Hi all
Could someone explain the affect hashis has on test results. Does it cause them to fluctuate? I think i read it on here.
Here are my last 3 results
Aug 2020
TSH 2.5 (0.20-4.50)
Free T4 13 (9-21)
Feb 2021
TSH 2.8
Free T4 14
August 2021
TSH 2.2
FREE T4 14
All tests done 8.15 am with water only.
I expected the latest one to have risen again. Albeit it's only ever so slightly.
My antibodies results May 2018 TPO >1000
Macey2009
With Hashi's the immune system attacks the thyroid, which causes the release of hormone into the blood. If tested at this point the FT4 and FT3 levels will be showing higher than usual and the TSH will be lower.
Eventually the levels will reduce and results show normal or hypo.
So yes, the levels to fluctuate with Hashi's activity.
However, looking at the results you have posted they are virtually the same, the minimal difference in your TSH is negligible and the FT4 to all intents and purposes the same, so those 3 results aren't showing any immune attacks at the time of the test.
OK thank you. Maybe i have not been understanding this properly. With the TSH going from 2.5 to 2.8 then back down to 2.2 is that normal? I thought with the destruction of the thyroid due to the antibodies i hoped it may have risen again slightly.
Macey2009
Nothing is static, there will always be slight variations. You can test your TSH at this very minute and you can test it 5 minutes later and they wont be exactly the same. As I said, the difference in your TSH is insignificant and your FT4 has not changed so whatever Hashi's activity there has been hasn't done that much damage to your thyroid to make any difference to your levels at the moment, looking at those results.
I thought with the destruction of the thyroid due to the antibodies i hoped it may have risen again slightly.
Why do you want it to have risen? Are you looking for an increase in your dose of Levo? TSH is not an indicator of thyroid status, this is where doctors are sadly mistaken. It's the FT4 and FT3 - the measure of our actual thyroid hormone levels - that tell us what we need to know. We can't say anything about your FT4 because you haven't given us the reference range, the ranges vary from lab to lab so we need the range to interpret the result. For example, my lab's range is 7-17 and the private lab's range is generally 12-22 (and we also see here 9-19, 11-23, and others). So with my lab's range your FT4 of 14 would be very close to the top at 70% through range if your range was the same and with the private lab's range it would be very close to the bottom at 20% through range if that was your lab's range.
Sorry i should have said. I am not diagnosed. My gp monitors my thyroid every 6 months because of the high antibodies. I have many hypo symptoms and had hoped a slight rise in TSH again. I know that's all the gp goes by
Free T4 range is 9-21
Macey2009
OK, so at the moment you wont get a diagnosis. With raised antibodies the TSH has to go over range for an enlightened doctor to start prescribing Levo. An over range TSH is regarded as subclinical hypothyroidism and when raised antibodies are also present the guidelines state that a trial of Levo can be given. All GPs will follow the guidelines where that's concerned.
I have no idea if going private would get you a diagnosis and prescription, but even then it would be a private prescription, it's unlikely that any NHS doctor would take over prescribing with a diagnosis based on those results.
Thank you. I know a gp would not diagnose at the moment. I just felt so deflated when i recieved those last results
I hoped it might have shown a further rise in TSH
Not sure if this is significant but for the first 2 tests I had been supplementing Vit D and igennus super b complex. As they had been low
With this last test i had kept forgetting to buy more so had no supplements for about 5 months prior to the last test.
Possibly but without knowing what your levels were it's difficult to say.
That's true i suppose. Maybe just clutching at straws and convincing myself that all my symptoms are thyroid related.
in reality those 3 sets of results are very stable. TSH and T4 are released in a pulsatile pattern through the day .. little spurts every 45 mins or something like that.. So the differences in your TSH here are not very significant at all.... eg . if you'd tested half an hour later on the same day you could possibly have seen similar differences.
When there is an attack on the thyroid from the immune system , the bit of thyroid tissue that is attacked dumps all the T4 /3 it contains into the blood all at once.. this will send fT4/3 higher. sometimes enough to cause symptoms of overmedication.. (TSH will then go lower) .
But fT4 will then go down again as it is used up /excreted /recycled . (TSH will then rise again )
That bit of damaged thyroid tissue will then be less able to make T4/3 .. so after that you may need a dose increase, as fT4 may end up lower than before, and TSH may end up higher than before
That's the nice neat theory ..... in reality i have no idea how long these periods of high T4 /3 low TSH can last for ... (and i'm not sure anybody else does either. never found any research following real people's blood tests through an autoimmune attack) so i don't know if it's days /weeks or months. I suppose it depends how long the attack continues for.
(T4 has a 'half life' of 7 ish days in the blood meaning after 7 days half of it is gone (less any that was used) .. after another 7 day's half of what's left has gone (less any that was used) etc etc )
Theoretically ... this period of autoimmune thyroid damage might be followed by a rise in TPOab.. as they come along and attach to any thyroid peroxidase (that ought to be contained in thyroid tissue) , but it's now in the blood.. so the antibodies label it to be cleaned up (by some other things but i've forgotten what they are called ) ... but not everyone with autoimmune thyroid damage have raised TPOab . they do find evidence on scans of autoimmune damage to thyroid in people with normal levels of TPOab
Sorry i should have said i am not diagnosed. My gp monitors every 6 months due to the high tpo antibodies.
So i was hoping that this last test showed another slight increase.
The fact that they found significant levels of antibodies does not mean they are attacking it now ( in fact they don't 'attack' it ,the immune system does.. ..they are labels to say "clean this up, it shouldn't be in our blood" )
So when NHS find very high TPOab , it shows them your thyroid has been attacked.. so that's why they monitor ..because it means it is likely to keep happening in future , and it means it's more likely you will eventually get so much damage to your thyroid that TSH goes over range and fT4 goes under range, and they then need to replace the lack of T4 (they conveniently ignore the loss of T3 cos they don't want to give us any, and unfortunately they are not convinced by symptoms while the TSH is still in range)
This is not a steady continuous process though .. some will get steadily worse with steadily rising TSH/ falling fT4 , some won't.
Some, even though they have evidence of over-range TPOab will never complain of symptoms of hypothyroidism.
Your TPOab result was pretty significant though ( i get the impression that anything over about 500 is 'noteworthy' as far as some in the NHS are concerned).. a lot of people only have them in the low 100's . so there is a fair indication that you are going to go that way eventually , but it could still be many years before enough damage is done to your thyroids ability to produce T4/3 for them to consider replacing the hormone ... or it could happen very quickly .. there is no way of knowing .. hence the regular monitoring.
OK thanks for all the helpful info. I guess i just need to carry on and seen what the next set of tests show.
Didn't you ask this same question a couple of day ago? And I answered you in great detail? That post seems to have disappeared now. I don't understand.
Hi greygoose. Yes i somehow managed to delete that post by mistake. Don't ask me how lol. And i had forgot what the replies were 🙈
I thought that and couldn't find anything, wasn't sure if I was mixing it up with another member though.
I remember the blood test results, so knew I'd answered it.
Glad somebody's on the ball .. i'm not even sure if it's thursday of friday.
Your memory must be better than mine lol.
Unfortunately my memory is selective. I remember a ton of things that are either of no use, or I'd rather forget. I can't remember what I went to the supermarket for! 
I appreciate all your insight. I guess I just need to wait for my next set of tests. The last ones were all at 8.15 is that an ok time? Suppose they have to be same time for consistency.
8.15 is fine. And, yes, best if they are all around the same time.
Thank you. I feel like i keep bombarding you with questions. So apologies 😊
If i'm right in thinking a TSH over 2 suggests thyroid is struggling. But now that it's gone from 2.8 to 2.2 maybe it's not struggling now?
It shouldn't be anything over 2. A euthyroid TSH is around 1, never over two. I would imagine your thyroid is still struggling to have a TSH that high to produce a level of FT3 that isn't even mid-range. You can't just look at the TSH in isolation. You have to consider the three results - if you have all three - as a connected unity, which they are. TSH+FT4+FT3. Together, they tell us what's going on with your thyroid. Alone, they don't tell us much at all.
That gives me some peace of mind. I keep forgetting to ask my gp to test Free t3 aswell. Is there any information i can give her that might help persuade her to test them all together next time? Seeing as they only focus on TSH
Not that I know of. Once they have an idea fixed in their head, it's difficult to change it. Besides, the lab will probably refuse to do it, anyway. But, no harm in asking.
Here in France, they try to get away with not testing the FT3, and the excuse usually is 'but I don't know how to interpret it' - I kid you not, that is what they actually say! So, I say, 'no problem, I know'! So, I usually manage to get FT3 tested. But, not always!
Yes i have seen posts on here where it's requested but refused by the lab. How frustrating. If it's the Free t3 that causes symptoms you'd think they would test it 🙄
That's exactly why they don't test it! If they did and it was low, you might want them to do something about it! And that rarely happens, so best you don't know. Most doctors would deny it's T3 that causes symptoms, anyway, because they know nothing about it.
No wonder people struggle with gps then. I think i'll write a letter to my gp before the next bloods are due. Any help would be greatly appreciated 😊
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