No, she is not diagnosed with hypothyroidism or taking lexothyroxine - just looking for advice as has been feeling unwell and both her parents have history of hypothyroidism. Takes Sertraline every other day.
These results suggest Central Hypothyroidism. This is where the problem lies with the hypothalamus (Tertiary Hypothyroidism) or the pituitary (Secondary Hypothyroidism)rather than a problem with the thyroid gland which would be Primary Hypothyroidism. With Central Hypothyroidism the TSH can be low, normal or slightly raised, and the FT4 will be low. As your daughter's FT4 is below range, there can be no doubt there is a problem and the results fit with the criteria for Central Hypothyroidism.
[Thyroxine (T4) 64.8 nmol/L 66.0 - 181.0 nmol/L
This is total thyroxine (the total bound to proteins and unbound [free to be taken up by the cells] ) and you can see this is below range, which is why her Free T4 is also below range, she's just not producing enough thyroxine naturally.
Her FT3 is currently in range because her body is doing it's best to produce some T3 to keep her going, it will eventually fall.]
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.
However, with Central Hypothyroidism the signal isn't getting through for whatever reason. It could be due to a problem with the pituitary or the hypothalamus.
Your daughter's GP can look at BMJ Best Practice for information - here is something she can read without needing to be subscribed bestpractice.bmj.com/topics... and another article ncbi.nlm.nih.gov/pmc/articl... She could do some more research, print out anything that may help and show her 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 that she sees. 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 you 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.
Well within the ranges and these results don't suggest autoimmune thyroid disease.
**
Active B12 116.0 pmol/L 25.1 - 165.0 pmol/L
This is a good result.
Folate 26.2 nmol/L8.83 - 60.8 nmol/L
This is pretty good, recommended is at least half way through range so that would be 35+ with that range. Eating plenty of folate rich foods should nudge it up a bit.
Ferritin 24.8 ug/L13.0 - 150.0 ug/L
This is low. For thyroid hormone to work properly (our own as well as replacement hormone), ferritin needs to be at least 70, recommended is half way through range. She should ask her GP for a full blood count and iron panel to check for anaemia.
Vitamin D 49.2 nmol/L 50.0 - 200.0 nmol/L
This is low but not low enough for most GPs to prescribe anything. 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].
The Vit D Council suggests, for this level to rise to the recommended level, taking 4,900iu D3 daily (nearest is 5,000iu).
Retest in 3 months. When the recommended level has been reached, then she'll need a maintenance dose which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. She can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking tablets/capsules/softgels, no necessity if using an oral spray
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking tablets/capsules, no necessity if using topical forms of magnesium.
Your daughter's low Free T4 in conjunction with a Free T3 in range shows that she is converting T4 to T3 ok. With her Free T3 level the TSH would normally be lower but her TSH indicates that her body wants a higher Free T3.
As she is still having what appear to be hypothyroid symptoms, one possible cause is a genetic condition: Impaired Sensitivity to Thyroid Hormone (more often known as Thyroid Hormone Resistance). It causes hypothyroid symptoms and requires very high T3 levels (often above the top of the normal range) in the body to overcome the resistance.
As it is genetic, the fact that both her parents have history of hypothyroidism would support this.
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