Help interpreting results please

[kb53]

I wonder if anyone could help with understanding my test results please? I had my results back from Monitor my Health and they said they showed an unusual pattern and to contact my GP. I had a further blood test a couple of weeks ago which haven’t come back yet but my GP seemed more concerned with my TSH than FT4.

Results were as follows with reference ranges in brackets:

FT3 4.3 pmol/L (3.1 to 6.8 pmol/L)

FT4 11.5 pmol/L (12 to 22 pmol/L)

TSH 1.09 mu/L (0.27 to 4.2 mu/L)

The GP ordered a whole range of blood tests which should be back in the next few days.

Thank you for any help.

[SeasideSusie Remembering]

kb53

Are you diagnosed with a thyroid condition and on any thyroid medication?

[kb53 in reply to SeasideSusie]

No diagnosis and I’m not on any meds at the moment. I’ve had a few years of exhaustion, hair loss, dry skin, low ferritin and have always been told it’s one of those things and I just need to live with it. I started HRT a few months ago and hoped that would help but still feel rotten. I paid for a private test as my GP practice aren’t exactly helpful unfortunately.

[SeasideSusie Remembering in reply to kb53]

kb53

OK, so it's possible - and I am not diagnosing, I am not medically qualified - but possible that what could be indicated here is Central Hypothyroidism. This 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. Your TSH is normal and your FT4 is below range so they fit this criteria.

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).

As Central Hypothyroidism isn't as common as Primary Hypothyroidism it's likely that your GP hasn't come across it before, and many endos haven't either.

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.

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

[e-mail]

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 may need to push for further investigation because of the lack of knowledge about this condition so present all the evidence that you can.

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.

[kb53 in reply to SeasideSusie]

Thank you for such a helpful response. I’ve not heard of central hypothyroidism so will definitely do some research before speaking with my GP again. It sounds silly but it would be good to have a diagnosis which explains all my random symptoms over the last few years.

[SeasideSusie Remembering in reply to kb53]

Good luck, please make sure that it's not just your TSH that is taken into consideration. That is only useful for Primary Hypothyroidism or autoimmune thyroid disease (when antibodies are raised), make sure they look at the FT4 level as well, there has to be a reason why your thyroid isn't making enough T4 hormone and it's because it's not receiving the TSH signal to do so.

[Lalatoot]

TSH low in range with ft4 low or below range is an indicator for central hypothyroidism. This is where the fault lies with the pituitary gland and not the thyroid . As ft4 drops TSH produced by the pituitary should rise to stimulate the thyroid to produce more t4. It has failed to do so in those results.

[kb53 in reply to Lalatoot]

Thank you for your response. It gives me something to look into before speaking to my GP again. I didn’t realise there was such a thing as central hypothyroidism.

[Lalatoot in reply to kb53]

Doctors don't either so read up as you might be the one explaining it!

[SlowDragon Administrator]

Request GP also test vitamin D, folate, ferritin and B12

Plus thyroid antibodies for autoimmune thyroid disease also called Hashimoto’s

Have you ever had head trauma, concussion or whiplash ….all can be possible cause of central hypothyroidism

Or dramatic blood loss after giving birth, called Sheehan syndrome

[kb53 in reply to SlowDragon]

I think those were all mentioned by my GP when she requested more blood tests a couple of weeks ago. My ferritin was around 4 a few years ago which resulted in an iron infusion. I waited patiently to feel better after that but never did.

I did have a bad car accident many years ago which kept me in hospital for a few days with concussion and head trauma.