TSH and T4 both dropped

[Badboybob]

Last September my tsh was 2.5 and t4 13 so both in range but was diagnosed B12 and folate deficient. Started b12 injections but lots of symptoms did not resolve. Pins and needle fatigue balance issues tinnitus etc. Had thyroid rechecked and tsh is 1 and t4 is 11. Any ideas as my thyroid has now swollen up. Daughter has Graves and coeliac. I have pernicious anaemia and lichen planus. Am I hypothyroid hyperthyroid or something else?

[SeasideSusie Remembering]

Badboybob

To be able to comment, can we please have the reference ranges that came with your results. They vary from lab to lab so if you don't have them just ask at your surgery's reception desk for a print out of your results (don't accept verbal or hand written results, mistakes can be made).

As your daughter has Graves, it's also essential that you have thyroid antibodies checked, so for a full picture we need to see results/ranges for

TSH

FT4

FT3

Thyroid Peroxidase and Thyroglobulin antibodies

[Badboybob in reply to SeasideSusie]

Tsh ref range 0.5-5 and t4 ref range 10-20.

The lab didn’t do t3 even though I asked for it and antibodies but was told the lab would only do that if tsh and t4 were abnormal as they are only just in range. It’s confusing that both levels dropped isn’t it? I’m so symptomatic I feel my life is on hold. Very breathless no energy

[SeasideSusie Remembering in reply to Badboybob]

Badboybob

Previously:

TSH: 2.5 (0.5-5)

FT4: 13 (10-20)

Current:

TSH: 1 (0.5-5)

FT4: 11 (10-20)

To compare results accurately, tests have to be done under the same conditions. We always advise here

* Book the first appointment of the morning, no later than 9am

* Fast overnight from evening meal/supper the previous evening, breakfast after blood draw

* Drink water only before the test, no tea, coffee, etc.

TSH, FT4 and FT3 all have a circadian rhythm so testing at different times will give different results, and eating affects TSH, as does coffee and caffeine containing drinks.

As you can't get the full tests done with your GP, you may wish to consider doing what hundreds of us here do and that is private testing with one of ThyroidUK's recommended labs. As you have PA it would be worth testing your nutrient levels as well and the cheapest way is with a full thyroid/vitamin panel:

Medichecks Thyroid Check ULTRAVIT medichecks.com/thyroid-func... You can use code THYROIDUK for a 10% discount on any test not on special offer.

or

Blue Horizon Thyroid Check PLUS ELEVEN bluehorizonmedicals.co.uk/t...

Both tests include the full thyroid and vitamin panel. They are basically the same test but with the following small differences:

For the fingerprick test, Blue Horizon requires 1 x microtainer of blood (0.8ml), Medichecks requires 2 x microtainers (total 1.6ml)

Blue Horizon includes Total T4 (can be useful but not essential). Medichecks doesn't include this test.

B12 - Blue Horizon does Serum B12. Medichecks does Active B12.

If you supplement with Biotin, or a B complex containing it (B7), Medichecks have confirmed that because they use biotin in their assay it's recommended to leave it off for 7 days before doing any blood tests as it can give false results. It's best to assume that any lab could use biotin.

When you have results, post them on the forum for comment.

[Badboybob in reply to SeasideSusie]

Thank you so much for replying. Both tests done under conditions you described. Fasting early 9.00am test no food or liquid before etc. Recently had both active and serum b12 and both high due to injections. Ie over 2000 and 300 respectively. I’m not supplementing with anything folate levels have risen back in range after 4 months folic acid supplements finished in March. Because I’ve had to give up work I can’t afford paying for any tests but not sure what I should be pushing for next. Could it be pituitary? I’m waiting now for an endocrinologist app but not sure how long it will take. Thank you for any help.

[SlowDragon Administrator in reply to Badboybob]

Ask your GP to test vitamin D and ferritin and that because of strong family connection to autoimmune diseases you should have thyroid antibodies tested

[Badboybob in reply to SlowDragon]

Yes thank you I’m going to ask for vit D next time I have an app. Good idea. I was told my ferritin was fine back in September.

[SlowDragon Administrator in reply to Badboybob]

September is 9 months ago. So ferritin needs retesting and ALWAYS get actual results and ranges on every test

Ferritin range is typically 30-150. We need ferritin at least over 70.....but GP would say it's fine if result was 31

Pernicious anemia and lichen planes are autoimmune, so this makes other autoimmune diseases more likely. You need to insist thyroid antibodies tested

Low vitamin D is strongly linked to autoimmune disease

You are legally entitled to printed copies of your blood test results and ranges.

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

[RockyPath]

Your resting heart rate will be an indicator of metabolic state as influenced by thyroid. If it's low, you're hypo. If it's high, I would imagine you're hyper. But I only know because I'm hypo and when resting rate is in the low 50 bpm or down to 47, then I need more T3.

Your FT4 was in the lower half of the reference range, so I would think that would also indicate hypo. The other symptoms you've described can be associated with hypothyroidism.

[Badboybob in reply to RockyPath]

Thank you for replying. Resting heart rate is between 70-90 and I have times where I am aware of heart beats pounding away. If t4 is low wouldn’t tsh be high if it was hypo? I’m new at this so a bit confused as to why both are in low range.

[Hidden in reply to Badboybob]

badboybob you are a bit unusual. Your pulse is normal. The T4 is normally a pretty good indicator of thyroid health, yet yours is low and pulse normal. What is your temperature? How many and how often are you having B12 jabs? It would be nice to see a T3 result but I presume unavailable. Are you on any meds? A low tsh and T4 often indicates secondary hypothyroidism. it might be helpful to you to cut out gluten to reduce automimmune symptoms. It would be good to get to the bottom of this. I did at one time have a high pulse when hypo add it used to reduce on exercise, adrenaline driven and stress related.

[RockyPath in reply to Badboybob]

Normally my resting heart rate was under 70, but I once met an apparently perfectly healthy woman whose resting heart rate was 100 bpm, and someone on this forum has a resting rate under 50, so we really don't know if 70 is super slow for you.

In my experience, I've found that being aware of my heart rate is often indicative of irregularity due to inadequate thyroid hormone. When lying still, it stays within a narrow range when I have adequate thyroid hormone; when there's inadequate, I could feel, as well as watch on the meter, a sinusoidal pattern, slowing down, building up to a faster rate, slowing down, building up, as though the cardiac muscle was trying to figure out what to do. Kind of disturbing.

If your thyroid is going nuts sending out too much hormone, you'd also get periods where your resting rate spikes, and you become aware of it.

Our bodily systems, when the work, are easy to under appreciate. When they start to go haywire, they're an enigma wrapped in an inscrutable mystery.

[Hidden in reply to RockyPath]

I'm not good at counting my pulse (poor memory for numbers lol, and tend to forget half way how many I've counted to). Seems to be around 80 most of the time I tried, but sometimes seems irregular or harder and/or faster than usual. Had an ECG test recently though and things were apparently OK.

[Angel_of_the_North in reply to Badboybob]

Low T3 and low iron can both cause higher heart rate when hypo