Extreme tiredness and many hypothyroid symptoms

This thyroid test result appears ok but I have a lot of hypothyroid -related symptoms

Many thanks

Serum free triiodothyronine level 4.16 pmol/L [3.1 - 6.8]

Serum free T4 level 13.5 pmol/L [11.0 - 23.0]

Serum TSH level 2.0 mU/L [0.27 - 4.5

[SlowDragon Administrator]

Are you already on levothyroxine?

Or trying to get diagnosed?

If on levothyroxine your dose is likely too low

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range

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

Ask GP to test vitamin levels and thyroid antibodies

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

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 .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

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

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

For thyroid including antibodies and vitamins

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 you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

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_...

[Hidden in reply to SlowDragon]

So sorry I omitted to say that I am not on thyroid medication.

[SlowDragon Administrator in reply to Hidden]

Well you still need full thyroid and vitamin testing

You may find you have high thyroid antibodies and/or low vitamin levels

Your Ft4 is low in range and Ft3 is low ....but TSH isn’t high enough for doctors to say hypothyroid

But vitamins may be very low and improving levels frequently improves symptoms

[Hidden in reply to SlowDragon]

Very grateful for your advice, thankyou

[Hidden in reply to SlowDragon]

Thankyou for responding so fully to my previous post with thyroid test

These were full blood results as at Jan 2020. Again U cant see anything pointing to an issue but if it excludes thyroid probs (even though all my symptoms ape hypothyroid) it is a step towards a diagnosis

Thanks in advance for looking at these

Pathology Investigations

Haemoglobin A1c level - IFCC standardised 39 mmol/mol [20.0 - 41.0] Take urgent same-day action if suspecting type 1

diabetes (HbA1c may be normal).

Full blood count

Haemoglobin concentration 137 g/L [117.0 - 149.0]

Total white blood count 8.0 10*9/L [4.3 - 11.2]

Platelet count - observation 348 10*9/L [150.0 - 400.0] Please note change in platelets reference range as

as from 01.08.2019

Red blood cell count 4.60 10*12/L [3.85 - 5.15]

Mean cell volume 89.0 fL [81.0 - 97.0]

Haematocrit 0.410 [0.347 - 0.445]

Mean cell haemoglobin level 29.8 pg [26.9 - 33.0]

Mean cell haemoglobin concentration 334 g/L [320.0 - 359.0] Neutrophil count 4.92 10*9/L [2.1 - 7.4]

Lymphocyte count 2.23 10*9/L [1.0 - 3.6]

Monocyte count - observation 0.58 10*9/L [0.3 - 1.0] Eosinophil count - observation 0.16 10*9/L [0.02 - 0.5] Basophil count 0.09 10*9/L [0.02 - 0.1]

Pathology Investigations

Urea and electrolytes

Serum sodium level 136 mmol/L [133.0 - 146.0]

Serum potassium level 4.7 mmol/L [3.5 - 5.3]

Serum urea level 3.5 mmol/L [2.5 - 7.8]

Serum creatinine level 76 umol/L [45.0 - 84.0]

eGFR using creatinine (CKD-EPI) per 1.73 square metres 68 mL/min [90.0 - 200.0] Outside reference range

Multiply EPI e-GFR result by 1.159 for African-

Caribbean patients.

Note that extremes of muscle mass and high protein

diet can affect serum creatinine and e-GFR.

Liver function tests

Serum total protein level 68 g/L [60.0 - 80.0]

Serum albumin level 37 g/L [35.0 - 50.0]

Serum globulin level 31 g/L [20.0 - 34.0]

Serum alanine aminotransferase level 12 U/L [< 33.0] Serum alkaline phosphatase level 72 U/L [30.0 - 130.0] Serum bilirubin level 5 umol/L [< 21.0]

Serum C reactive protein level 1.2 mg/L [< 5.0]

Blood haematinic levels

Serum vitamin B12 level 448 ng/L [197.0 - 771.0] Serum folate level 8.3 ug/L [2.0 - 18.7]

Serum ferritin level 51.4 ug/L [20.0 - 260.0]

Serum TSH level 2.2 mU/L [0.27 - 4.5]

Please note that thyroid hormone,tumour markers, haematinics,hormone,troponin,HCG,BNP and digoxin assays may be subject to interference in patients receiving biotin therapy.

Serum total 25-hydroxy vitamin D level 87 nmol/L Vitamin D is seasonal but levels should be >75 nmol/L at all times. Levels 50-75 are probably suboptimal,

long term may lead to clinical effects. Consider safe

sun exposure, diet, supplement. Levels 25-50 indicate deficiency, supplementation is indicated. Levels <25 suggest severe deficiency-may need pharmacological preparations- in which case serum calcium should be checked after 1 month. Toxic levels of vitamin D are

not well defined but advise check serum calcium if

25 OH vitamin D exceeds 300 nmol/L and consider dose reduction if appropriate.

Urea and electrolytes

Serum sodium level 139 mmol/L [133.0 - 146.0]

Serum potassium level 5.0 mmol/L [3.5 - 5.3]

Serum urea level 3.9 mmol/L [2.5 - 7.8]

Serum creatinine level 70 umol/L [45.0 - 84.0]

eGFR using creatinine (CKD-EPI) per 1.73 square metres 75 mL/min [90.0 - 200.0] Outside reference range

Multiply EPI e-GFR result by 1.159 for African-

Caribbean patients.

Note that extremes of muscle mass and high protein

diet can affect serum creatinine and e-GFR.

Thyroid function test Please note that thyroid hormone,tumour markers, haematinics,hormone,troponin,HCG,BNP and digoxin

assays may be subject to interference in patients

receiving biotin therapy.

Serum free triiodothyronine level 4.16 pmol/L [3.1 - 6.8] Serum free T4 level 13.5 pmol/L [11.0 - 23.0]

Serum TSH level 2.0 mU/L [0.27 - 4.5]

[SlowDragon Administrator in reply to Hidden]

Nothing obvious jumps out

Ferritin on lower side. But iron looks ok

B12 and folate look ok

Vitamin D too

Suggest you get both TPO and TG Thyroid antibodies tested privately

[Hidden in reply to SlowDragon]

Many thanks I will do that