Shin Rash Reduced TSH normal T4 and T3 - Thyroid UK

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Shin Rash Reduced TSH normal T4 and T3

Brumhoy68
Brumhoy68

Hi guys hope you can help.

Over the last three months I have developed a rash that has gradually grown week by week on one shin before transferring to the other one to a lesser extent. I left it a while a month I guess before it got on my nerves. Visited GP who claimed it was a drug allergy to the many epilepsy meds I was taking I knew it wasn't as I hadn't changed them in two or more years. So I tried another go who said it was a bacterial infection be gave me cream did no good. Last Thursday I had enough as it was spreading and I was feeling quite pissed off and felt generally unwell so I went to hospital. To cut a long story short they had no idea what it was but my blood pressure was high and heart rate was high and blood tests seemed to be ok. So they kept me in. Finally they decided it was excema. I'm a calm man but I nearly thumped the doctor I had seen seven different doctors during my stay and not one of them could have not been able to point it was that. So I asked them to explain the high heart rate and blood pressure, they had no answer. So I decided to sign myself out.

When I got home the doctor had called about the blood test I had the previous week to say my vitamin d was low and gave me some pills. So I thought I would check my results on patient access. My TSH has fallen from 0.56 to 0.2 from Nov to Feb. Having explored this on the internet I think this is the reason for my rash. If it' is I'm shocked it hasn't been picked up earlier, and I can't understand why it is changed has I have been taking 150 mg of levoythroxone for over 18 months since radioiodine treatment. Any comments ????

37 Replies

A low TSH does not cause rashes. TSH itself doesn't cause any symptoms at all, or make you feel anything. It is just a messanger between the pituitary and the thyroid: Thyroid Stimulating Hormone.

Is TSH all they tested? That is totally inadequate to know thyroid status. You need the thyroid hormones tested: T4 and T3. If the T3 is too high or too low it will cause symptoms of many kinds, but not the TSH.

Brumhoy68
Brumhoy68 in reply to greygoose

My free T4 and T3 are both within normal range. So why would the TSH half within three months surely it must be connected, as my TSH has never been that low since I started being medicated. My vitamin d levels are very low. Something weird is happening My cholesterol level has gone from five to six since Nov I don't understand it all

greygoose
greygoose in reply to Brumhoy68

Do you have your exact number for the FT4/3: results and ranges? Just because they're in-range doesn't mean they're at the right level for you. And, the increase in cholesterol is saying that your FT3 is too low.

TSH and Frees are connected, of course, but the fact remains that the TSH does not cause symptoms whether it's high or low.

Brumhoy68
Brumhoy68 in reply to greygoose

Free T4 13.7 range 9 to 19. Free T3 level 4.2 range 2.4 to 6 What's causing the change in TSH then. Something has made it shrink down to 0.2 the normal range for that is 0..4 to 4.9. As I am on levoythroxone and I have not changed doses and I was in the range I surely should still be comfortably within that range and not below that range but I don't understand how that could change in the last three months. I am very confused

greygoose
greygoose in reply to Brumhoy68

Were both tests done under the same conditons and at the same time of day?

But, honestly, TSH is not something to worry about. It's a very poor indicator of thyroid status.

Free T4 13.7 (9 - 19) 47%

Free T3 4.2 (2.4 - 6) 50%

Your Frees are actually quite low for someone on thyroid hormone replacement. A lot of hypos need them quite a bit higher than that.

Can you please explaim to me how to work out percentages 🙏

SlowDragon
SlowDragonAdministrator in reply to Brumhoy68

Was test done as recommended

Early morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Ft4 is only 47% through range Ft3 slightly better at 50% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Suggests you are under medicated

Being under medicated will result in low vitamin levels

helvella
helvellaAdministrator

For many skin issues, it can be helpful to look at pictures - and I often post this link:

dermnetnz.org/

Far from knowing anything about skin disorders and rashes, but is there any possibility you have pretibial myxoedema?

dermnetnz.org/topics/pretib...

eachpeach
eachpeach in reply to helvella

I was wondering about pretibial myxoedema too. If you had RAI for Graves' have read that the disease can sometimes affect other areas of the body, like the shins - see casereports.bmj.com/content.... Can you get back in touch with your endocrinologist's secretary and send them a pic? Or ask your GP to refer you?

SlowDragon
SlowDragonAdministrator

For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

How much vitamin D are you currently taking

On levothyroxine we frequently need to supplement vitamins to maintain optimal vitamin levels

Low vitamin levels tend to lower TSH

Ask GP to test folate, ferritin and B12

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)

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 antibodies and vitamins

medichecks.com/products/adv...

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 down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Vitamin D NHS postal kit

vitamindtest.org.uk

Skin rashes can be caused by vitamin / mineral deficiencies. Very few doctors know anything about nutrition and deficiencies. Your low vitamin D might be part of the problem but it's not the only vitamin which can cause rashes.

Have you had vitamins and minerals tested? It helps your thyroid treatment if you have good vitamin and mineral health. See this page from the ThyroidUK website.

thyroiduk.org/role-of-vitam...

Do you take any supplements? It's always advisable to supplement where you have deficiencies rather than taking multivitamins.

I hope that helps.

Yes they were done at the same time if day early morning. I had taken my meds. Vitamin d is very low. Ferritin is ok.I looked at that picture on that link hellvella provided and that sent me down the thyroid route. The pictures are so similar to my leg I thought it may be linked to my thyroid. That's why I hoped I had finally found the answer to this bloody rash

greygoose
greygoose in reply to Brumhoy68

Yes, I don't doubt your rash is linked to your hypothyroidism. But, what I was saying was that it has nothing to do with the TSH itself. TSH is not a thyroid hormone, it's a pituitary hormone. :)

What's more, I think - although I wouldn't swear to it - that low nutrient levels can lower the TSH so that it has no relation to the levels of your Frees.

Stourie
Stourie in reply to Brumhoy68

If you had taken your meds before the test your results would be elevated, so even more likely that you’re under medicated. Jo. Xx

I've got the same on both of my ankles.

Eucerin cream is really good to stop the itch and get rash under control.

I have an explained large rash for 10 weeks now on inside of knee. Had it since I’ve had Covid. Have you had it and can tie it in. Doctor cannot suggest anything other than some people reporting coagulation or that is is small clot dispersing which I find quite worrying tbh. Also people having chilblains after Covid. After much pushing and that I didn’t want a ‘cream’ she is giving me blood test to check clotting levels. I too have high cholesterol with hashimotos but I’ve been working on great diet, more movement, less toxins in food and skincare to just let my liver work on what it was intended to do. and lifestyle changes and keeping levels in check since coming off statins and keeping iodine levels in check (too much is as bad as too little fine balance) which is vital as well as D3, B12, selenium. But don’t rely on support from GP. Try Thyroid Care Group Facebook page. Also Izabella Wentz Thryoid protocol (she’s a pharmacist who had to use other things to help her Hashi). Interesting. It’s a minefield and sometimes we know more about our condition than our docs sadly. Also join Thyroid Trust social media.

I don't think I have had covid. He gave me daktarin which failed. Its virtually impossible to sleep with the pain in my shins in night caused by the rash even though I take antihistamines. When I was in hospital last week they had no idea what it was. I spent four nights in there for fast heart rate and high blood pressure to which the only connection was the rash. I would love to get the bloody rash off my leg it's a nightmare. I only knew my vitamin d was low and my gp had prescribed me pills when I went to pick up my dads prescription the gp never called me or told me I was low in the vitamin. I guess the connection from the thyroid to the rash to the fast heart beat to the blood pressure crosses too many specialists in the NHS to get a definitive diagnosis. Does anyone think I'm taking too much levothyroxine 150mg which may be causing this

helvella
helvellaAdministrator in reply to Brumhoy68

I do not think that your level of thyroid hormone is causing this.

It might be that it worsens with too much, or too little, thyroid hormone - and improves when that is corrected. But I don't think it is a cause.

It it were so, we we expect such things to be far more common in all forms of excess thyroid hormone - including toxic multinodular goitre pushing out masses of thyroid hormone. And, instead of only sometimes occurring alongside Graves, we'd expect it to be common.

I have had it for several months and gradually it has spread to other body parts. I have tries so many over the counter products and various doctor prescribed remedies currently Betamethasone cream sparingly. Helps a bit. Also using Epimaz Oatmeal Cream and ointment by the bucket load. Spent a fortune changing bedding washing products and fed up of going to the doctor. No stay in hospital🤪. I shall monitor this discussion with interest. If you find a solution I for one would be grateful if you could share it👍

helvella
helvellaAdministrator in reply to Dave1000

Have you seen a consultant dermatologist?

There are some treatments that could be considered for you and Brumhoy68 - but you'll only get them from a dermatologist - so far as I can see. For example, hyaluronidase injections in the affected area.

Dave1000
Dave1000 in reply to helvella

Thank you Brumhoy68 i will try to get a referral. The injection option already has me thinking that I will resemble a pin cushion. 😂

helvella
helvellaAdministrator in reply to Dave1000

You might, or might not, find this, umm, interesting:

lasvegassun.com/news/2011/j...

:-) :-) :-)

Dave1000
Dave1000 in reply to helvella

Just one small tattoo was enough for me thanks 😊

Oatcake
Oatcake in reply to Dave1000

See my reply to Brumhoy below. I think Betamethasone is like Betnovate which didn't help me. GP eventually gave me Dermovate which is stronger and it worked.

helvella
helvellaAdministrator in reply to Oatcake

For information only: Dermovate has active ingredient Clobetasol Propionate.

Two GPs four different A and E doctors two ward doctors and finally an official medical photographer was sent to take detailed photographs of my leg to send to the dermatologist. They somehow managed too lose these and sent another doctor with a mobile phone to take pictures and pass them to dermatologist allegedly , he came back with excema diagnosis. I was their four days. In the second cities biggest hospital and couldn't get to see a skin doctor amazing. I'm still not sure why the heart rate was so high .anyway excema it isn't I know that if eight doctors cant diagnose that I'm not buying it either. I'm just not sure where to go. I may just cut a 50mg in half and take 125mg instead of 150mg so how I feel and whether it goes away. I had no sleep again last night painkiller cream antihistamine nothing works.

May we see your leg pls Brumhoy? (Image😊)

I have many the bruising is only a recent development on the top and bottom of the rash I have no bloody idea what it is, any suggestions what it is greatly welcomed because the NHS are as much in the dark as I am . I know with excema there is no bruising so that diagnosis is not correct.

Partner20
Partner20 in reply to Brumhoy68

Was antiphospholid syndrome considered as a possibility, I wonder? It is another autoimmune condition, and one that can be linked with high BP and heart issues.

SlowDragon
SlowDragonAdministrator in reply to Brumhoy68

Are you sure this isn’t pretibial myxoedema

Google images

Looks like it

Alternatively on levothyroxine it’s EXTREMELY common to develop gluten intolerance

Get coeliac blood test BEFORE trialing strictly gluten free diet 3-6 months

Strongly recommend getting FULL thyroid and vitamin testing done BEFORE reducing dose levothyroxine

Never reduce dose by more than 25mcg

Likely to need dose increase in levothyroxine, not reduction

Low vitamin D result of being under medicated

Likely B12, folate and ferritin may be low too

To be honest all the doctors in the hospital really had no idea what it was. I was in four days and got little or no help at all in finding out what it is. I had blood taken twice but I guess that was just tested for bog standard things, I'm stuck really don't know what to do. I'm helpless

Oatcake
Oatcake in reply to Brumhoy68

This time last year I was struggling with a rash that kept spreading. To cut a long story short, after many months GP sent photos to dermatologist and the reply came back 'eczema'.

Now it didn't look like any photos I had seen of eczema but the GP went with that and prescribed Dermovate (clobetasol) which is about the strongest steroid cream available. Weeks of applying this along with vast amounts of E45 brought it under control. I do get occasional patches but one application of the steroid cream usually stops it developing and I still use lashings of E45 daily.

I know some people don't like using steroids but for me it was worth it and it was only for a while. Maybe you could ask your GP for this. Hoping you find relief.

Is this a ‘bumpy’ rash ?

No it's not bumpy it's smooth. I thought it might be pretebrial myexodomia. But no one in NHS is listening. I have set up another post yesterday my doctor wants me to drop my levithyroxine by 50mg a day because he believes my epeilpsy medication is interfering with the levels. Cobblers I have been on the same meds for 5 years. He's useless

Hello Brumhoy

Are you sure that this rash isn’t related to your anti epileptics? Allergies often develop quite a while after commencing drugs.

I’ve been looking at some photos and there is a similarity.

Another thought about rashes. See this link to the page for a program in the BBC Two series - 'Trust Me I'm a Doctor' - this one headed 'Are my wash products damaging my skin?'

bbc.co.uk/programmes/articl...

Sodium Lauryl Sulfate (SLS) is in many skin products if you look at the list of ingredients on the label. In particular it's in Aqueous Cream which has been around for years. I'm guessing that may have been to do with a rash on my legs where I had used it regularly. I didn't know about the problem before. I think many people use it as a simple skin cream. I went to the chiropodist today and he offered to cream my feet, but I asked what he was using - it was aqueous cream, so not for me.

I've even consulted a dermatologist who didn't seem to know about SLS. I didn't go back.

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