T4

[Reemfali]

Hi guys

I was wondering if this means my anything being lower than the reference range ?

Thank you

[SeasideSusie Remembering]

If you are diagnosed hypothyroid and on levothyroxine it means that you are undermedicated.

If you are not diagnosed then it means you are hypothyroid.

If you are not diagnosed with hypothyroidism then tell us what your TSH is and we will tell you if it is primary hypothyroidism or central hypothyroidism.

[Reemfali in reply to SeasideSusie]

Hi

TSH is 2.940 reference range 0.27-4.2

I have not been diagnosed. Went to an endocrinologist but she didn’t mention anything

[SeasideSusie Remembering in reply to Reemfali]

With a TSH of 2.94 then your results suggest Central Hypothyroidism. With Central Hypothyroidism the TSH can be low, normal or slightly elevated with a low/below range TSH.

Central Hypothyroidism is where the problem lies with the pituitary (Secondary Hypothyroidism) or the hypothalamus (Tertiary Hypothyroidism).

Central Hypothyroidism is not as common as Primary Hypothyroidism and many doctors have no knowledge of it. You need an endocrinologist who is a thyroid specialist, most are diabetes specialists.

Information about Central Hypothyroidism :

bestpractice.bmj.com/topics... - your doctor will be able to read the full article.

cks.nice.org.uk/hypothyroid... -

"Scenario: Suspected secondary hypothyroidism

Management:

If secondary hypothyroidism is suspected, refer urgently to an endocrinologist for specialist assessment of the underlying cause.

Basis for recommendation:

The recommendation on urgently referring all people with suspected secondary hypothyroidism to an endocrinologist for further specialist investigation is based on a statement from the Royal College of Physicians The diagnosis and management of primary hypothyroidism [Royal College of Physicians, 2011] and expert opinion in a review article [BMJ Best Practice, 2015c]."

Your endocrinologist is very likely a diabetes specialist so you may need to ask your GP to push to send you to someone more specialised.

[SlowDragon Administrator]

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, when hypothyroid, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels and thyroid antibodies

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)

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

Email Dionne at Thyroid Uk for list of recommended thyroid specialist endocrinologists

thyroiduk.org.uk/tuk/About_...

Vast majority of endocrinologists are Diabetes specialists

Central hypothyroidism can be result of head trauma, whiplash amongst other things

Essential with central hypothyroidism to always test FT4 and FT3 as TSH is not reliable

[Reemfali in reply to SlowDragon]

Hi yes my ferritin is low my vitamin d is low and my b12 is low does this condition need medication ?

[SlowDragon Administrator in reply to Reemfali]

Can you add the actual results and ranges on these

Members can advise on next steps and what supplements you need....or if Gp should be prescribing

It's extremely common to have low vitamin levels when hypothyroid.

Vitamin levels frequently need supplementing to improve.

Low TSH can be due to low vitamins....rather than central hypothyroidism

You may see TSH increase as you improve vitamin levels

[Reemfali in reply to SlowDragon]

Hi thank you for your time and effort to respond to me. My vitamin d is 14 range is 30 and up. My b12 is 160. Ferritin is 7 😊

[SlowDragon Administrator in reply to Reemfali]

So what is GP doing about these low levels

Vitamin D .....is that measured in nmol or ng/ml

B12 - private test of active B12

or standard serum B12 test on NHS?

Serum test - range typically 210 - 750. Anything under 500 can be too low

Active test - range 30-150. Anything under 70 considered suspicious and further testing required

Ferritin looks extremely low. GP should do full iron panel test for Anaemia

Folate needs testing

[Reemfali in reply to SlowDragon]

They told me to take iron, b12 and d. Didn’t ask for further testing. Hemoglobin is fine, I think ferritin is low because of heavy periods. I also had a baby a year ago hence the deficiency's. They didn’t ask to further investigate thyroid

I’m not what type of test the b12 was but was not at NHS was at private practice

[Reemfali in reply to Reemfali]

I’m not sure what*

[Reemfali in reply to Reemfali]

I don’t think they are that thorough

[SlowDragon Administrator in reply to Reemfali]

Heavy periods are classic sign of being hypothyroid

So these were private tests ?

Did you get printed copies of your blood test results?

Are you in the UK?

If so, vitamin D is most likely in nmol

Any result under 50nmol the GP should prescribe vitamin D supplements

If result is 30nmol, then GP should prescribe 1600iu per day for 6 months

Local CCG guidelines

clinox.info/clinical-suppor...

GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve by self supplementing to at least 80nmol and around 100nmol may be better .

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Retesting twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is good as avoids poor gut function.

It's trial and error what dose each person needs. Frequently with Hashimoto's we need higher dose than average

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Iron is complicated and toxic in excess, so you should be monitored if taking ferrous fumerate supplements

Low B12 - it's always important to also test folate. They work together. Folate frequently low if B12 is.

If both B12 and folate are low you should have full testing by GP for Pernicious Anaemia

Suggest you get full Thyroid and vitamin testing via Medichecks or Blue Horizon in a few months after supplementing vitamin D and working on improving low iron by eating an iron rich diet plus daily vitamin C

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 .

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

[SlowDragon Administrator in reply to Reemfali]

Just seen on your profile that you are not in UK

Vitamin D is likely ng/ml

40ng/ml is equal to 100nmol

endmemo.com/medical/unitcon...

[Angel_of_the_North]

If you are taking T3 or NDT, it's fine as long as you feel well. If you are not on meds, it means you have aba underactive thyrpoid. If you are on thyroxine only, it means you are undermedicated and need a dose increase

[Reemfali in reply to Angel_of_the_North]

Thank you angel of the north. Such a nice name 🌷 I appreciate your support. Thank you