Should I see the doctor?: I've recently had a... - Thyroid UK

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Should I see the doctor?

HermitageGardens profile image

I've recently had a blood test as I've be diagnosed with rheumatoid arthritis. I'm on medication for that but I have pain in my ankles that the medication doesn't seem to be helping. The blood test checked many things including my thyroid levels:

TSH. 1.3. 0.27 - 4.20

T4 Total 67.9 66-181

FT4 11.6. 12.0 - 22.0

FT3 4.22. 3.1 - 6.8

Friend suggested I may have an issue and should go to my doctor for medication. It would be great to get some advice.

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HermitageGardens
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14 Replies
SeasideSusie profile image
SeasideSusieRemembering

HermitageGardens

Not sure what your friend thinks there's an issue with. If you include the reference ranges it will give us a clearer picture.

A normal healthy person would have a TSH of no more than 2, often nearer one, which your is. They'd also probably have an FT4 level around mid-range-ish but without a range we can't tell with your result. Can you add the ranges so we can try and help.

JAmanda profile image
JAmanda in reply to SeasideSusie

Hi SeasideSuzie, I think I'm the friend... I had thought her T3 was below the range but can now see it isn't. I suspected with the low t4s it might be central hypothyroidism..?

SeasideSusie profile image
SeasideSusieRemembering in reply to JAmanda

JAmanda

Now the ranges have been added we can see that her FT4 is below range and, yes, this could suggest Central Hypothyroidism.

HermitageGardens Central Hypothyroidism 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 low.

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).

Your 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 and show your GP.

As Central Hypothyroidism isn't as common as Primary Hypothyroidism it's likely that your GP hasn't come across it before. You may need to be referred to an endocrinologist. If so then please make absolutely sure that it is a thyroid specialist that you 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

tukadmin@thyroiduk.org

for the list of thyroid friendly endos. Then ask on the forum for feedback on any that you can get to. Then if your GP refers you, 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.

JAmanda profile image
JAmanda in reply to JAmanda

I now read it's common for T3 to be normal with central hypothyroidism.

DippyDame profile image
DippyDame

Sorry to hear you have been diagnosed with RA, joint pain can be a symptom of thyroid disease

This will give you a list of hypothyroid symptoms that may also be worth checking

thyroiduk.org/if-you-are-un...

My pain level certainly improved with correct thyroid medication so it is a possibility worth exploring

Please can you add reference ranges for lab results...they vary from lab to lab.Once we have these we can get a better idea of what is going on

We are also advised to test Vit D, vit B12, folate ferritin and thyroid antibodies

thyroiduk.org/thyroid-funct...

Feel free to ask any questions you may have

Best...

DD

HermitageGardens profile image
HermitageGardens in reply to DippyDame

I have some of those results:

Vit D. 66. 50-175

Vit B12 365. 145 - 569

SlowDragon profile image
SlowDragonAdministrator in reply to HermitageGardens

Vitamin D and B12 are on low side

You also need folate and ferritin levels tested

Improving low vitamin levels can help improve how thyroid hormones work

Antidepressants may sometimes lower TSH (the only result many medics look at)

Your Ft4 is very low

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 folate and ferritin levels plus thyroid antibodies or test privately

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)

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/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Having one autoimmune disease (RA) makes other autoimmune disease more likely

Also request coeliac blood test BEFORE trialing strictly gluten free diet

Buddy195 profile image
Buddy195Administrator

Hi HG, Can you edit your post & add the ranges for the tests in brackets. Different labs have different ranges and it will help members offer better advice.

Buddy195 profile image
Buddy195Administrator

Are you having any other symptoms along with ankle pain? Are you taking any supplements?

HermitageGardens profile image
HermitageGardens in reply to Buddy195

I have weight gain, I'm on antidepressants now and have joint stiffness generally. Just ordered some supplements recommended by my functional medical practitioner.

Buddy195 profile image
Buddy195Administrator

What supplements have you ordered? I find magnesium glycinate helps with anxiety and is easy in the stomach. Glucosamine can help with stiff joints.

shaws profile image
shawsAdministrator

Welcome to our forum, and first of all I'm sorry you have Rheumatoid Arthritis which can ve very disabling and I hope you have a good specialist to deal with this condition. If not, request a referral to a hospital Specialist.

It does look like you've a problem with your thyroid gland also as both your 'Frees i.e. 3 and 4 are too low.

Your GP may not diagnose you as your TSH hasn't yet reached the 'magic' number (by that I mean we've to wait until our TSH reaches 10 before we can be diagnosed). Both Free T4 and Free T3 are too low and you must be symptomatic.

Unfortunately in the UK, it has been 'deemed' not to diagnose until the patient's TSH reaches 10 but hopefully your GP will prescribe

I shall give you a list of symptoms and you can tick them off, make an appointment to see your GP and he may suggest you get another blood test. Always make the very earliest appointment. It is a fasting test and don't take thyroid hormones before (when prescribed) but afterwards.

You can get a private home blood test if you wish, and I'll give a link for you.

This is the method advised to get the best results for blood tests for thyroid hormones. i.e. TSH is always highest early a.m.:-

1. Always make the very earliest appointment and it is a fasting test.

2. Don't take thyroid hormones before appointment, but afterwards.

3. Ask for B12, Vit D, iron, ferritin and folate to be tested at the same time.

Always request a print-out for your own records and post here if you have a query and members will respond.

This is a list of clinical symptoms:

thyroiduk.org/?s=list+of+cl...

Yeswithasmile profile image
Yeswithasmile

Hi HermitageGardens

I’m sorry to read you have been diagnosed with RA. There does seem to be some useful advice and people already answered you.

I just wanted to mention (only a beginner here so I’m hoping someone else may chip in) but I would have thought your tsh should be higher considering your low t4 and so would be inclined to think this is secondary and am pasting a link the nice guidance website.

cks.nice.org.uk/topics/hypo...

It may be worth you mentioning this to your dr?

Good luck and I hope you manage to get some answers soon x.

SlowDragon profile image
SlowDragonAdministrator

NHS Guidelines on dose vitamin D required

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

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

Some areas will prescribe to bring levels to 75nmol or even 80nmol

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...

But, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/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 NHS postal kit

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

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need

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-...

Taking too much vitamin D is not a good idea

chriskresser.com/vitamin-d-...

Web links about taking 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...

2 good videos on magnesium

healthunlocked.com/thyroidu...

Vitamin D and Covid

Notice how much vitamin D many of these medics are taking

vitamind4all.org/letter.pdf

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