Help with interpreting TSH, Free T4 and Free T3 results please

[ShonaGreen]

Hi,

I'm new here. I've been unwell for a few months, fatigue, joint pains, headaches, numbness, have some good days but more bad days. I'm usually a very active person, but some days find it hard to get out of bed. I've had a lot of tests done, consultant mentioned possible thyroiditis as tested positive for ANA blood test a few years ago and also have Reynauds. I've just had another ANA blood test which was also positive. So just had more tests for dsDNA (which was negative) and checking thyroid levels. The results are below, I'd really appreciate your thoughts as I've lost the faith in trying to get help, I just want to feel normal and be active again! The T3 level was highlighted as below range, but unsure if this is significant or not?

TSH - 1.92 (Range 0.35 - 4.50)

Free T4 - 11.8 (Range 11.0 - 26.0)

Free T3 - 2.8 (Range 3.9 - 6.8)

Many thanks for your help!

Shona

[SeasideSusie Remembering]

I'm not diagnosing (I'm not medically trained) but your results could possibly indicate Central Hypothyroidism, this is where the thyroid is not at fault but it could be a fault with the pituitary (Secondary Hypothyroidism) or the hypothalamus (Tertiary Hypothyroidism). These forms of hypothyroidism are not particularly common so many doctors may be unaware of them.

With Central Hypothyroidism the TSH can be low, normal or slightly raised, and the FT4 will be low.

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. If there is enough hormone then there's no need for the pituitary to send the message to the thyroid so TSH remains low.

However, with Central Hypothyroidism the signal isn't getting through for whatever reason so it could be due to a problem with either the pituitary or the hypothalamus.

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... 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.

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).

[ShonaGreen in reply to SeasideSusie]

Thanks so much for your reply. I've had a look at the links you provided, I didn't think to mention that I started to get bad headaches around Sept last year (clear MRI, neurologist diagnosed chronic migraines and prescribed amitryptline which has helped a lot) and bad constipation with bleeding on and off since last December. This led me to have a colonoscopy (which was clear) but the CT scan showed a very enlarged liver (which gastroenterologist now thinks is Riedel's lobe and not a problem). But during all this time I've steadily been feeling worse, have lost about half a stone in weight and unable to run anymore. Some days I can barely function, been having chest pain and short of breath from doing normal things. I've got 3 young children and just want to go back to the fun and active mum I used to be! I'm lucky that I've been able to see these consultants privately, but I had to pay for the recent blood tests myself. I've seen my GP a lot of times over the past few months, but as I didn't have diverticiultis (which he was nearly 100% sure I had) or a pulmonary embolism (thankfully!) they've lost interest it me and now saying it could be the menopause!

[SeasideSusie Remembering in reply to ShonaGreen]

I'm afraid I can't comment on your other conditions and whether they would affect your thyroid results, but those results alone do suggest it could be Central Hypothyroidism.

[ShonaGreen in reply to SeasideSusie]

Thanks again, I'm seeing a locum GP tomorrow so going to go armed with all this info and hopefully can make some progress with feeling better soon!

[SlowDragon Administrator]

Have you had TPO and TG thyroid antibodies tested?

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised or if FT3 is low.....which your is

Get GP to test vitamin levels and antibodies

Central hypothyroidism -

have you ever had a head trauma?

pituitary.org.uk/support-fo...

Or whiplash?

theinvisiblehypothyroidism....

For all future thyroid tests

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)

[ShonaGreen in reply to SlowDragon]

Thanks for your message, had most of the others tested, folate and B12 normal, ferritin above normal at 180. Next test is for TPO and TG. I had an accident last summer, could have had whiplash too, hopefully get some answers soon.

[HughH]

TSH is not a thyroid hormone. It is produced by the pituitary gland and travels in the blood to the thyroid gland where it signals to the thyroid gland to produce more thyroid hormones. Your TSH is normal so does not indicate hypothyroidism.

T3 is the active thyroid hormone which controls the metabolism and therefore the symptoms. Your Free T3 is below range so you are hypothyroid.

The TSH is often used as the only test but it is a secondary test - the TSH level does not cause symptoms. When a Free T3 test is done it is a direct test of the active hormone, so this test should be regarded as the most important in diagnosis.

[ShonaGreen]

Just an update - I saw a new GP today and thankfully they're being very supportive. Thinks that need to do some more tests to see what's causing the low TSH, T3 and T4 levels, including thyroid antibodies, FSH & LH, prolactin, Vitamin D and iron panel (as previous higher than normal ferritin level). Also starting on Levothyroxine at 50mg to see if that makes a difference. GP wants to see me again in few weeks once have blood test results and will refer to endocrinologist of rheumatologist if needed. So fingers crossed I'm on the right track now, thanks for all your responses and helpful info!

[NieuwOndaatje]

Hi Shona, I have very similar TSH, fT4 and fT3 results and the Endocrinologist that I was seeing in November last year suspected undertreated Central Hypothyroidism but he had unfortunately left the UK before my follow up appointment in January to review the latest blood tests. At the moment I don't have any alternative HPA, HPT or thyroid specialists that will see me until another Endocrinologist is recruited to the local NHS hospital services. I'd be very interested in hearing how you get on over the next few months. Very best wishes, Mark

[ShonaGreen in reply to NieuwOndaatje]

Hi Mark, sorry to hear that, what area do you live in? I'd be happy to keep you updated, I'm just learning about thyroid issues at the moment. To be honest I had expected to have to put up a bit of a battle at the GP's today based on previous experience, but this new GP is like a breath of fresh air, long may it last!