Under range FT4

[MY04zzz]

Hi

Thank you all for your input regarding my friend and her suspected central hypothyroidism which her GP wasn’t interested in.

I would be grateful for any comments regarding these latest results.

The last thyroid results from 2019 showed

TSH 1.19(0.27-4.2)

FT4 13.80 (12-22)

FT3 4.60 (3.1-6.8)

Thank you all for your fab input and advice

[SeasideSusie Remembering]

MY04zzz

The below range FT4 is even more evidence that it could be 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 very low or below range.

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).

The GP can look at BMJ Best Practice for information - here is something you can read without needing to be subscribed:

bestpractice.bmj.com/topics...

and another article which explains it:

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

and another here:

endocrinologyadvisor.com/ho...

You could do some more research, print out anything that may help your friend. Your friend is going to have to assertive, take someone with them if necessary, and not leave until further investigation has been promised.

As Central Hypothyroidism isn't as common as Primary Hypothyroidism it's likely that your GP hasn't come across it before. Your friend may need to be referred to an endocrinologist. If so then they should make absolutely sure that it is a thyroid specialist they see. 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 possible ones. Then if the GP refers, 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. You could also ask on the forum if anyone has been successful in getting a diagnosis of Central Hypothyroidism, possibly in your area which you'll have to mention of course.

[MY04zzz in reply to SeasideSusie]

Thank you Seaside Suzie - I hope the fact that her FT4 is below range will help in getting a diagnosis and treatment - she is feeling awful at the moment. I’ll pass the links on to her - I have passed Dionnes list to her already.

I felt awful too myself when my FT4 was under range so I know what she’s feeling like - couldn’t think straight or remember anything plus so many other symptoms , but my TSH was heading towards 10 so was diagnosed fairly easily with Hashi’s and treated with levo.

Thank you

[SlowDragon Administrator]

What vitamin supplements is she taking....if any

Any history of head trauma, whiplash or traumatic labour (Sheehan syndrome)

All can trigger central hypothyroidism

Or some medication - lithium, some acne treatments

[MY04zzz in reply to SlowDragon]

She takes Vit D - that’s the only vitamin. She also has a family history of both hypothyroidism and B12 deficiency (not sure if PA) which GP was informed of.

She was diagnosed by GP with dementia a few years back and she is medicated for that. She was not referred to a specialist for this and the GP Organised medication for this On her online records She cannot find any reference to FT4 test results prior to this although there are some TSH. If her FT4 was never tested then Central Hypo would have been missed??

I will pass on all of the info to her including about the causes you mention

Her folate is dire and active B12 I think I have seen on this forum should be at least 70 p/mol/L? Could you please just comment on these?

Thank you so much again for your valued input

[SlowDragon Administrator in reply to MY04zzz]

Suggest you research any interaction between dementia medication and thyroid

Causes of dementia......Low B12 and hypothyroidism both listed here

helpguide.org/harvard/whats...

Yes I want to know if she was taking any B vitamins before replying about low folate and borderline B12

Perhaps trying a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B is another option that contain folate, but is large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

[MY04zzz in reply to SlowDragon]

No B vits at all. Her sister and father have B12 injections every 3 months but GP has said her B12 was fine. This is the first active b 12 test she has done Her B12 last year (not active) was 528 pmol/L (insufficient 145-300, reduce if over 569) this was a private done by Blue Horizons

Thank you