My Medicheck thyroid test results

[MaggieSylvie]

Hello all, particularly Slow Dragon and SunshineSusy,

I posted on here some weeks ago after my GP said my thyroid was underactive and prescribed Levothyroxine based on a TSH level of 0.02. Thank goodness for this forum! You all pointed out how clueless my GP was and so I just managed to get a full spectrum test from Medichecks and the doctor writes: "As you are not known to have thyroid problems your results suggest that your thyroid is becoming overactive".

TSH has returned to 0.19 (range 0.27 - 4.2). I wonder whether, had I taken more than the single dose of Levothyroxine, it would have done me much harm. The Medichecks doctor is concerned that ferritin is high (467 ug/L (range13-150)) but that is probably due to the blood cancer which has produced ring sideroblasts on haemaglobin cells, thus trapping iron to some extent, and not due to diet. Some people have to have the iron removed. He also says B12 is at the low end of normal (45.300 pmol/L (range 37.5 - 188), and in general, that I should discuss this outcome with my GP (who I have now changed), with a view to more tests - serum methylmalonic acid (MMA) blood test and a liver function test, but that has probably been done already by Haematology.

I wonder what's next - is this agitation, anxiety, sleepless nights and hair loss going to be part of life now? The doctor only says it is becoming hyperactive, not that it IS so it would seem my symptoms are somewhat ahead of the results.

I have taken a screenshot of the page of test results but had to shrink it to get it all on one page; I hope you can read it but I have already added the relevant details to this post. The other results are quite normal, with Free T3 at 4.80 (range 3.1-6.8) and Free Thyroxine 14.500 pmo/L (range 12 - 22).

Thanks so much for your help; I welcome comments from anyone here.

[SlowDragon Administrator]

Sorry image not readable

Can you reattach cropping in closer

Or type out results and ranges

B12 at 45 is very low

Ask GP for full testing for Pernicious Anaemia before likely starting on B12 injections. If not B12 injection, daily B12 supplements

[MaggieSylvie in reply to SlowDragon]

Hi SlowDragon, Thanks for getting back to me so quickly. Folate was 13.29 ug/L (range >3.89). I've been taking EvalcalD3 so vitamin D was 112.00 nmol/L (range 50 - 200) - optimal. I have refractory anaemia, not pernicious (RARS-T). I don't know whether I should take B12. Antibodies seem fine. Infammation 0.51 (range 0 - 5).

I will try and do some more screen prints but it was a steep learning curve this morning and I only managed to do sections of the page before learning how to do the whole page.

🙂

[kissemiss in reply to SlowDragon]

To get the image bigger: Click on the picture with your mouse then hold the ctrl key and press + at the same time...good luck.

[MaggieSylvie in reply to kissemiss]

Oh! Thank you for that.

[helvella Administrator Thyroid UK in reply to kissemiss]

Sure - Ctrl key and Plus (+) zooms in and makes it bigger. But the detail isn't there. You just get the same blur. Bigger.

Posted images are scaled by the HealthUnlocked system. I zoomed in until the image was more than filling my screen yet I still couldn't read it.

The poster needs to get rid of the blank areas, the menus/toolbars/scroll bars and just post the bit that has the results.

[greygoose]

What time of day was the blood taken for this test?

[MaggieSylvie in reply to greygoose]

I arranged the test for 08.35 but encountered a "jobsworth", the result being that the blood was not taken until 08.58. Quite a bit of stress involved as well.

[greygoose in reply to MaggieSylvie]

That's not too bad, then. But, it is very strange that your TSH was so low with such low Free T4/3. The FT4 isn't even euthyroid.

Frankly, the Medichecks doctor's comments are worth the 'paper' they're written on. You are in no way hyperthyroid, but he is only looking at the TSH. And, had you taken the levo, you might actually have felt better. It rather looks like your thyroid is struggling due to lack of TSH. So, one wonders about your pituitary...

If I were you, I would continue testing at regular intervals, and keep notes on your symptoms. Things might be better. But, then again, they could get worse.

[MaggieSylvie in reply to greygoose]

I wonder about my pituitary as well, but if you remember, my GP diagnosed it as underactive in September and everyone on here said she was "clueless". She only looked at TSH, whereas this doctor on Medichecks has looked at everything. Yes, FT4/3 is low as well and I don't know what euthyroid means. At least this doctor confirms that it is not underactive, which is why my GP, believing it was, prescribed Levothyroxine. Medichecks is one of the private labs recommended on this forum. I have a face to face appointment with my new GP on 8th.

[SlowDragon Administrator in reply to MaggieSylvie]

TSH has returned to 0.19 (range 0.27 - 4.2)

Free T3 at 4.80 (range 3.1-6.8)

Free Thyroxine 14.500 pmo/L (range 12 - 22).

Ft4 and Ft3 are fairly low ……despite low TSH

But if you have other illness this might be “normal “

Thyroid does need optimal vitamin levels….so next step is to investigate B12

Request GP do serum B12 and testing for PA

academic.oup.com/cdn/articl...

Perhaps discuss with your specialist

[MaggieSylvie in reply to SlowDragon]

Thanks for the link, SlowDragon, but I am not iron-deficient. I have a bit too much! The problem is that haemoglobin cells are not maturing properly and have developed iron rings around them. Result - less oxygen to go round the body. So low haem count and at the opposite end, high platelets. I don't know whether this effects my thyroid or not but I have had parathyroid tested and it's ok. I will discuss these results with my new GP who I am to meet next week and my haematologist at the end of December when I have an appointment.

[SlowDragon Administrator in reply to MaggieSylvie]

Iron, ferritin and B12 all complicated!

Active B12 under 70 is considered low

viapath.co.uk/our-tests/act...

>70*; * between 25-70 referred for MMA

Worth getting serum B12 tested via GP

NHS never does active B12 test……apart from via St Thomas hospital in London

nutris.viapath.co.uk/pages/...

[MaggieSylvie in reply to SlowDragon]

I've just found this in my records:Free T4 level, serum

27 Sep 2021 11:30 BST 15.9 pmol/L

19 Jan 2021 00:00 GMT 13.5 pmol/L

26 Jun 2019 10:28 BST 15.9 pmol/L

07 Sep 2018 00:00 BST 16.2 pmol/L

so all much of a muchness from 2018. Perhaps this is normal for me. TSH doesn't vary much during that period, either.

[MaggieSylvie in reply to SlowDragon]

I forgot to say that I don't have a specialist in the field of thyroid complications or any other issue except for blood cancer. My haematologist looks after me well but in every other area, such as bone health and osteoarthritis, I'm all at sea.

[greygoose in reply to MaggieSylvie]

No, not everyone said she was clueless. But, it was a surprising 'diagnosis' given your levels. But, to be honest, she could have been right, because your FT4 has fallen again and is now pretty low, only 25% through the range. Euthyroid (meaning no thyroid problems whatsoever) would be around 50%. I know we're all different, but I don't think 25% would be 'normal' for anyone.

So, possibly, it's the Medicheck's doctor that is 'clueless'. And, he is only looking at the TSH, because no-one in their right mind could think that an FT4 of 25% through the range could be suggesting that you're becoming hyperthyroid!

If you look at your FT3 level, this is higher - 45.95% through the range - and this is what often happens when the thyroid is failing, or doesn't have enough TSH stimulation, it makes more T3 than FT4 to keep you alive. 'Normall', FT3 would be slightly lower through its range than the FT4.

But, if you do have a pituitary problem, and the TSH stays low, the FT4/3 will just get lower and lower, until it becomes obvious that you are actually hypo, despite the low TSH. Which is why I said to keep an eye on levels.

[tattybogle]

previous GP Gave you levo for TSH 0.02 ! and fT4 15.9 [12-22].. at the time , it beggared belief .

but i agree .... keep testing ,and keeping notes to see what happens next.

looking back ,i note your previous GP did write that she prescribed levo due to 'your reducing levels of thyroxine , and she had ignored your TSH as it could be affected by a miriad of other conditions, but she was sure you would eventually not produce enough thyroxine. however she would now postpone prescribing Levo until fT4 fell out of range if you didn't want to take it now ..... '

.... this latest test does indeed have lower fT4 14.5 [12-22].... not by much .. the difference could easily be explained by just the normal variation in fT4 levels.... but if it does keep going lower .. perhaps she wasn't as mad as we first thought ? had she seen a history lowering fT4 results before the 15.9 perhaps ?

I still don't know why she was so sure you'd eventually need Levo ? .. usually it is high thyroid antibodies that points them in this direction.. but if i can read it correctly those are both negative on this test ?

The medicheck comment about ' your thyroid is becoming overactive' is not very relevant . because they don't know your previous result ... TSH is actually now slightly higher and fT4 is now slightly lower.. so if anything your latest results have become more 'underactive' (less T4 / more TSH)

But the differences are so small that both are within the normal amount of variance we all have every day, so you can't be sure from just these two tests...

It could be that she was right to ignore your TSH ... perhaps pituitary is not responding adequately or has been messed up buy something else you've got going on ?

[MaggieSylvie in reply to tattybogle]

She didn't ignore the TSH. In her phone call to me, that was her "red flag". It was only later, after I wrote to her, that she changed her story to say she was going on T4 results. I think I should phone my Macmillan nurse tomorrow and tell her about this result, just in case my haematologist has any answers to this enigma. It could well be that MDS/MPN is affecting my thyroid, or B12 is messing things up, or maybe it's the other way round. I'm not happy that people are saying "oh, perhaps she's right after all!" I'm not symptomatic of hypo but what symptoms I have are common in MDS/MPN, except for the anxiety and agitation leading to sleeplessness at night. I expect my new GP will want to do an MMA test. It's starting to get expensive.

Incidentally the TSH has gone just a little higher than it was in a previous test and I suspect its plummet to 0.02 was due to the stress I was under at the time. 0.18 didn't worry her. What worries me is that she wasn't prepared to test again for another year.

The thyroglobulin antibodies are 11.800 IU/mL (range <115) and

thyroid peroxidase antibodies are 10.80 IU/mL (range 34). I don't think these were tested previously.

There is something going on and I'm wondering about these historical nodules on the thyroid, and certainly, what might be up with my pituitary. Or perhaps at my age, things are just dropping off and there's nothing to be done but die.

[tattybogle in reply to MaggieSylvie]

i do understand you're not happy hearing there is a possibility she was right .but ... this forum would be a poor show if no one on it was prepared to admit they may ever be wrong .

Everybody including you, went with the information we had at the time.. and the picture becomes clearer as we get more information. And as you say .. the reasoning the GP gave you does seem to have changed between her first prescribing Levo, and her later letter in response to yours. which really doesn't help anybody,

If she had seen previous results showing a consistent lowering of fT4 over time it would have been helpful if she explained that you that in the first place .

It would also have been helpful if she had explained why she though you would eventually become hypothyroid.

Yes , i saw that the TSH is now a little higher again, and the fT4 a little lower .. and it is seeing the lower fT4 which caused me to say 'she may have been right' .. but as i said it is only a little bit lower ... you would have to see the trend of some previous fT4 levels and some future ones to see if it really is getting lower over time , or if the small difference is just part of the expected daily variation in ft4 levels.

Do you have any of your previous fT4 results (from before the 15.9 ).. that may confirm her comment in the letter about " your reducing levels of thyroxine" ?

Now that we have seen your fT4 is a little lower in this test ,,, we now say 'she may have been right' .. but at the time of your first post she hadn't said any thing about lowering fT4 levels ... if we'd had that information then , our comment's would probably have included 'how much it has lowered by , over how long ? , and we might have been questioning the pituitary's production of TSH sooner .

Thyroid is a complex subject and relies very much on the accuracy of the details provided, before you can unpick what is going on .

It is often not possible to be certain of anything from just one result , the correct interpretation becomes clearer when you observe which direction the results are going in .

And this is still far from clear in your case, (which is further complicated by the potential influence of other issues you have gong on, which most of us here don't know much about.)

It will probably be equally unclear to anybody else at the moment. no matter who you ask ..... which is why people are saying keep an eye on your results over time.

This may not be the last time you hear " we may have been wrong " and as more information is gathered over time thing will hopefully become clearer.

[MaggieSylvie in reply to tattybogle]

It's also worth noting that my latest test is the only one taken before 9 am. The others would most likely been done in the afternoon after lunch. So no fasting etc.

[tattybogle in reply to MaggieSylvie]

Ok so that would be a likely explanation for the TSH looking a little higher this time.

TSH is highest everyday in the middle of the night /very early hours of the morning .... falling to It's lowest everyday around 1-3pm ish,, then slowly going up again over the evening.. with some people's moving more than others.

But (i think ) you might expect the fT4 to be slightly higher at that time.. as it increases a few hours after the TSH gets to its highest. (fT4 levels follow a few hours behind TSH stimulation each day) ... so this also points toward your fT4 may actually be getting a little lower over time... but you will need to see what next test says to get a clearer idea if this is so ... or not.

(but even that is complicated.... because as well as a background level of secretion, fT4 is also produced in little spurts every ?45minutes or so ,, so if you plot a whole days results taken every hour on a graph... it looks like pinking shears !

(eg . you could test it at 8.45am and get 14.5 , then at 9.30 and get 15, then at 10.15 and get 14. 7)

[MaggieSylvie in reply to tattybogle]

Yes, I would say that is true of all blood tests; we can rely on them only as a random photo shot at some point in the day. As such, small changes cannot be taken very seriously. I've only had four thyroid tests, that haven't been taken at the best time of day, so there's not enough to go on at this stage. I already do blood tests every three or four months; this thyroid issue is extra and not routine for me. Should I be seeing a specialist at this stage?

[tattybogle in reply to MaggieSylvie]

I'm not sure if there would be much point yet ... they would still have the same problem ie. " it's not very clear what , if anything, is going on with thyroid yet ..." Out of interest what were the results of other 2 thyroid blood tests you have had ?

[MaggieSylvie in reply to tattybogle]

I've just found this in my records:Free T4 level, serum

27 Sep 2021 11:30 BST 15.9 pmol/L

19 Jan 2021 00:00 GMT 13.5 pmol/L

26 Jun 2019 10:28 BST 15.9 pmol/L

07 Sep 2018 00:00 BST 16.2 pmol/L

Thyroid stimulating hormone, serum

0.02 mIU/L

Date:27 Sep 2021 11:30 BST

Reference Range:0.27 mIU/L - 4.2 mIU/L

0.18 mIU/L

Date:19 Jan 2021 00:00 GMT

Reference Range:0.25 mIU/L - 5 mIU/L

0.16 mIU/L

Date:26 Jun 2019 10:28 BST

Reference Range:0.25 mIU/L - 5 mIU/L

0.20 mIU/L

Date:05 Nov 2018 16:00 GMT

Reference Range:0.25 mIU/L - 5 mIU/L

0.11 mIU/L

Date:07 Sep 2018 00:00 BST

Reference Range:0.25 mIU/L - 5 mIU/L

The see-saw effect can be seen between the T4 and TSH even with these small differences between test-dates.

[tattybogle in reply to MaggieSylvie]

sept 2018 ............ TSH 0.11 [0.25-5] ...... fT4 16.2 [12-22 ?]

Nov 2018 4pm TSH 0.20 ...... " ...................................................

Jun 2019 10am TSH 0.16........ " ............... fT4 15..9 [12-22]

Jan 2021 ............. TSH 0.18......... " ............... fT4 13.5 [12-22]

Sep 2021 11am TSH 0.02 [0.27-4,2].......fT4 15.9 [12-22]

So even though it's a teeny bit lower than some people , your TSH is static since 2018 , fT4 is possibly falling a little , but nothing conclusive and nobody would have thought anything of it.

Then at Sept 21 test she sees TSH has suddenly dropped.

wonders why ?

and looks back at previous results and sees 16/15/13 ... and thinks " is thyroid slowly failing ?"

perhaps she knew enough to realise TSH can bounce around in early thyroid failure, and doesn't always match with fT4 levels (because they change before it catches up ) .

I think the drop in TSH is why she said the "low TSH was the red flag for her" . because the sudden drop was the trigger for her to look back at the previous tests ..where she then noticed fT4 appeared to be falling.

Now TSH 0.19 (back to your 'usual') .... fT4 14.5 [12-22] ...... fT3 4.8 [3.1-6.8]

I think ..... the only unusual thing here is TSH was 0.02 .. which since it now looks like a 'one off' should probably be ignored .

i don't think i see anything odd going on with the fT4 , and now we see fT4 has been at a very similar level all the time since 2018 with very similar 0.1/0.2 .

So i'm going to change my mind again ... i don't think there's anything going on ..... other than a one off low TSH for some reason.

I think perhaps you are someone who's 'usual' level of thyroid test is TSH 0.1/0.2 ish who 'usually' has fT4 levels being 13-16 ish.

But i am of course prepared to be wrong again.

[MaggieSylvie in reply to tattybogle]

I started with my new GP about six weeks ago and he said he couldn't understand why my previous GP had jumped to the conclusion that I was hypo. She has also requested a new TSH test, and apart from this not being sufficient to diagnose anything, should she do this when I am no longer under her care?

[tattybogle in reply to MaggieSylvie]

I'm assuming 'new GP' is just a different one working at same practice ? In which case ,i assume that technically you're still 'under the care of all of them'

...... the new one will still be able to see the result .. even if he if he didn't order it.

[MaggieSylvie in reply to tattybogle]

You are right, and I gave him a copy of my private test results. I had so much to "put before him" that it was a very rushed first appointment (10 minutes), but I had a second phone appointment and he has put me on pregabalin for neuropathy and irritable bladder and I am still on the lowest dose because I have had a lot on, but oh boy - my sleep has been so much improved. The first day, if I could have danced, I would have! Blood cancer is the elephant in the room, I think. I have been given a blood form for TSH and refused it, requesting that it included T3 and 4. Now I have a phone message that there is a blood test form waiting for me. I will collect it when I am up that way, and in the meantime, I have copied my private results for her as she may not have seen them.