Friend diagnosed with thyroid issues and new to all this. Help Please!!

[Ziggyzazu]

a friend has just been diagnosed with thyroid issues. He was also diagnosed with low testosterone a couple of years ago and is on Testosterone injections. We are not sure if the two isssues are related. He has had various symptoms inc low weight, tired, anxiety etc. The GP has advised him to take eltroxin. I wonder could we get feedback on his blood results? It is impossible for him to get an appt with a specialist at the moment. The test suggests that he is hypo we gather. He thought he was hyper as he has a high calorie intake but is not gaining weight. He would be very grateful for any advice.

[SeasideSusie Remembering]

Ziggyzazu

It says "on treatment". Is that thyroid treatment?

[Ziggyzazu in reply to SeasideSusie]

Thanks for replying. No he is not on thyroid treatment. I presume they mean treatment for low testosterone.

[SeasideSusie Remembering in reply to Ziggyzazu]

Ziggyzazu

Ok, so if he isn't on any thyroid meds then with the following results:

TSH: 1.35 (0.27-4.2)

FT4: 9.7 (12-22)

this is not Primary Hypothyroidism (diagnosed with high TSH and low FT4).

I am not medically trained, and I am not diagnosing, and I see that your friend has been diagnosed with Hypothyroidism, 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).

Here are some articles which explain this:

bestpractice.bmj.com/topics...

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

endocrinologyadvisor.com/ho...

(You don't have to register, just click that box and it disappears).

Your friend could do some more research, print out anything that may help and show his GP.

As Central Hypothyroidism isn't as common as Primary Hypothyroidism it's likely that his GP hasn't come across it before (and to be honest your friend is very lucky to get a diagnosis of hypothyroidism with such a low TSH even though his fT4 is below range. Most doctors would want to see TSH over range). Whether there is any need for him to be referred to an endo I cannot say, but if there is then he should make absolutely sure that it is a thyroid specialist that he 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 he can get to. Then if his GP refers him, 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.

Although weight gain is common with hypothyroidism, not everyone does gain weight. Here is a list of signs/symptoms of hypothyroidism:

thyroiduk.org/tuk/about_the...

Ferritin: 38 (30-400)

This is very low (but may satisfy the GP because it falls within range). Ferritin should be half way through range, this result is 2.16% through range. Low ferritin can suggest iron deficiency or iron deficiency anaemia. He should ask for an iron panel (which would show iron deficiency) and a full blood count (which would show anaemia). No thyroid hormone (our own or replacement) can work with such a low ferritin level.

As ferritin is so low, there's a chance that other nutrient levels could also be low so he should ask for the following to be tested:

Vit D

B12

Folate

His thyroid peroxidase antibodies (TPO) are reasonably low but that is only one thyroid antibody, there is also thyroglobulin (Tg) antibodies and if this came back positive it could suggest autoimmune thyroid disease (Hashimoto's), so it would be worth asking for that to be tested as well. Normally it's raised TPO antibodies that confirm Hashi's, but we can have negative TPO but positive Tg antibodies.

Thyroid, adrenals and sex hormones are all connected so it's not impossible that his low testosterone may be involved.

[Ziggyzazu in reply to SeasideSusie]

Thank you so much for all the extremely helpful information. I have passed it on to him and he sends his grateful thanks. He has sent me his full blood test which flag a few other things as too high or low. Would I be able to post these to see if they offer any further clues?

[SeasideSusie Remembering in reply to Ziggyzazu]

Ziggyzazu

You can only post one picture in the opening post of a thread, so you would either have to edit and remove the current picture and post the new picture, or start a new thread with the new picture (and link back to this thread for information).

If you post a new picture, make sure no personal information is showing, i.e. name, date of birth, NHS number, which would then risk identity theft.

Or you can just type the other results, with reference ranges, into a post in this thread.

[Jazzw]

That looks like secondary hypothyroidism potentially—which might mean a degree of pituitary failure is causing the problem. The low testosterone could be related...

The reason I say this is because his TSH is normal but for some reason he’s not producing enough thyroid hormone. That can be because the signalling mechanism has gone awry.

Has he ever had a head injury or whiplash?

Have a read of this article about pituitary problems—see if any more of it fits: yourhormones.info/endocrine...

[Ziggyzazu in reply to Jazzw]

He twice had concussion as a child. So yes. Thank you very much for all your help. I have passed all this on to him. I have his complete blood tests which have other flagged areas, if they might throw further light I could post them too? Not sure where I would post them??! Again many thanks.

[Jazzw in reply to Ziggyzazu]

To get a few more reviewers of further results it would be better to start a brand new post—in this forum older posts slip out of view really quickly.

So by all means post them in a new post for comment but refer back to this thread when you do.

[humanbean]

His ferritin (iron stores) is recorded as 38 with a reference range of 30 - 400.

This is only 2% of the way through the range. Ideally it should be approximately 50% (mid-range) of the way through the range.

With the reference range supplied mid-range is 215.

I would suggest that you get an iron panel done privately. A doctor probably won't agree to do it because your ferritin is in range.

A private finger-prick test you can do is this one :

medichecks.com/products/iro...

The sample should be produced on a Monday or Tuesday early morning (e.g. about 8am - 9am) and be posted immediately with "Guaranteed next day delivery by 1pm". You need to go to a Post Office to do this. If your friend is on iron supplements he needs to stop them for a week before producing his blood sample. Also it is essential to stop any supplements containing Biotin for 5 - 7 days before producing the sample. Iron testing should also be done while fasting (except for water), so before breakfast is a good time.

You want to get the blood sample to the lab as quickly as possible, and avoid it sitting in a post box or in a sorting office or at the lab with nobody there to process it.

Some links on the subject of testing :

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

Read SeasideSusie 's advice on the subject of how best to get a good sample for finger-prick testing on this link : healthunlocked.com/thyroidu...

[Ziggyzazu in reply to humanbean]

Thank you so much for the information. I will pass that suggestion on to him.

[SlowDragon Administrator]

Low testosterone and hypothyroidism can be linked

ncbi.nlm.nih.gov/pubmed/151...

tau.amegroups.com/article/v...

[Ziggyzazu in reply to SlowDragon]

Thank you. I have forwarded him the link. Appreciate your help.