Borderline thyroid blood test: Hi I am new here... - Thyroid UK

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Borderline thyroid blood test

taurusthebull profile image

Hi I am new here. I have recently had blood tests for underactive thyroid which have come back as borderline and I have been advised to have a further test in 3 months time. I have experiences symptoms of under active thyroid for a long time so asked my GP for blood tests. Will I require medication to treat this . GP on holiday for 2 weeks so I want to be prepared to ask several questions when I speak to him. Thank you

13 Replies

Welcome to the forum

First thing: what exactly has been tested and what exactly were the results? You are legally entitled to your blood results, without giving a reason (although it's often easiest to say "for my records")

The primary diagnostic tool for GPs is TSH. This is a message from the pituitary to the thyroid - so broadly the higher the TSH, the worse your thyroid is at actually producing the hormones it should. But this is pretty crude: it doesn't say how much hormone you are actually producing. In many countries, you are treated as hypo (under-active) when your TSH gets to 3. In the UK it usually needs to go much higher - well over range and sometimes as high as 10 before you will be treated.

The second thing that should be tested are thyroid antibodies. The biggest single cause of hypothyroidism are high antibodies (also know as Hashis). You will also generally be treated as hypo if TSH is over-range AND you have high antibodies. Note that once you have had an over-range result, you don't need to continue to have antibodies tested. They will go up and down as they wish and will - eventually - destroy your thyroid (but this takes a long, long time so don't worry).

The next thing your GP should test is free T4 - the inactive thyroid hormone produced by your thyroid. You want this to be at least half-way through range - and usually higher than this.

Free T4 converts into free T3, the active hormone needed in every cell of your body. This is arguably the most important result, but is usually the last thing you will get tested. You also want this to be mice and high through range. A high free T4 doesn't guarantee a high free T3 - some people (lke me) are "bad" at converting.

Finally you also need key nutrients to be "good". Your GP won't know anything about these because it isn't part of GP training, but really you need ferritin, folate, vit D and B12 testing. I have had some success by saying that these are the tests recommended by Thyroid UK - but it's usually pretty difficult to get the NHS to test vit D.

Lots of people on the forum get the tests they need done privately, so you will see lots of posts about these.

If you post your blood results (and lab ranges, which vary from lab to lab) the lovely people here will help you to understand them

Finally, you may find it helpful to have a good rootle around the hypo part of the Thyroid UK site, and to get to grips with the jargon, helvella (one of the admins) has produced an excellent glossary (look in "pinned posts")

Good luck with the GP x

Hi fuchsia-pink thank you so much for your reply it's much appreciated. My GP who asked for the blood tests at my request is on annual leave until 21st October so I have only sppoken to the receptionist as I had a text saying I have to have another bllod test in 3 months as TSH test was borderline. I have had several symptoms of under active thyroid for several months so I consulted my GP and asked for a blood test. General muscle aches and pains depression fatigue feeling slow and sluggish dry skin ridges now developed on my nails weight gain tingling in fingers I had an underactive thyroid in my pregnancy 36 years ago but had no symptoms but was prescribed Synthroid whilst living in Canada. Now I have many symptoms associated with low thyroid yet TSH tests have come back as negative. I have done a lot of reading about under active thyroid and I am aware that the results of these TSH blood tests are very contenscious ( many people have symtoms of under active thyroid yet tests come back as normal so no treatment is given. I really need to be prepared with many questions when I do speak to my GP as I have around 20 symptoms associated with under active thyroid despite blood tests saying it's borderline. I will ask him the results of the blood tests and which components of thyroid have been tested as I am sure it's only TSH and T4 and not T3 I can envisage having no treatment as many others are in the same boat despite blood tests being borderline or "normal". B12 and FBC done and all fine. I take vit d and magnesium daily as GP asked me if I take vit D and stated my symptoms could be related to B12 deficiency but test came back as normal. So glad I have found this forum and happy to post blood test results when I receive them as I have zero knowledge of the thyroid test ranges. Due to borderline results I feel a fight on my hands to receive proper treatment , Prescribed anti depressants a few moths ago and they are not effective . Middle aged and in menopause too. Thank you again for your reply and take care

SlowDragon profile image
SlowDragonAdministrator in reply to taurusthebull

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

Far too often only TSH is tested

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

About 90% of primary hypothyroidism is caused by autoimmune thyroid disease

Ask GP to test vitamin levels and thyroid antibodies at next test, if not been tested yet

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)

Is this how you do your tests?

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 vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

Come back with new post once you get results of last test

Hi Taurus (and J_10)

Thank you for your kind comments :)

One more thing: please don't allow your GP to tell you your results are "normal" or "in range" or "getting there" - you are aiming for "optimal" ...

For example, say the free T4 range is 12 - 22; if your result is 12.2 you will probably feel dreadful. If it's 20, you'll probably feel fine. But both are "in range" (and "normal" - because that just means "in range" as well). That's why it's so important to get the actual results and lab ranges x

J_10 profile image
J_10 in reply to fuchsia-pink

Hi I'm new to this forum and in a similar situation to the poster and just wanted to say thanks for all the info and explanations in your reply to them, I've found it really useful for me too 👍

Dillongirl profile image
Dillongirl in reply to J_10

I'd like to add my thanks for the same reasons. Its been very encouraging to read about similar cases. I've been feeling that I'm perceived as a neurotic hypochondriac by my GP over the years and began to feel hopeless myself, especially during lockdown etc.

I've had so many of the symptoms described and lately to a severe level - not realising that they have been linked to hypothyroidism. It took two years to be diagnosed back in 1998 and once I took Levothyroxin all appeared to return to normal.

Since 2004 I've had occasional episodes of irregular heart beats which made me dizzy and which became very frequent. Then from 2007 I started to ask for p I will sort out my questions and come back later but rinted results and kept track of my TSH levels.

2015 I took the matter into my own hands and reduced my intake drastically (and foolishly) my TSH went to 10.49 but I felt well most of the time and no dizzy spells. This led to having a 7 day cuff heart monitor in the December. The findings were unbelievable in that it recorded, irregular, missed and rapid heartbeats. So in 2016 I had a pace maker fitted. However, I still got dizzy spells and AF's from time to time. The pacemaker was checked, it was working well but I still got episodes out of the blue.

It was in 2018 that a health food shop owner observed my breathlessness and suggested I was low in ferritin - I'd never heard of it! She sold me 'Easy Iron' (plant based) and Methyl B compound (as some people can't metabolise Vit B) I started to feel very much better within 3 or 4 days. Some symptoms dropped away.

Finally, I've made the connection that when my TSH is low (ranging from 0.49, 0.70 and 1.1) is when I've had more of these episodes. Instead of my heart racing as before, the sensation has been a tingling in my arms, neck and head and the last one took over my whole body. Very frightening! My GP made no comment and said that I was older and had other things going on - she couldn't justify a referral to the Endocrine clinic on the NHS. !!? then advised me to continue with 75mg per day, a drop from 100mg.

I did feel very vulnerable so all this information is reassuring. I'm 70 now and understand that certain conditions may change as one gets older - I just want help and advice on how to manage the situation so that I can contribute and enjoy a certain quality of life. Otherwise, I'm quite strong and active in between. Occasionally, I'm now left with a very feint sensation under my sternum which sets off a throb at the base of my throat and sometimes the pulses in my head when I'm tired - so going to bed earlier and taking a rest early afternoon.

Thank you ! its given me hope.

Hi Your situation sounds similar to mine. I'm new to the forum too. I've had 3 blood tests at 3-monthly intervals showing my TSH to range from 6-4.2 (it's gone down each time) My GP doesn't treat until it reaches 10. Like you I have many symptoms so the repeated tests were at my request, the third one they actually texted the T3 T4 and antibodies. My GP has confirmed I do have antibodies and therefore says I will develop and therefore need medicating for an Underactive Thyroid in the future. He's recommended I take vit D supplements and have 6-monthly blood tests to keep an eye on my thyroid function and to get back in touch if symptoms worsen. From my experience all I can say is trust your own instinct, you know your own body and if you're not happy with the response from your GP then keep pushing. Hope you have some joy with it.

SlowDragon profile image
SlowDragonAdministrator in reply to J_10

Suggest you print out these guidelines

See flow chart on top of page 2

gp-update.co.uk/Latest-Upda...

If you have high thyroid antibodies and symptoms and TSH over range you should be prescribed a trial

Essential to test vitamin D, folate, ferritin and B12 too.

As vitamin levels drop, due to being hypothyroid, TSH tends to drop lower and lower.....frequently making it harder and harder to get diagnosed the longer you are hypothyroid

SlowDragon profile image
SlowDragonAdministrator in reply to J_10

So how low was vitamin D

How much vitamin D have you been prescribed

Important to retest Twice year - aiming to improve to at least around 80nmol and around 100nmol maybe better

(NHS will only test once every 2 years)

Frequently B12 and folate are low too with low vitamin D

Get hold of results, or test if not been done yet

If you have high antibodies this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

healthcheckshop.co.uk/store...?

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

J_10 profile image
J_10 in reply to SlowDragon

Hi My Vit D levels weren't tested so I don't know what they are and haven't been prescribed anything. My doctor suggested I try vit D supplements when I asked what I could do to help manage my symptoms until I do get to the point where thyroxine is needed.

I have started taking a B vitamin complex supplement recently to hopefully help my energy levels and metabolism.

Can I get my vitamin levels tested on NHS or need to be done private?

I don't know how high the antibodies are, just that they exist.

I terms of Hashimotos affecting the gut, could that be sluggish digestion and constipation?

SlowDragon profile image
SlowDragonAdministrator in reply to J_10

Strongly recommend getting FULL thyroid and vitamin testing

Ideally you would have tested BEFORE starting any vitamin supplements

Just vitamin D

vitamindtest.org.uk

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

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)

If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

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 vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

SlowDragon profile image
SlowDragonAdministrator in reply to J_10

Essential to stop vitamin B complex a week before ALL BLOOD TESTS as biotin can falsely affect test results

SlowDragon profile image
SlowDragonAdministrator in reply to J_10

GP should have tested vitamin D first

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

With your Vit D, are you also taking it's important cofactors - magnesium and Vit K2-MK7?

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

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