As a newbie to all of this I’d really appreciate some help and advice.
A few weeks ago I went to see my GP because I was feeling exhausted. I’ve been many times over the years, and looking back, my visits have been around tiredness (mostly), feeling like there’s a lump in my throat when swallowing, pins and needles in hands and feet, even when sitting or walking normally (no constriction of flow) and forgetfulness, getting words jumbled and general memory issues. The blood test in April showed:
TSH 5.0 (0.5 – 4.4)
T4 15.4 (10-20)
The GP said subclinical hypothyroidism, and for the first time in years things started to make sense. She said to repeat the test in 3 – 4 months time.
That’s when I started exploring this fabulous forum and decided to do a Medichecks Ultravit test (I even waited until Thursday and got it at discount).
These are the results I’ve received today:
CRP HS 1.25 (<5)
FERRITIN 51.7 (13-150)
FOLATE SERUM 4.88 (>3.89)
VIT B12 ACTIVE 87.1 (>37.5)
VIT D* 32.8 (50-175)
TSH* 7.79 (0.27 – 4.2)
FREE T3 4.24 (3.1 – 6.8)
FREE THROXINE* 13.8 (12 – 22)
TGA* 13.5 ( <115)
TPA* 9.71 (<34)
I can see that I definitely need Vit D, as that is really low, but I’m not sure about the rest of it, except the +2.79 increase in TSH since April. This was an early morning test.
TGA & TPA seem low – but I don’t know whether that means anything??
Also, free thyroxine is low on the scale.
Any help and advice deciphering this would be greatly appreciated.
Thanks
xx
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Mak0828
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This is an inflammation marker and is quite low so that's fine.
FERRITIN 51.7 (13-150)
This isn't dire but could be better. Ferritin is recommended to be half way through range, so 82 with that range. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
Folate is recommended to be at least half way through range, their range shows 3.89-19.45 so you're looking at 12+ with that range. Folate rich foods will help, as will a good quality, bioavailable B Complex such as Thorne Basic B or Igennus Super B. Always leave B Complex off before any blood tests because it contains Biotin and when Biotin is used in the testing procedure (as Medichecks do) then this will give false results.
VIT B12 ACTIVE 87.1 (>37.5)
This isn't too bad but I'd want mine over 100. The B Complex will contain B12 and this will help improve your level.
VIT D* 32.8 (50-175)
This is dire, not much above deficiency level.
The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L.
To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 5,000iu D3 daily
Retest after 3 months, post new result for information on what to change your dose to at that time.
Once you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
This is indeed classed as subclinical, which is nonsense really because some countries diagnose hypothyroidism when TSH reaches 3, in this country we have to wait until it reaches 10. Unless you have a very enlightened GP you may have to wait until your TSH goes higher, which it will eventually.
TGA* 13.5 ( <115)
TPA* 9.71 (<34)
These are low and your current antibody levels don't indicate autoimmune thyroid disease (patients call it Hashimoto's). However, it is possible to have Hashi's without antibodies being raised.
The one I always suggest is Doctor's Best D3 softgels. It's the one I use, it increased my severe deficiency of 15nmol/L to 202nmol in 2.5 months and I still use it to maintain my level at around 150. It's a very small gel cap, a good clean supplement with just 2 ingredients - D3 and extra virgin olive oil. It's also very reasonably priced.
Don't forget the cofactors, they're very important.
Start with D3 first, then add further supplements one at a time at two weekly intervals, that way if you have an adverse you will know what caused it.
The thing I'm finding frustrating right now is what is causing me to feel so rubbish. Is it the low Vit D or the TSH, or is it probably both?
My question is, should I tackle one area first i.e. the D3 (with cofactors- all ordered:)) as that may be the cause of my symptoms, or should I be addressing the TSH too?
The only way you can tackle the TSH is by being prescribed Levo and at the moment most doctors wont do that until TSH reaches 10. Maybe work on your GP. Print out the pdf list of signs/symptoms of hypothyroidism on ThyroidUK's main website here:
Tick off any that apply, discuss with your GP. Show her your Medichecks results, emphasise your over range TSH, negotiate and ask for a trial of Levo (it should be no less than 50mcg, if she offers 25mcg that is for the elderly, children, and anyone with a heart condition).
If your GP wants to do another thyroid test, remind her that she's already diagnosed subclinical hypothyroidism from your earlier test, your TSH has risen since then, and emphasise how much the symptoms are affecting your every day life and relationship (do you have a partner who can go along with you for support and to speak on your behalf if necessary?).
At the same time start the D3.
At the same time start eating liver and iron rich foods to help raise your ferritin.
Once you've added all the cofactors for D3, I'd start the B Complex but remember to leave this off for 7 days before any blood tests.
Actually, the presence of any auto antibodies shows you have something going on. I would guess Hashimotos. It took me 10 years to get the correct diagnosis. TSH of 7.79 is too high. My doctor medicates symptomatic patients at 3 . You need a free t4 test as that is the most accurate picture of thyroid function. It is different from a free throxine because it avoids changes in plasma protein binding. Don't wait like I did. I also have trouble swallowing to this day though not as bad. I have 2 cysts and a "they don't know what" under my thyroid. Get an ultrasound, tell your doctor you would like to try a trial of medication. Slowly titrate up. If he says no, go somewhere else. For sure an endocrinologist. Be an advocate for yourself. Doctors tend to blow this off but it can make you miserable if your thyroid is malfunctioning.
I was under the impression that free thyroxine IS free t4. TotalT4 is the test that's different.
You write 'a free t4 test is the most accurate picture of thyroid function'
I think it would be more accurate to say 'TSH/FT4/FT3 viewed together give the most accurate accurate picture of thyroid function'
Also thyroid antibodies levels are important to get a clear picture. However, i believe that a lot of people have some level of certain kinds of antibodies, which are not specific to Auto immune thyroid disease.
I had raised TPO/ab on two occasions which did help a diagnosis of hypothyroidism, but they were very high levels ie; 2499[0-50] and >3000[0-50] 6 weeks later in conjunction with a rising TSH and a falling TT4.
Over a decade later on levothyroxine treatment they are still 195.4[no range].
Thank you very much . But still my doubt is not cleared , Is there any method which correlates total t4 and total t3 values to free t4 and free t3 , so that we can fin d out whether thyroid gland functioning is normal or near normal . TSH is important factor- it is said . But when TSH is normal and t4 or t3 is high it is termed as hyperthyroidism and vice . versa . Then what is the role of FREE T3 OR FREE T4 . Doctors usually do not have patience to clear out doubts . On the other hand they think that we are questioning their knowledge in the subject .
It is perfectly possible to be tested for Total T4, Free T4, Total T3 and Free T3 from one blood sample.
But the Total tests to a large extent simply tell you how much binding protein you have. (Transthyretin, Thyroid Binding Globulin and Albumin.)
Free T4 and Free T3 tells you how much thyroid hormone is available, in the bloodstream, to be picked up by cells and transported into them. Bound thyroid hormone (which is what the Total tests tell you) just circulates round and round and acts as a reservoir to keep the levels of unbound (Free) thyroid hormone reasonably stable.
That is why many labs, many countries, have moved away from Total tests almost entirely.
In the UK, Total T4 is very rarely done (I can't remember seeing NHS results which include Total T4 - mostly you see them on private test results). Total T3 is sometimes done but, from memory and without further checking, I think Free T3 is more common.
(Technically, Total tests give you bound and unbound thryoid hormone. But the amount that is unbound is so small that it makes next to no difference to the numerical values.)
There are many reasons TSH can be high, low or middle of range whether you are hypothyroid or hyperthyroid. That is why TSH alone is a an unsatisfactory test. In the majority, very high TSH implies hypothyroid, very low TSH implies hyperthyroid, but as you get nearer the middle of the referenece interval, it tells you much less. Free T4 and Free T3 tell you far more.
You have replied to me instead of Mak0828 (the original poster).
When you are replying to a specific member's post, you need to click on the blue REPLY box directly below their post for them to get notification of your reply. As you can see you have clicked the reply box directly under my post and your reply shows as "upanddown25 in reply to SeasideSusie".
Also, as tattybogle has pointed out, Free T4 and Free Thyroxine are one and the same thing, just two different ways of saying it, usually referred to here as FT4.
If you have Hashimoto’s, even if antibodies are negative, scan will show granular thyroid and/or nodules ...or some people have very small thyroid...Can be due to Ord's thyroiditis - autoimmune without goitre
That term "sub-clinical" drives me nuts! The definition is "relating to or denoting a disease which is not severe enough to present definite or readily observable symptoms."
So patients walk into a doctor's office, describe how they are suffering, and based on a single test of a PITUITARY hormone, the guidelines tell them to diagnose "sub-clinical hypoTHYROIDism." The guidelines further lie by saying the erroneous lab result will self-correct, so no treatment is needed.
Go forth and continue suffering. I will test you again in 4 months, or 6 months, or a year and then maybe, maybe, maybe I will treat you to ease your suffering.
In my experience, when I questioned things, "But doctor, what about my fatigue? My way below normal temperature? My feeling so cold all the time?" the doctor tried to fob off other diagnoses on me. Chronic Fatigue Syndrome, Menopause, etc.
Go to another doctor. They tried to put me on antidepressants every time I went in. I was not depressed, I was tired, fat and my hair was falling out. My husband goes in with the same complaint - a battery of tests and scans were done and he is fine
I have also had this experience- the GP tried to prescribe antidepressants and I refused them because I knew that wasn't what was wrong. That was 4 years ago!
I stopped going to the GP for a long time as a result.
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