Can you have ‘normal’ blood test results but still have an under active thyroid?

[Lynsey24782]

Hi everyone, I posted a little while ago about symptoms I’ve been having over the last couple of years. I’ve had some further blood tests recently where my T4 came back as 12.7 & TSH 2.49. Since 2018, each test has shown the T4 in decline each time and TSH increasing but still in ‘normal range’. My free T3 is 5.39 but never had that tested before so no idea about changes on that. I am negative for thyroid antibodies but I do have a vitamin B12 deficiency (treated with injections) and a vitamin D deficiency. I’m 37 years old and have always eaten well and I’m active so have been a size 10 all my life but have gained 3 stone with no explanation at all! Nothing is shifting the weight - I just continue to gain. Hormone tests FYI are normal apart from FSH slightly low and some others on the low end but in normal range - these show zero indication of PCOS or anything else. I’m honestly at my wits end. Could those thyroid levels be in normal range but not be normal for me? Will they try treating with Levothyroxine at my request to see if this helps? My sister has hypothyroidism and has done for years. I just want to look and feel like me again...

[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, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised 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)

Is this how you do your tests?

NHS highly unlikely to have tested both TPO and TG antibodies

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

Do you have Pernicious Anaemia or just B12 deficiency?

As you have B12 injections doe you also supplement a daily good quality vitamin B complex?

This helps keep all the B vitamins in balance

When was vitamin D last tested ...how much vitamin D do. You supplement

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

20% of Hashimoto's patients never have raised antibodies

Ask GP to arrange ultrasound scan of thyroid

healthunlocked.com/thyroidu...

[Lynsey24782 in reply to SlowDragon]

Hey, the recent blood test was not by the NHS, it was a private blood test. I do not have pernicious anaemia (tested negative) and I’m not vegetarian or vegan so I don’t know why I’m deficient. NHS never offered any further tests - just injections. My B12 levels are ok now with the injections. Vitamin d only tested within last couple of weeks and came back deficient so I’m now taking 3,000 IU daily as suggested by the doc. My iron and ferritin levels are normal

[SlowDragon Administrator in reply to Lynsey24782]

When hypothyroid it’s extremely common to have low stomach acid. We need high acid in gut to absorb nutrients

Low B12 if not vegetarian or vegan suggests poor gut function....

Low B vitamins and low vitamin D often appear together

Gut needs good vitamin D to “grow” B vitamins in gut biome

drgominak.com/sleep/vitamin...

In YouTube video when Dr Gominak talks about vitamin D levels ...vitamin D at 40ng/ml (USA units) is equal to 100nmol (UK units)

youtu.be/74F22bjBmqE(Not working as expected?)

Look at improving gut function....

Fermented foods like kefir, sauerkraut and kimchi

Probiotics

Etc

[Lynsey24782 in reply to SlowDragon]

Funny enough I started having kefir daily a few months ago as I’d heard it helps with gut issues. I assumed the B12 deficiency stemmed from an issue somewhere in my digestive system

[SlowDragon Administrator in reply to Lynsey24782]

Getting all four vitamins optimal can help improve thyroid issues or can help get thyroid treatment started....TSH can sometimes rise once all four vitamins are optimal

[fuchsia-pink]

"Normal" and "in range" often don't mean much - it's how you feel and where you are in the range that is more important. For instance, if your free T4 range is 12 - 22, you are just in range, but crawling along the bottom of it, and would probably feel much better if it were much higher!

I assume you're not currently on thyroid meds [if you are, I'd suggest a small increase] which is a shame, as you are most unlikely to get treated until your TSH gets much higher - not just out of range but waaay out of range - sometimes doctors won't treat you until it get to 10 - at which point you will feel dreadful.

In my experience it's pretty tricky to lose weight until free T4 and free T3 are optimal ...

Suggest you follow SlowDragon 's words of wisdom - and keep checking your bloods; hopefully once your TSH goes over-range you can persuade your GP to put you on medication.

Good luck x