Test results - normal thyroid but raised anti bodies

[Rosie139]

Hi - first time poster here.

After a couple of years of borderline tsh results plus some mild symptoms especially achy joints I recently got a thyroid check done by medicheck (first thing in the morning before food). Results:

Thyroid Hormones

TSH

0.27 - 4.2 R

3.45

mIU/L

FREE T3

3.1 - 6.8 R

4.02

pmol/L

FREE THYROXINE

12 - 22 R

15.7

pmol/L

THYROGLOBULIN ANTIBODIES

< 115 R

122

kIU/L

THYROID PEROXIDASE ANTIBODIES

< 34 R

99.9

The report says may indicate Hashimotos and to have an annual check but also to consider checking vitamins. I had some blood tests at the end of last year and these were in range.

I am looking for help on what next really. Aware my GP won’t do anything (my tsh has improved quite a bit since my last test in October). I have read quite a lot about going gluten free but that seems like a fairly major step.

Any help gratefully received.

[SlowDragon Administrator]

Ask GP to test vitamin D, folate, ferritin and B12 plus coeliac blood test BEFORE considering GF

Low vitamin levels are EXTREMELY common with Hashimoto’s

[greygoose]

Hi Rosie139, welcome to the forum.

First thing you have to learn is that there's no such thing as 'normal', where thyroid is concerned. When a doctor says 'normal', all he means is 'in-range'.

So, yes, your thyroid results are all 'in-range', so we have to look at where they fall in the range to know what's going on.

TSH: I don't know how much you know about all this, so forgive me if I seem to be preaching to the choir. Thyroid Stimulating Hormone: a chemical messenger from the pituitary to the thyroid, telling it when to make more hormone. When the pituitary senses there's not enough thyroid hormone in the blood, it raises TSH to stimulate the thyroid to make more hormone. A euthyroid TSH would be around 1 - certainly no more than 2. A TSH over 2 indicates that your thyroid is struggling to make enough hormone to keep you well. A TSH over 3 is technically hypo - not in the least bit 'normal' - and in some countries you would be diagnosed at that level. But, the NHS likes the TSH to go over 10 before it will admit you have a problem! The fault is with the NHS, not the TSH.

FREE T3 4.02 (3.1 - 6.8)

FT3 is the test to see how much T3 you have available for your body to use - Free T3. A euthyroid FT3 would be about mid-range. Yours is only 24.86% through the range, so too low. T3 is the active thyroid hormone, needed by every single cell in your body to function correctly. It is T3 that causes symptoms when it's either to low or too high.

FREE THYROXINE 15.7 (12 - 22)

Also known as FT4. T4 is basically a storage hormone that needs to be converted into T3. A euthyroid FT4 would be about mid-range, too, just slightly higher in-range than the FT3. Yours is only 37% through the range, so it's too low.

Both your antibodies are over-range, so it's pretty certain - given your hormone levels - that you do have Hashi's, and you've probably had it for some time.

Hashi's is an autoimmune disease where the thyroid is slowly destroyed by the immune system. So, it gets worse, rather than better.

consider checking vitamins. I had some blood tests at the end of last year and these were in range.

So, as you can see above, it's not just about being 'in-range'. It's more complicated than that. It's about interpreting the position of the result within the range - something that doctors are no good at. Just because your nutrients were somewhere in the range doesn't mean that they are good. So, given also that nutrient levels will decrease with time when you have Hashi's, it would be advisable to test them again. Nutrient levels need to be optimal for your body to be able to use thyroid hormone efficiently. Plus, they will cause symptoms of their own. So, this is probably something you need to work on. And, as long as the results aren't too low, you're best off working on them alone. Doctors do not learn about nutrients in med school so fail to appreciate the importance o optimal levels, and are only concerned if they are under-range.

I have read quite a lot about going gluten free but that seems like a fairly major step.

The thing about gluten-free is that a lot of Hashi's people are gluten-sensitive, even if they don't actually have Coeliac Disease (which a lot of them do). So, gluten-free is worth trying because it could make you feel so much better. It doesn't work for everybody, and it won't cure your Hashi's, but it is worth a try for the possible benefits.

I am looking for help on what next really. Aware my GP won’t do anything (my tsh has improved quite a bit since my last test in October).

'Improved' is not quite the right word, here. It's not really about the TSH. TSH doesn't make you feel anything, or cause symptoms, whether it's high or low. It's just a rough guide to thyroid status. But, when you hav Hashi's, it is normal for levels to jump around a bit, so the fact that it's reduced doesn't have any impact on the state of your disease. It also depends on the time of day you have the blood draw. TSH is highest early morning, and drops throughout the day. It also drops after eating or drinking coffee. So, unless all your tests are done under exactly the same conditions, you cannot compare results. But, as more and more of your thyroid is destroyed, the over-all trend for your TSH will be to increase.

As I said before, doctors - especially GPs - are not good at interpreting blood test results. They do not appreciate the finer points. And, your GP is probably waiting for your TSH to go over 10. However, the guide-lines state that an over-range TSH, together with raised antibodies, should give a diagnosis of hypo-Hashi's, without the TSH having to reach 10.

So, it's a case of watching and waiting - and retesting - until your TSH goes over-range. And, in the meantime, retesting your nutrients, and optimising levels (we can help with that), and experimenting with gluten-free. That's about all you can do, at the moment, I'm afraid.

[Rosie139 in reply to greygoose]

That’s so helpful thank you. Sounds like I have a next step at least which is something positive.

[greygoose in reply to Rosie139]

You're welcome.