Results advice

[Judthepud]

Hi all,

My 26 year old daughter just got the result of her thyroid function test as follows:

TSH - 1.4 (0.27 - 4.2)

T4 - 12 (12 - 22)

Is T4 the same as "free thyroxine"?

She had similar results when she was privately tested by Medichecks a few months ago. She's permanently tired and her brother and I are both hypothyroid. Her TSH appears normal, but her T4 is on the lower end. Should she go back to the GP to discuss or would that be a waste of time?

Would be very grateful for any advice.

[SeasideSusie Remembering]

Judthepud

Is T4 the same as "free thyroxine"?

Yes, that's correct.

TSH - 1.4 (0.27 - 4.2)

T4 - 12 (12 - 22)

She had similar results when she was privately tested by Medichecks a few months ago.

Was her FT4 at the very bottom of range, like this, or maybe below range?

I am not medically trained, and I am not diagnosing, but what could be indicated here is Central Hypothyroidism. This is where the problem lies with the hypothalamus or the pituitary rather than a problem with the thyroid gland. With Central Hypothyroidism the TSH can be low, normal or slightly raised, and the FT4 will be low.

TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). In Primary Hypothyroidism the TSH will be high. If there is enough hormone then there's no need for the pituitary to send the message to the thyroid so TSH remains low.

However, with Central Hypothyroidism the signal isn't getting through for whatever reason. It could be due to a problem with the pituitary (Secondary Hypothyroidism) or the hypothalamus (Tertiary Hypothyroidism).

Your GP can look at BMJ Best Practice for information - here is something you can read without needing to be subscribed:

bestpractice.bmj.com/topics...

and another article which explains it:

ncbi.nlm.nih.gov/pmc/articl...

and another:

endocrinologyadvisor.com/ho...

She could do some more research, print out anything that may help and show her GP.

As Central Hypothyroidism isn't as common as Primary Hypothyroidism it's likely that her GP hasn't come across it before. She may need to be referred to an endocrinologist. If so then please make absolutely sure that it is a thyroid specialist that she sees. Most endos are diabetes specialists and know little about the thyroid gland (they like to think they do and very often end up making us much more unwell that we were before seeing them). You can email Dionne at

[e-mail]

for the list of thyroid friendly endos. Then ask on the forum for feedback on any that she can get to. Then if her GP refers her, make sure it is to one recommended here. It's no guarantee that they will understand Central Hypothyroidism but it's better than seeing a diabetes specialist. You could also ask on the forum if anyone has been successful in getting a diagnosis of Central Hypothyroidism, possibly in her area which you'll have to mention of course.

[Judthepud in reply to SeasideSusie]

Thanks for your reply Susie. I don't think her T4 was below range on her previous blood test. I think it was exactly where it is now. I'll check out the articles. Thank you very much

[SlowDragon Administrator]

Did you get her vitamin levels tested as per advice in previous post?

healthunlocked.com/thyroidu....

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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Obviously she needs both TPO and TG antibodies tested and thyroid ultrasound scan too

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Presumably you and her brother have Hashimoto's

[Judthepud in reply to SlowDragon]

I'm not sure if my son and I have Hashimoto's. If that's the commonest cause of hypothyroidism, then presumably that's the case.

Thanks for your reply. She hasn't had her vitamin levels checked because her interest in wanting to help herself varies, depending on how she's feeling.

[SlowDragon Administrator in reply to Judthepud]

Sounds like you all need to get full Thyroid and vitamin testing

Autoimmune thyroid disease (Hashimoto's) is diagnosed by high thyroid antibodies

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

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

[Judthepud in reply to SlowDragon]

OK thanks