid antibodies to be tested.

Ferritin is way too low, it should be at least half way through range. Low Ferritin = decreased thyroid function.

restartmed.com/low-ferritin/

[Grundywhiffs01 in reply to SeasideSusie]

Thanks so much for your reply / advise. I should add the Ranges the NHS use are slightly different, so it can be classed as "in range" with there labs. I use Medichecks ranges, as i feel they are more accurate. What Ferritin supplements / dosages would you recommend?

Thanks

[SeasideSusie Remembering in reply to Grundywhiffs01]

Ranges aren't interchangeable. Each lab has their own range that is set by the equipment they use, so whatever Lab A's result is you only use Lab A's range, and Lab B's range can only be used for Lab B's result.

I know those ranges quoted in your opening post are Medichecks ranges. Are those results from Medichecks or are they NHS results? If they are NHS results, what were the NHS ranges?

I can't say what you should supplement with for your low Ferritin. Iron is complicated and when Ferritin result is low then it's best to get a full blood count and iron panel to check for anaemia.

All I ever suggest for low Ferritin is to eat liver, maximum 200g per week due to it's high Vit A content, liver pate, black pudding and other iron rich foods.

[Grundywhiffs01 in reply to SeasideSusie]

Ok.

Ranges for NHS were...

TSH - 0.34-5.6

FT4 - 7.5-20

So both in range, but knowing that's not a indication of good levels. I wasn't advised anything on these levels, or the Ferritin,just told all normal.

[SeasideSusie Remembering in reply to Grundywhiffs01]

TSH - 4.4 (0.34-5.6)

Free T4 - 8.6 (7.5-20)

So yes, they are in range so you will be told they're normal, but TSH over 3 would give a diagnosis of hyperthyroidism in another country but not here in the UK. FT4 is very low in range.

Did you have this test early in the morning, no later than 9am, after an overnight fast (water allowed)? TSH is highest very early morning and lowers throughout the day, so test needs to be done as early as possible. Eating can lower TSH, and coffee aftects TSH.

Have you had thyroid antibodies tested?

In your shoes I would do a full thyroid / vitamin panel with one of our recommended labs, either Blue Horizon Thyroid plus Eleven or Medichecks Thyroid Check UltraVit and do it early morning and fasting.

You were told Ferritin is normal because it's in range. Doctors don't "do" nutrition at med school, so in range means perfect as far as they are concerned. Yours is too low, as the article I linked to explains.

[Grundywhiffs01 in reply to SeasideSusie]

Thanks.

Bloods were taken at 11am. Ate breakfast at 8. No coffee etc. They didn't do Thyroid antibodies, just TSH and FT4.

I will order the full thyroid panel through Medichecks and post back results.

Thanks for your help, you have been very helpful

[Angel_of_the_North in reply to Grundywhiffs01]

Yes, those tests were not really any use if done at 11 after eating.

[Grundywhiffs01 in reply to Angel_of_the_North]

I did check with the receptionist, as to whether it needed to be done fasted, first thing. They said no, not requested. Kinda lost all hope with NHS tbh.

Ive just ordered a full thyroid panel including antibodies, plus a full iron panel both through Medichecks. Hoping to sort it myself.

[Angel_of_the_North in reply to Grundywhiffs01]

That's because they don't care that TSH is higher in the am and can fall after eating - they want NOT to have to spend money on you, so they want the opposite to what we want. Just don't bother discussing that. Many of the private tests now specify fasting tests and no levo for 24 hours, You also need to stop any B vitamins, or hair and nails supplements containing biotin for about 3 days beforehand and these can interfere with test results. Why would a receptionist even know any of that?

[Grundywhiffs01 in reply to Angel_of_the_North]

Ok.

I didn't expect the receptionist to know, but she would be able tp tell if early morning / fasted was requested by my GP, which is why I queried the 1st appointment she offered of 3pm

[Grundywhiffs01 in reply to SeasideSusie]

Hi again.

Just received my results from a full thyroid panel with antibodies.

Results are.... No antibodies.

Tsh - 3.3 (0.27-4.2)

FT3 - 4.4 (3.1-6.8)

FT4 - 15.2 (12-22)

RT3 - 15 (10-24)

What would your advise based on these results?

Thanks

[SeasideSusie Remembering in reply to Grundywhiffs01]

Hi Grundywhiffs

Those results will be classed as euthyroid (normal) because they're all in range.

Again, TSH 3.3 would give you a diagnosis in another country but not here. Both FT4 and FT3 are low in range - FT4 32% and FT3 35%. Unfortunately, nobody knows where we need our FT4 and FT3 levels to be because they're never tested when we're well to give a baseline. Most fit/healthy people would probably have a TSH no higher than 2 and FT4/FT3 probably over half way through range.

So at the moment there's nothing your doctor will do other than say everything is normal.

What were the actual figures for the antibodies?

Did you have vitamins and minerals tested - if so what were those results?

[Grundywhiffs01 in reply to SeasideSusie]

Ok thanks.

Thyroid antibodies were...

Tga - <10 (<115)

Tpa - <9 (<34)

Vitamins are normal apart from b12 too high. Currently supplementing with a multivitamin containing high levels of b12, so have reduced the dosage.

I was considering seld medicating with low dose Thyronorm to try and optimise the thyroid levels and see if my energy levels improve. Would you recommend this? Was going to start at 50mcg ED

[SeasideSusie Remembering in reply to Grundywhiffs01]

OK, so antibodies are nice and low so no problems showing with those results.

Vitamins are normal apart from b12 too high. Currently supplementing with a multivitamin containing high levels of b12, so have reduced the dosage.

What is "normal". They need to be optimal so if they aren't are the following levels they probably need supplementing:

Vit D - The Vit D Council recommends a level of 125nmol/L [50ng/ml] and the Vit D Society recommends a level between 100-150nmol/L [40-60ng/ml].

B12 - top of range for serum B12, well over 70 for Active B12.

Folate - at least half way through range

Ferritin - half way through range

Multivitamins are generally a waste of time and money. They tend to contain too little of anything to be of help if we have any low nutrient levels, and generally use the cheapest and least absorbable form of active ingredients. They often contain things we shouldn't take unless tested for and only should supplement if they are deficiency, i.e. iron, calcium, iodine. If they contain iron then that affects the absorption of everything else so renders them pretty useless.

Always best to address any low levels individually and forget multivitamins altogether.

Before considering starting any Levo, you need to make sure all your vitamin/minerals are optimal.

[Grundywhiffs01 in reply to SeasideSusie]

Ok, appreciate the advice.

Vitamin D - 88 nmol (50-175)

Ferritin - 63 (30-400)

Serum Folate - 14.6 ( >3.8)

Active B12 - 214 (37-188)

I am now supplementing 10,000iu D3 with k2mk7 to raise D3, and taking iron with vitamin c to raise iron/ferritin levels.

Will improving these levels boost thyroid function and improve levels?

[SeasideSusie Remembering in reply to Grundywhiffs01]

10,000iu D3 - is that daily? If so with a level of 88nmol/L (35.2ng/ml) already it's a bit like taking a sledgehammer to crack a nut. With your level the Vit D Council recommends a daily dose of 2,500iu to achieve the recommended level.

vitamindcouncil.org/i-teste...

Is the iron prescribed? Have you had an iron panel carried out and know your serum iron level? If not then you may not need iron tablets, that can raise serum iron as well as ferritin, and if your serum iron isn't low you could possibly take it over range which isn't a good idea. Eating liver regularly is your best bet to raise ferritin, or liver pate, black pudding. Iron rich foods also apjcn.nhri.org.tw/server/in...

Optimising nutrient levels means that thyroid hormone (that's our own as well as replacement) can work properly.

By the way, apparently it's possible to have Hashi's without raised antibodies. If your TSH continues to rise that's an indication that your thyroid is struggling and will eventually need thyroid replacement hormone.

[Grundywhiffs01 in reply to SeasideSusie]

Ok.

I was already taking 5000iu D3 before these tests. A well respected Vitamin D3 protocol group on Facebook recommends a starting dose of 10,000iu D3 daily, some need 20,000iu to get above 150nmol D3.

Iron tests showed levels were low normal, so i am only taking a low dose of iron.

I will continue to try get my Vitamin D levels closer to optimum, and keep an eye on thyroid function.