Very low TSH and low T4

[Tuscansun]

Got my test result - both TSH and T4 are low. TSH is 0.01mU/L and free T4 7.2pmol/L. Could someone help to interpret the result?

[jimh111]

You haven't given the reference intervals but you said they are low and they look very low. This suggests central hypothyroidism and you should be referred to an endocrinologist. Did you doctor run this test and if so, what did they say?

Get hold of the reference intervals (numbers in brackets) and post them here. Also, what symptoms do you have? Why did you have the test done?

[Tuscansun in reply to jimh111]

Thank you for your reply. Plasma TSH 0.01 (0.30-4.20) Plasma free T4 7.2 (9.0 - 19.0)

It was my first test, and had another test yesterday - hopefully, will get the result tomorrow.

Typical hypothyroidism symptoms - fatigue (sometime extreme fatigue), hair loss, brittle hair and nails, dry skin.

I asked for HRT and was told to get a blood test done. Everything else is blood is within normal ranges.

[jimh111 in reply to Tuscansun]

Looks like your doctor is on the ball. I'm guessing the second test is to confirm the results of the first one and perhaps check a few other hormones. If you get the same sort of result you should be given a referral to an endocrinologist as it is specialist stuff. Your GP could prescribe you some levothyroxine in the meantime to help you out.

[Tuscansun in reply to jimh111]

OK, many thanks!

[SlowDragon Administrator]

Results suggest central hypothyroidism which would need further investigation by endocrinologist

Can you add the ranges on these results, figures in brackets after each result. Especially on FT4

But 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

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water . This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If you are in the UK

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

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten.

So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

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

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

List of hypothyroid symptoms

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

Come back with new post once you get results

[Tuscansun in reply to SlowDragon]

Many thanks for your reply and for the links.

My vitamins and minerals levels are within normal ranges:

Sodium 143 (135-145); Calcium 2.5 (2.2-2.6); B12 323 (180-900); Ferritin 43.3 (10-200); Folate 20 (3-20); Iron 18.7 (11-30); Vit D 93 (greater than 50 Vit D sufficiency) - though should say I take Vit D supplement.

Thyroid: TSH 0.01 (0.30-4.20) and free T4 7.2 (9.0-19.0).

Have had a second test and expect the result tomorrow and depending on it, will decide which further tests to take.

Regarding finger prick tests - I am very sceptical of those - remember Theranos?

[SlowDragon Administrator in reply to Tuscansun]

B12 is on low side. Anything under 500 can cause symptoms.

b12deficiency.info/signs-an...

Folate is good.

Ferritin is low. Perhaps increase iron rich foods

Ever had ultrasound scan of your thyroid?

Central hypothyroidism can be caused by head trauma or whiplash amongst other things

Personally I struggle to get enough blood out on DIY finger prick test, and pay the extra £25 via Medichecks for private blood draw. They have a wide number of partner clinics who can do this around UK

[Tuscansun in reply to SlowDragon]

Many thanks for insight! Much appreciated

[Tuscansun]

Just wanted to share my update as I got my Tue test result - TSH looks very different and is within normal range but T4 is still low:

TSH 2.31 (0.30-4.20)

Free T4 6.4 (9.0-19.0)

Free T3 4.5 (2.6-5.7)

Plasma prolactin level 286 (110-560)

IGF 1 - 15.3 (6.4-31.0)

I guess either it was an error in TSH measurement before (or now) or it can fluctuate that much.

[SlowDragon Administrator in reply to Tuscansun]

You replied to yourself so no one was notified of these results

Fluctuations in levels suggests Hashimoto's

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also EXTREMELY important to regularly retest vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Are you working on improving low ferritin

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you do your tests?

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

[Tuscansun in reply to SlowDragon]

Oh, sorry! Was not sure how to post an update and thanks for noticing it...

Both tests were done in the morning on empty stomach. I had a conversation with GP and will repeat the test in 5-6 weeks.

Meanwhile, have started B12 injections and increased vit D intake - plus multivitamins. Also, started to eat beef - hopefully, it will help with iron.

Will ask to include antibodies in next test.