Hi, I'm interested to see what people make of these test results? I was told years ago by a Dr that I was borderline hypo, but since moving have been told my TSH is in range so I'm fine. The symptoms certainly dont agree and seem to get worse year on year.
Unfortunately I couldn't get hold of the test results from the original Dr, but I have access to results from 3 tests done over a 7 yr period. Not every test was done each time, so some results are missing
Those results don't make a lot of sense and I'm wondering if there was some kind of assay interference. Was the test repeated due to it being very unusual.
TSH is a signal from the pituitary to tell the thyroid to make hormone when it detects there's not enough. When there is not enough hormone FT4 will be low and TSH high. The fact that you have a high TSH when there is a very good level of FT4 is questionable.
When was this done? This result could possibly suggest Central Hypothyroidism which is where the fault lies with the pituitary or the hypothalamus rather than the thyroid. Central Hypothyroidism is suggested when TSH is normal, low or minimally elevated with a very low/below range FT4.
How do you do your thyroid tests? We always advise:
* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH
* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
If they are done this way every time then the results can be compared accurately.
B12 - 363ng/L (191-663); vit D - 58.4nmol/L (50-125)
Again, please confirm when tests were done. Both these are two low but I wont comment until I know if they are old results or new ones, don't want to waste time giving information if these results are way too old. Also please say if you are supplementing, with what and the dose.
You are correct, the tests are listed in chronological order and I am not taking any thyroid hormone replacement and no suppliments.
The tests are quite old now:
Test 1 - 2011
Test 2 - 2014
Test 3 - 2018
Usually give up through not getting anywhere with the Dr, but then try again a few years later when the symptoms get worse, before not getting anywhere again. I recently tabulated the results and noticed the inconsistencies so wondering if it is something worth re-checking. The relationship between TSH and T4 seems to be the opposite to what I would expect, but I don't know how much I can read into just 2 data points.
Test 1 was not re-done and was advised levels are normal.
I believe I was advised that the tests don't need to be fasted but I can't say for certain now since they were done a while ago. Same with the time, I know some were done between 9-10am but couldn't be certain which.
It might be a good idea to do a new test and get current levels, best done when you feel unwell (not that you may ever feel well, but maybe test at your worst).
Follow the advice for testing above.
I would suggest you get a full thyroid and vitamin panel done and we have recommended private labs who do all the tests needed in one bundle, and it can be done as a fingerprick test or venous blood draw (extra cost for that).
Both tests include the full thyroid and vitamin panel. They are basically the same test with just a few small differences:
Blue Horizon includes Total T4 (can be useful but not essential). Medichecks doesn't include this test.
B12 - Blue Horizon does Total B12 which measures bound and unbound (active) B12 but doesn't give a separate result for each. Medichecks does Active B12.
Total B12 shows the total B12 in the blood. Active B12 shows what's available to be taken up by the cells. You can have a reasonable level of Total B12 but a poor level of Active B12. (Personally, I would go for the Active B12 test.)
Blue Horizon include magnesium but this is an unreliable test so don't let this sway your decision, it also tests cortisol but that's a random cortisol test and to make any sense of it you'd need to do it fasting before 9am I believe.
The Medichecks test is on special offer today (they do one thyroid related test every Thursday, special price valid until midnight) and you have 120 days to use the test. See here for details of special offer:
My doctor agreed to do a thyroid function test. I asked for a full test and not just TSH, but was advised its up to the lab what they test! They will only check T4 if TSH is abnormal!
So they only tested TSH and it is 6.4miu/L. Advised this is borderline and to retest in 3 months time!
Same old same old. I can't really afford one of the private tests so lookls like I'm waiting.
From everything I've read I would say 6.4 is high and certainly warrants further investigation, but Dr. has said anything under 10 is fine and was confident this test wouldn't find anything.
With how long this has been going on I really don't understand why they wont just do a full set of tests, including antibodies, so they can put a line under it and move on. Instead they hare happy for my to come back every year with the same symptoms I've had getting worse for a decade. You'd think they were paying for the tests out of their own pocket with how reluctant they are.
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of this article from Dionne at ThyroidUK:
tukadmin@thyroiduk.org
print it and highlight Question 6 to show your GP.
Thanks for the ammo! Its really frustrating because I just knew they would cheap out on the test and only test TSH. Its beyond me why they wont order the full test. TSH was above 6 in 2011, and here I am a decade later with worse symptoms and a higher TSH, yet they only did a TSH test! Is it so hard to tick the T4, T3, and antibodies boxes on the order form and put this to bed?
Interesting how your link suggests keeping TSH below 2.0. The lowest I've ever tested was 2.6miu/L
To be fair, it is the lab who decides which tests get done regardless of what the GP requests. It's probably your CCG's policy to only test TSH but if it's out of range I really don't understand why your FT4 wasn't done.
NHS guidelines for diagnosing 'subclinical hypothyroidism' (where TSH is over ref range but fT4 is still within ref range) say if it's the first over range TSH then re -test in 3 month's time (to make sure it's not a temporary raise that will go down on its own)
Since TSH seems to have been back in range for several years before this , i imagine they are treating this latest result as the 'first over range TSH'. .. So there's no way round the 3 month wait for diagnosis.. even if you could afford a private test earlier.
However the lab should really have done an fT4 when they saw the TSH at that level.
If repeat TSH in 3 months comes back as still over range then (if hypothyroid symptoms are a problem) GP's are told they MAY CONSIDER a trial of Levo to see if getting TSH back into range resolves symptoms.
I noticed in your link that they recomend testing TSH and FT4 if secondary hypothyroidism is suspected...but it gives no information on why you would suspect secondary hypothyroidism.
I found another article from NICE which suggests secondary hypothyroidism with a recurrent headache and diplopia, and it confirms you can have secondary hypo with a slightly elevated TSH.
The whole reason I started going to the doctor was for fatigue and headaches! I literally have the same headache everyday, just above my right eye, and it gets much worse after a few minutes looking at a screen. They know this. I also get double vision quite often but they have never asked about this.
So I've had TSH consistently above the range, and an FT4 seemingly unlinked to TSH that has been at the very top of the range and also below the range. But none of this has warranted further investigation...
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