TRH test - should I do it? What are the risks?

[Freemek]

Hello, I am with a lovely endocrinologist at the moment who is trying to help me with my CFS/ME. In the past I was totally cured by taking armour thyroid, however he doesn't think that I need it. In the past all of my thyroid tests have come back normal, however in the last lot I took your advice and did them early in the morning (see results below). He is still not sure if there is anything wrong with my thyroid, as he says that it can get low if you are ill for other reasons, and so has suggested a TRH test. I am doing it tomorrow but suddenly wanted to check whether others have had any bad reactions to it or whether it can have any lasting effects just because I don't want to accidentally make myself worse?

Thank you so much, I really appreciate it!

Results

Free Thyroxine 11.7 (12 - 20)

TSH 3.02 (0.27-4.2)

Ferritin 27 (13-150 but females 27-150)

[greygoose]

Were those your results on diagnosis? Or your results now? Have you stopped taking the NDT?

Your doctor is right in that high TSH can be caused by illness or other things. But, it wouldn't stay high, in that case. Normally, what happens is, you have a blood test with a high TSH, and the doctor says to go away for a couple of months and then come back for another test, to see if it's still high. If it is, then you get a diagnosis of hypo.

But, not only is your TSH over 3, your FT4 is below range. How can he deny that you need to take thyroid hormone? He doesn't sound very lovely to me.

So, are you having the TRH blood test? Or the stimulation test? I thought the stimulation test was for people with low TSH, it's to see if the pituitary is receiving the correct stimulation to make enough TSH. It's sometimes done when Central Hypo is suspected - i.e. a low TSH. So, why is he doing it for a high TSH?

I don't think it can cause any lasting effects, but I've never had one myself. I'm just not sure your endo knows what he's doing. Some of them will go to rediculously extreme lengths to prove a patient isn't hypo. Lord knows why!

[SlowDragon Administrator]

These results show you are hypothyroid

But just testing TSH and FT4 is completely inadequate

Below range FT4 and relatively high TSH (most common TSH in healthy population is around 1)

Good that you did your blood test as early as possible in morning (and fasting?)

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

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Ferritin is too low and won't be helping. Have you had full iron panel

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)

Median TSH graph

healthunlocked.com/thyroidu...

TSH daily variation

healthunlocked.com/thyroidu...

Daily variation

healthunlocked.com/thyroidu...

Research into fasting or non fasting tests

- [ ] ncbi.nlm.nih.gov/pmc/articl...

[Freemek]

Sorry I meant to say TRH stimulation test

[Ginny52]

Hi there! Where abouts in the country are you?

I ask because I would dearly love to find an endo prepared to do a TRH test- I may ask you his name,

Thanks!

[AmandaK]

It looks as though he is suspecting central hypothyroidism, rather than commenting on primary hypothyroidism. TSH can be low or normal (not forgetting that your result would be considered normal by the endo/GP as it is within range) and FT4 below range or low in range in central hypothyroidism. I'm surprised however that the test is being carried out as I thought it wasn't used any more (i.e. considered moribund). I suggest you discuss your concerns about side effects with the doctor. Has the doctor told you about potential side effects or have you read about them?