Don’t know whether to laugh or cry... help with husband’s thyroid results, please! And hypo / gout connections?

[Lotika]

So, here’s me with hashis on an NHS T3/T4 trial after 3 years of fighting the system to get my thyroid medication right... and there was The Husband over Christmas, sleeping a lot and feeling generally stressed, tired and achy. He has gout but wondered if his new symptoms suggested rheumatoid arthritis and I said he should ask for a thyroid test too, whilst he was at it... and, well, who’da thunk it, here are the results.

TSH 6.5 (0.27 - 4.2)

T4 12.4 (12-22)

The doctor has just called. As I heard my husband mention “my wife” and “hypothyroidism”, I started hovering(!) and writing frantic notes to stick under my husband’s nose telling him to ask for antibody and vitamin tests. My husband’s uric acid level is high at the moment, so the doctor wants to medicate that and then test thyroid again, including antibodies, in 6 weeks...

So... does anyone know if uric acid levels can impact thyroid? That seems like the GPs working theory, although I’d have thought it would more likely be the other way around... The other thing which occurs to me is that the poor old husband is unlikely to have T3 in range with such a low T4 result... what do you think?

Should we just bite the bullet and get him a full thyroid and vitamin panel privately now rather than waiting 6 weeks and probably getting refused a T3 test by the system? Following my own experience, I don’t trust them with this one little bit and don’t want the husband feeling unnecessarily unwell for any longer than he has to whilst they mess about: I know how awful it is! And I know they tend not to medicate until TSH is over 10, but I suppose a shoddy T3 result might persuade them otherwise. Is that likely do you think? I wasn’t diagnosed until my TSH hit 28, so I am less certain what ought to happen at the low end of the scale. I hope he doesn’t have hashis He is saying I gave it to him, ha ha!

Honestly, I feel like I am panicking, so I’d really appreciate it if you could check my logic. The worry that he is about to go through what I’ve been going through for all these years breaks my heart.

Lotika xx

[Alanna012]

I'd get the private test for T3 for sure. Forearmed and all that.

I wasn’t diagnosed until my TSH hit 28, so I am less certain what ought to happen at the low end of the scale

It really doesn't matter how much lower a TSH of 6.5 is in relation to one of 28. All that matters is that it is elevated. I read here of incredible stories of people walking about in the realm of the living with TSHs above 50 or even 100 + and when mine is just under a mere 5, I can't get out of bed. It reached 30 once and I nearly ended up in hospital.

So T3 is more important to know in terms of how it is affecting your poor husband x

[Lotika in reply to Alanna012]

Thank you for this, Alanna012. It's good to know that over range is over range and that some people can feel really shoddy just a little over. I obviously have no idea how it felt to be a little over. The chances are that I was a little over at some point, of course, given that I wouldn't have suddenly gone from normal to TSH 28 over night, but as I wasn't tested, I'll never have that experience to think back on! Sounds like we should be pushing to get him medicated... It's strangely quite a blow to me on the husband's behalf! Husband, on the other hand, is not that bothered about the whole thing and is trying to blame symptoms on work stress, COVID stress, lockdown stress, etc. Have pointed out to him that I spent years putting my symptoms down to similar things... I guess we'll chat later and work out our best way forward.

[Alanna012 in reply to Lotika]

Yes to qualify, if your husband's TSH rose to 28 he'd likely be feeling a great deal worse, because he already feels ill with 6.5. However if comparing to someone else with a TSH of 28, or even higher, that person may well be going about life and work feeling a bit crumby, but ok, so comparing TSH numbers as if it really means much in terms of effect between people is meaningless, and even on an individual basis one finds TSH can be suppressed and feel awful sometimes and a bit higher and feeling good.

A case in part is my Aunt who has a goiter the size of an orange. You see it before you see her. Never taken her levo properly, despite my arguments, her TSH last time she tested was 72. She works, sleeps well, has all her hair etc. Had few issues with carpel tunnel and weight gain.

I have fibromyalgia and am bedbound most of the time if I don't take NDT and my tsh has never been anywhere near that high.

All that really matters is Symptoms along with elevation of TSH. And we know there are people with TSH suppressed but still feel very ill.

[Lotika in reply to Alanna012]

I hear you - agreed that it is all very subjective. And you're definitely right. I see some people's results on the board and think to myself that I would probably feel amazing with my T4 and T3 at their levels, but they don't, because they need their levels somewhere different to where I need mine!

[SeasideSusie Remembering]

Lotika

To be honest, I don't think it's worth worrying about a T3 test at this stage.

Your hubby is obviously hypothyroid in my opinion.

It's usual to retest thyroid again a few weeks after the first high TSH result, just to check that it's not a non-thyroidal illness that caused the raised TSH.

However, with FT4 barely scraping into range I would say there's no doubt.

The reason to not bother with FT3 test at this stage is because the body will be trying to make as much T3 as possible as this is the active hormone that every cell in our bodies need, so it may not show as low at this stage.

He needs a prescription for Levo, he needs to get his TSH down to 1 or below and see where that takes his FT4 and that's when it's useful to also test FT3 to see how well he converts.

You could ask the GP to test his antibodies, he may be willing to do that. If not then he'd need to do a private test for the full thyroid panel and that would include FT3 as well as the antibodies.

[Lotika in reply to SeasideSusie]

Thank you, SeasideSusie. The fact that you see him as obviously hypo from the low fT4 is really useful and when I look again, I can see that it does look like that typical hypo pattern of TSH frantically increasing just to get fT4 into the bottom end of the range, doesn't it? Will chat with the husband tonight and see what he wants to do...

[SlowDragon Ambassador]

I would request they treat the cause of high uric acid.....ie hypothyroidism FIRST

pubmed.ncbi.nlm.nih.gov/117...

was this thyroid test done as early as possible in morning before eating or drinking anything other than water?

See flow chart on top of page 2

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

Recommend getting FULL Thyroid and vitamin testing done

Ask GP to test thyroid antibodies, folate, ferritin, B12 and vitamin D NOW

If GP unhelpful, test privately

[Lotika in reply to SlowDragon]

Thank you, SlowDragon, I have had a look at the flow chart and it makes me think he should definitely mediated, along with what SeasideSusie said... And I agree, the research seems to suggest that hypo could cause a rise in uric acid, rather than the other way...

You're right - he does need to have the next test first thing in the morning and all that. This one wasn't, mainly because I just told him that maybe he should have thyroid thrown in with the other things the GP wanted to do, given that I could see that some of his symptoms were the same as mine but we didn't really expect him to have it, it was more of a "just in case". Will make sure he does that for the next NHS test in 6 weeks.

In the meantime, I intend to try to persuade him into what I consider to be the most expedient option, which is full thyroid, vitamin + antibodies, privately... We can then get it done ASAP and quite honestly, I think I'd rather drop £80 than waste time fighting the NHS.

I will make sure he does any private test he might agree to let me purchase for him first thing!

Thanks again. I've been a little bit tearful about this, because I was worried that the husband is going to have the same old torrid time of it that I had... but he isn't, of course, because we have my experience to fall back on and we know we can get good advice here. It won't be the same at all

[jimh111]

It would be very useful to know what his fT3 is so I would get TSH, fT3 and fT4. Depending on finance you could consider checking antibodies also and possibly vitamins, at least for one initial test.

[Lotika in reply to jimh111]

Agreed re the private test - I think it's worth the money to save the stress as much as anything! And in my view, if we're going to do something - like a private test - we may as well do it properly!

[Miffie]

I am not so sure about a link between thyroid and gout as I have had several bouts of gout however I never thought about it in relation to hypothyroidism. In my case the gout was linked to osteo arthritis. I was treated several times to reduce uric acid levels. A few years ago following a referral to a rheumatologist I was prescribed a hefty daily dose of Allopurinol and Furosemide. Never had a problem since. I hope your husband soon feels more human gout is miserable I know.

[Lotika in reply to Miffie]

Hi Miffie, Thanks for responding - I knew there was a regular poster who had gout, so I thought to put gout in the title at the last minute in the hope that someone with both gout and hypo might comment!

They're going with a hefty dose of Allopurinol, in husband's case. He has taken it before but stopped years ago as he found he was managing it fine with black cherry extract and apple cider vinegar, oddly enough...

Agreed that gout is a truly horrible thing - I hear it is incredibly painful. Husband is very good at just getting on with it. He tells a rather funny story about how he was laughing at his dad for having gout many years ago, to which his father responded "laugh all you want, now son. It's bl00dy hereditary!"

[Miffie]

I had a huge left ankle for may years which no one ever bothered about other than dishing out diuretics. It was after several gout incidents in my right toes that the GP sent me to Rheumatology muttering that with my arthritis maybe I shoukd have the ankle looked at. It had never hurt anything like as much as the acute gout sessions but the consultant assured me it was gout and that it can last a lifetime. I have been amazed at the difference although it’s still larger than my right ankle. I can now wear boots for the first time in thirty years. I suspect it will never be the same size as my whole leg is fatter than the right. I have been thinking more about this since you posted and I couldn’t rule out the relationship between hypothyroidism and uric acid levels.

Hope your poor husband gets his thyroid and gout sorted . Take care.

[Lotika in reply to Miffie]

Thank you - I am glad your ankle is fixing itself! The father in law used to swear that orange juice caused him gout flares!

We are planning to have a chat about it after dinner as I am keen to try to work out what the timeline was with the latest gout flares and other symptoms... whilst he’s had gout flares for 20 years, he’s suddenly started having it in more than one joint at a time, which is apparently uncommon but not impossible

I feel a bit better as I feel as if we can get half a plan together when we can discuss it properly later and then we will be golden, eventually...

[Miffie in reply to Lotika]

I do hope he finds a solution.