I’m 38 and have been very unwell over the last three years (symptoms include crushing exhaustion, hair loss, tingling in my hands and limbs, forgetfulness, chest pain, joint and muscle pain, etc).
I had my thyroid tested by my GP in 2017 and my TSH was 2.31.
He refused to check my thyroid again and so I had private blood tests this week (to get my T4 and T3 levels). My results are:
Free T4: 14.5 (11.0 - 26.0)
TSH: 1.5 (0.35 - 4.50)
Free T3: 4.0 (3.9 - 6.8)
Do these look okay?
I’ve also had iron and folate anaemias, and a vitamin D deficiency, but these have been treated.
Thank you for your help.
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Can see from previous posts you have been investigated for coeliac
What were results?
Are you now on strictly gluten free diet?
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to regularly test vitamin D, folate, ferritin and B12
When were these last tested...add recent results and ranges if you have them
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Is this how you did your tests?
FT4 is low
FT3 is very low
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
I’m currently being investigated for Coeliac Disease. I’ve tested positive for the Coeliac Disease gene. I’ve developed an IgA deficiency - as part of the problems I’m having with my intestines - and so haven’t been able to get a reliable antibody reading in the Coeliac blood tests.
My hospital has long waiting lists for routine procedures. I haven’t been able to have my colonoscopy yet.
I’m now on a gluten free diet because, alongside the possible Coeliacs, I also have a wheat allergy.
I don’t have any TPO or TG thyroid antibody results. My GP is being VERY obstructive with my blood testing. He wants to diagnose me with depression and said: “There are things that the NHS can do, and things that it can’t do”. It’s heartbreaking. I feel so exhausted and poorly that I don’t have the strength to fight him.
I’ve had iron and folate anaemias in the last two years. These have been treated (ferritin is now 160 and folate at 20). My B12 is 1166 - it had also been on the low side, but I now take sublingual supplements. My vitamin D deficiency was also treated and is now 50.
My TSH, F4 & F3 tests were done by Nuffield Health this week. I had them at 10am, but hadn’t fasted. (I wasn’t aware that this would have helped).
I hope that this is clear. My head feels very foggy. Thank you, again.
B vitamins best taken in the morning after breakfast
Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks ).
Or Jarrow B-right is popular choice, but is large capsule
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
Calm vitality magnesium powder is cheap and easy to use. Good if you tend to suffer constipation, best start on low dose....or you can get opposite problem
Or magnesium sprays,or cream for skin, or magnesium flakes in bath.....very relaxing
Thank you for giving me so much of your time, SlowDragon. I didn’t know any of these things.
I’ve been gluten free for eighteen months. There have been some issues with accidental cross-contamination (as recently as December 2018).
My GP said that I should stop taking folate, iron and vitamin D so, as of now, I’m only taking my B12 sublingual supplement.
I did also have a magnesium deficiency (forgot to mention that!). I’ve been using the BetterYou spray and my levels were at 0.88 last November. I stopped using the spray, but will start again.
I’ll also buy a B complex, selenium and vitamin C.
I’m grateful that you’re here. It sounds dramatic but I feel like I’m dying - it’s like I’m slowly losing my life force - and I’ve been so, so scared.
I know that something is wrong with me. It feels like my body is deficient, low in something and screaming out for it. My GP is pushing for a diagnosis of Chronic Fatigue Syndrome and it breaks my heart.
It’s like he wants to send me away to my bed. My husband and I would love to have children and it feels like - if I rely on my GP - time is going to slip away and I’ll miss the chance to have my own family.
Suggest you get FULL Thyroid and vitamin testing via Medichecks or Blue Horizon 6-8 weeks after adding all supplements
You can buy the tests when on offer and use anytime within about 6 months
Medichecks do Thyroid Thursdays off offers. You want the thyroid plus ultra vitamin. £99 or offer price £79 (plus £25 if getting private blood draw at local to you clinic)
Essential to test both TPO and TG antibodies
You can also have Hashimoto's and never have raised antibodies
An ultrasound scan of thyroid can be helpful in getting a diagnosis, but your GP unlikely to agree
I’m currently being investigated for Coeliac Disease. I’ve tested positive for the Coeliac Disease gene. I’ve developed an IgA deficiency - as part of the problems I’m having with my intestines - and so haven’t been able to get a reliable antibody reading in the Coeliac blood tests.
My hospital has long waiting lists for routine procedures. I haven’t been able to have my colonoscopy yet.
I’m now on a gluten free diet because, alongside the possible Coeliacs, I also have a wheat allergy.
I don’t have any TPO or TG thyroid antibody results. My GP is being VERY obstructive with my blood testing. He wants to diagnose me with depression and said: “There are things that the NHS can do, and things that it can’t do”. It’s heartbreaking. I feel so exhausted and poorly that I don’t have the strength to fight him.
I’ve had iron and folate anaemias in the last two years. These have been treated (ferritin is now 160 and folate at 20). My B12 is 1166 - it had also been on the low side, but I now take sublingual supplements. My vitamin D deficiency was also treated and is now 50.
My TSH, F4 & F3 tests were done by Nuffield Health this week. I had them at 10am, but hadn’t fasted. (I wasn’t aware that this would have helped).
I hope that this is clear. My head feels very foggy. Thank you, again.
You've actually managed to reply to yourself rather than SlowDragon , so she won't know that you've replied unless she remembers to look at this thread again.
Where SlowDragon's name is in blue I have "tagged" her, and she will get a notification that she has been mentioned in this post. It's very useful to know how to tag people :
I’m feeling incredibly unwell right now and my brain just isn’t working correctly. I’m making lots of little errors like this, typos, forgetting things, etc.
It’s frustrating and upsetting. Thank you again for helping me and for your kind welcome.
I've seen about 50 similar cases on these forums in the past couple of years. As fT4 starts to fall TSH shoots up and this increases the rate of T4 to T3 conversion and so keeps fT3 around mid-interval. This is not happening in your case. It's sometimes called 'isolated thyrotropin deficiency', sometimes a 'down-regulated hypothalamic pituitary thyroid axis'. The name doesn't matter, your pituitary is not producing as much TSH as it should given you have an fT4 below average AND an fT3 that is boderline. There can be many causes for this such as a period of thyrotoxicity caused by a period unnoticed hyperthyroidism, severe dieting or depression. Depression is tricky as hypothyroidism can cause depression and depression reduces TSH causing hypothyroidism, so it's difficult to know which came first.
If an obvious cause can't be identified the only solution is to prescribe thyroid hormone, which will probably need to include liothyronine (L-T3). Fasting makes no difference to the blood test results (I've had this argument for so long .....) but in any event the last thing you want to do is make your TSH look higher, the problem is your LOW TSH, you are not producing as much TSH as you should be in response to your low normal fT3, fT4. This results in reduced T4 to T3 conversion, especially in organs such as the brain and skeletal muscles resulting in tiredness, cognitive impairment and muscular pain.
I don't know how you can persuade your doctor to prescribe and unfortunately most endocrinologists are no better.
It’s really interesting to read. So, it might not actually be an issue with my thyroid... but my pituitary gland?
In terms of possible causes, I’m not on a diet. There have been changes to my diet - going gluten-free and having to eliminate some foods (mostly fruits) as my intestinal issues have caused allergies - but I try to eat well and regularly.
I do have low mood. I’ve taken a questionnaire with my GP and have “mild” depression. To me, it feels more like frustration. I’m desperate to be out doing things, going for a short walk, trip to the cinema... just living... and it upsets me that I can’t. I’m trapped in my bed.
I’ve ordered the Medichecks thyroid profile (TSH, fT3, fT4, thyroid antibodies) to see if anything comes up on the antibodies front. (I got 20% off with the code SPRING20 if anyone is reading this and thinking about testing themselves).
Is there a protocol that I need to follow before taking the test (morning sample, fasting, etc) ? It’s a finger-prick one.
I forgot to mention that hypothyroidism often leads to 'pseudo allergies', you become sensitive to foods but this resolves when your hypothyroidism is sorted. This comment does not apply to true allergies or problems like coeliac, just to some food intolerances. Minor changes to diet will not affect TSH, you need to be on a very low calorie diet to kick in the mechanism that lowers TSH to slow metabolism and avoid the effects of starvation.
I disagree with comments that fasting has a noticable effect on blood test results. In any event it is irrelevant in your case because your TSH is not marginal and I believe your problem is due to your TSH being too low. Taking the blood early morning gives a higher TSH figure and it can enable some patients to get a levothyroxine prescription if their TSH is already marginal, they can get a TSH result above the upper limit. In your case I think a higher TSH would obscure the problem and so I would take the blood at a convenient time during the day.
The antibodies if very high would raise the possibility that you were hyperthyroid at one stage (without realising it) and this could have knocked your pituitary back. If you have high fT3, fT4 for a long time it can deaden the response of the pituitary to thyroid hormone.
Could you tell me what TSH should be, optimally, in a healthy person? Mine was 2.31 in November 2017 - the same time that I was diagnosed with iron deficiency anaemia and low B12.
It was ‘out of context’, though, because my GP didn’t test fT3, fT4, etc.
I thought it was a good thing that it’s dropped to 1.5? I think I read somewhere that it’s best to have TSH as near to 1 as possible. Is that not correct?
If I take my blood test in the morning (and catch the highest TSH level), is the risk that I’ll be diagnosed Levothyroxine?
But you think that Liothyronine - or addressing underlying causes like depression - might be more appropriate?
I’ve been reading this article today about thyroid patterns that don’t show up in lab tests: kresserinstitute.com/why-yo...
It talks about hypothyroidism being caused by chronic stress and/or inflammation.
I have had higher levels of ESR for a few years (it was 18 in 2017, and is down to 14 now that I’m off gluten).
TSH should be within its reference interval most of the time and between 1.0 and 2.0 is 'ideal' usually. However, this is only meaningful if fT4 is normal and fT3 around mid-interval. If both of these are below average TSH should go high, this is not happening in your case.
I've skimmed the article you referenced, a lot of it is vague and of poor quality, I feel a lot of these websites do hypothyroid patients a disservice.
The only way to diagnose your case is to look at your blood test results for anything unusual (such as low TSH, fT3, fT4) and carry out a trial of thyroid hormone. We can take a guess at the likely problem but it's your response to treatment that is definitive.
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