What does this result mean please can anyone help

[jessiejakes]

Hi hope someone can help I had thyroid blood test and results came back saying Abnormal need to speak with doctor ,they have booked me appointment by phone on 15 sept.my results were as follows TSH level 0.081 miu/L ( 0.38-5.33) says below low reference limit.T4 level 10.3 pmol/L ( 7.0-16.0) serum free triiodothyronine level 5.2 pmol/L ( 3.8-6.0) have I got hyperthyroidism or hypothyroidism ? Also would thyroid problems cause liver enzymes to go HIGH as my results on liver came back serum alanine aminotransferase level 419 and serum gamma- glutamyl transferase level 363 now waiting to have ultrasound scan on liver.any help would be appreciated thank you I live in uk as don't no if our readings are same as other countries.

[Nanaedake]

As you can see your FT4 reading and FT3 reading is within the lab range which means they are considered normal. Your doctor is concerned that your TSH level is lower, below, the lab range so further checks are needed to rule out a health problem. It's good your doctor is following it up. You could find out if antibodies were tested. To check look for thyroid peroxidase TPO and Thyroglobulin TgAb on your results list. If available then post results here for help in understanding them.

Can't help you with liver but wait for results via doctor and try not to worry about it. Sounds like your doctor is on the case, just make sure you follow things up and keep copies of results as NHS is short of time. If you have to see a different doctor, don't presume they know your history, try to understand what's been tested so you can explain.

You could ask doc to leave copies of results at reception for you to collect. Just say you're keeping a file to help you manage your health appointments as well as possible. It's easier to discuss and make decisions if you can consider the evidence.

[jessiejakes in reply to Nanaedake]

Thankyou for your advice I just hate feeling so tired and unwell

[greygoose]

I take it you still don't have a diagnosis and are not on thyroid hormone replacement?

Your TPO antibodies were high when you posted a year ago, so you have Hashi's. And, having Hashi's can skew your levels. It looks as if you're just coming down from a Hashi's 'hyper' swing, and the TSH hasn't yet caught up with the levels of the Frees - it changes a lot more slowly than the FT4/3.

So, you're still not hypo, with that good FT3 level, and a low TSH does not, on its own, mean you are hyper. Unfortunately, doctors just don't understand that. They panic when they see a low TSH. So, don't allow him to put you on any medication at this point. Tell him gently that you are not hyper, you have Hashi's. It's not the same.

[jessiejakes in reply to greygoose]

Thankyou for your reply will look up hashi,s yes my TPO have been really high before and been told I got thyroid eye disease by eye specialist.i have had really bad anxiety and shaky could that be caused by thyroid problems and lost about 5 lb over past few months my mum had thyroid problems my brother to and now my niece who is 25 just been diagnosed my daughter had groitule when she was pregnant with her first child and had opp to remove alot of thyroid but didn't have any medication.thank you I will look up hashi,s

[Nanaedake in reply to jessiejakes]

Yes, Greygoose has given you a good response re. Hashimotos and how antibodies activity affect results. Still there could be something else going on so good that doctor is following up since you have symptoms. Have you had all your basic vitamin levels tested for B12, folate, ferritin and vitamin D? They are often low in people with thyroid disease.

There is an explanation of Hashimotos on the Thyroid UK website. Also if you have been told you have thyroid eye disease you need to find out if you have had TSI and TRAB tests for Graves disease. It is possible to have antibodies for both conditions but you won't know until you view results.

Given that you may have both conditions, you could ask for referral to an endocrinologist but make sure they are a thyroid specialist not a diabetic specialist nor an ENT with an 'interest' in thyroid for best help.

[jessiejakes in reply to Nanaedake]

My B12 was low but Dr just said she would check again and 2 ND test came back just within limits so didn't give me anything.but vitamin D was abnormal and had to have little phails of vitamin D and cut top of and tip down throat every week on same day for 6 weeks

[Nanaedake in reply to jessiejakes]

I hope your doctor then prescribed a maintenance dose of vitamin D3 after the loading doses and has checked vitamin D levels again because if you do not utilise vitamin D well its likely you will need to always supplement. There are cofactors for vitamin D and read SeasideSusie's posts and visit the Vitamin D council's website fore more information. Post your B12 results on the Healthunlocked forum for further advice on low B12. Your doctor needs to exclude pernicious anaemia and there are a number of tests available.

[jessiejakes in reply to greygoose]

No not on any medication for it when TPO was really high Dr just said we will leave it and see if my body will cure itself

[SlowDragon Administrator]

High TPO antibodies confirms that you have autoimmune thyroid disease also called Hashimoto's. This is Hypothyroidism, but often starts with fluctuations in levels as thyroid is attacked

But your results show you are classified as sub clinical at the moment, because your FT3 and FT4 are still within range

That doesn't mean, however you may not have plenty of symptoms and may benefit from starting on Levothyroxine

SeasideSusie has a link about that - she may pop along

Certainly likely to have low vitamin levels and important to regularly retest these. Improving vitamin levels to optimal levels by supplementing can significantly reduce symptoms

So ask GP to test vitamin D, folate , B12 and ferritin

I noticed you said you had low B12 last year.

ncbi.nlm.nih.gov/pubmed/186...

There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,

ncbi.nlm.nih.gov/pubmed/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet




(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)




Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

anxiety and depression are common hypothyroid symptoms. Anxiety can improve noticeably on gluten free diet

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

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)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

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

Come back with new post once you get vitamin levels test results and ranges

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

[Nanaedake in reply to SlowDragon]

This patient has been told she has thyroid eye disease... So just wondering whether she needs to clarify this before further action? Maybe needs to get all antibodies results before taking levothyroxine, any suggestions?

[SlowDragon Administrator in reply to Nanaedake]

Plenty of people with just Hashimoto's have eye problems

But yes......good point

jessiejakes

Suggest you also get GP, endo or private testing of Graves' disease antibodies

medichecks.com/thyroid-func...

It's possible to have Hashimoto's and Graves at same time. This is tricky to manage and you should be referred to thyroid specialist endocrinologist if it's the case

Email Dionne at Thyroid Uk for list of recommended thyroid specialists

[SeasideSusie Remembering]

jessiejakes

Subclinical hypothyroidism plus raised antibodies that SlowDragon refers to is discussed in Dr Toft's article in Pulse magazine. Dr Toft is past president of the British Association and leading endocrinologist. He says that when TSH is over range, but below 10 (with 10 being the level where Primary Hypothyroidism would be diagnosed) with normal FT4 then this is classed as sublinical hypothyroidism and if positive thyroid antibodies are also present then Levo should be started.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

and it's Question 2 which refers to this:

Question 2 asks:

I often see patients who have an elevated TSH but normal T4. How should I be managing them?

Answer:

The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat thyroid function tests in 2 or 3 months in case the abnormality represents a resolving thyroiditis.

But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune thyroid disease - the patient should be considered to have the mildest form of hypothyroidism.

In the absence of symptoms, some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow up.

Treatment should be started with levothyroxine in a dose sufficient to restored serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.

[SlowDragon Administrator in reply to SeasideSusie]

Trouble is, at moment her TSH is low

Obviously this may change rapidly at any time in near future

jessiejakes you will need to regularly retest thyroid and vitamin levels, perhaps at least twice yearly. Especially once you start supplementing to improve low vitamin levels

[Treepie]

My recent liver results were: alaline aminotransferase 63 ( 0-40)

gamma - glutamyl transferase 973 (0-73) , alkaline phosphatase 189 ( 30-130) ,bilirubin 21 ( 0-21).

Nothing to do with hypo , I am blaming chemo ,my wife reckons alcohol!

Difficult to discover cause, GP said he did not know!

Will see if consultant can illuminate ,tomorrow.

[jessiejakes in reply to Treepie]

Thankyou for your reply ,but I don't drink alcohol that's first thing doctor asked me ,please let me know how you get on did you have liver scan ?

[Treepie in reply to jessiejakes]

Not had a liver scan ,had a CT scan some weeks ago .May find out more tomorrow. Had last chemo session at end of May so still recovering strength and balance .

[jessiejakes in reply to Treepie]

Hope it all goes well for you tommorow .

[Treepie in reply to jessiejakes]

Thanks, I will be having an ultrasound for the liver but the consultant suggested that any specific liver blood test was not that important ,they had to be considered in the round. Not sure that was too reassuring ! Will be tested again in 3 months. CT scan was Ok .Now its echo cardiogram on Friday.

[jessiejakes in reply to Treepie]

Glad to hear all went well with CT scan ,not sure what you meant about liver had to be in round ?

[Treepie in reply to jessiejakes]

Meant one test on its own ( e.g. my own 900 + result) did not mean much. Had to consider all the tests i.e. “in the round”.

[jessiejakes]

Thanks understand now