Blood results advice

[SarahJLD]

I’ve posted my son’s (age 25) blood results in past and yesterday he collected print out from last weeks tests with a message to recheck thyroid in 3 months. My gut reaction is he should push for treatment now so any insight from those more knowledgeable would be great.

Results 29/7/19 NHS

TSH 3.15 (0.27-4.20)

Free T4 10 (12-22)

testosterone 11.16 (8.64-29.00)

Early morning sample, only water 12 hrs prior.

Results May 19 Medichecks

TSH 3.94 (0.27-4.2)

Free T3 5.05 (3.1-6.8)

Free thyroxine 11.9 (12-22)

Testosterone 9.51 (8.64-29)

Antibodies in range.

Early morning sample, only water 12 hours prior.

Results June 16 NHS

TSH 3.22 (0.27-4.20)

Free T4 16.8 (12-22)

We only picked these results up recently as wasn’t aware could have copies until joined forum. Random sample, won’t have been early morning as suggested on forum, part of a wide screen recommended by private psychiatrist. Two most recent blood results on venlafaxine.

With advice from helpful members on the forum he has been taking vitamin/mineral supplements the last few months and the results for those are on the up. Eg Ferritin in May 87 now 133, Folate in May 6.16 now 11.2. Same ranges with medicheck and recent NHS test. Vit D optimal, B12 477 (197-771).

Symptom wise he could sleep for England, has no appetite and looks bloated esp around neck,face and hands. GP recommends returning in 3 months for repeat thyroid blood test. My feeling is that treatment needs to start now as he is struggling to function and knows it isn’t due to his mental health problems.

Saturday evening he ‘collapsed’ in garden, knocking self out and splitting head requiring stitches. ECG, BP and blood sugar all appear normal when paramedics arrived. No idea how he fell as he had no recollection, hadn’t been drinking as hasn’t really used any alcohol since on medication. Nothing obvious that he tripped on so all a bit of a mystery.

Sorry for long post but would appreciate any thoughts on what his next step should be.

Thank you

[jimh111]

This is complicated. Depression can lead to 'low T3 syndrome', it gives a lower TSH than normal (for given fT3, fT4 levels) but his fT3 was fine. Given his case history the NHS should always test his fT3 along with fT4 and TSH. I believe venlafaxine can disrupt thyroid hormone levels so I would ask if they could try a different drug to see if he then presents with more normal thyroid hormone levels (low fT4 normal TSH is not usual). Refractory depression is sometimes treated with liothyronine (L-T3) but given his normal fT3 I'd hold off that option. (His fT3 might be lower now his fT4 is down to 10, so they really should measure fT3).

I would look into an alternative to venlafaxine if that is an option, it might explain his unusal thyroid results. There's no point putting him on levothyroxine if another drug is causing low thyroid, a bit like putting water into a leaky bucket.

[SarahJLD in reply to jimh111]

Thank you for replying. I will ask the pharmacist about venlafaxine and thyroid as I’ve struggled to find anything today or previously on internet searches that is conclusive. He will be reluctant to change SNRI unless he has conclusive evidence it is causing his current symptoms as it took a long time to get to his current dose and control the problems he was suffering.

[jimh111 in reply to SarahJLD]

A very quick Google search found this study rcm.mums.ac.ir/article_1155... which is why I raised the possibility. However, now I've looked in PubMed I can't find anything to suggest venlafaxine can affect the thyroid. I'm guessing the journal that published the above case study is not on PubMed, i.e. it is not fully accredited. Nonetheless there's no reason to doubt the quality of this case report.

I think it's a difficult decision as to whether he should try a different drug, I'm certainly not qualified to advise either way. Maybe discuss it with your son and his doctors.

[SarahJLD in reply to jimh111]

Ah thanks for your time @jimh111. I saw that article yesterday but as had maximum dose and increase schedule incorrect I didn’t get past first paragraph. We will ask a local pharmacist as found in past they are very willing to give time to research and discuss interactions and side effects of medications.