Crushing tiredness and brain fog: Does anyone on... - Thyroid UK

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Crushing tiredness and brain fog

Harlie2020 profile image

Does anyone on here have normal thyroid results but they need to sleep in the day because of brain fog and/confusion? In this case, no amount of good sleep in the night seems to make a difference.

70 Replies
SlowDragon profile image
SlowDragonAdministrator

Welcome to the forum

Are you diagnosed as hypothyroid or trying to get diagnosed

Do you have any recent thyroid and vitamin results to add

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.

In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)

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 and if on levothyroxine…….last dose levothyroxine 24 hours before test

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 all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

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

About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s.

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

List of hypothyroid symptoms

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

As we often say around here, normal is just an opinion… Your thyroid blood tests might have results which fall within the laboratory reference ranges but often that doesn’t mean they’re optimal.

Do you have a copy of your blood test results? If not, that’s the place to start. Ask your GP’s receptionist for a copy of them (just say you want them for your records—you’re allowed!) and then post them here for comment.

Harlie2020 profile image
Harlie2020 in reply to Jazzw

Ok thanks. Will do

shaws profile image
shawsAdministrator in reply to Harlie2020

Post them as a new question.

Harlie2020 profile image
Harlie2020 in reply to Jazzw

TSH 1.19

T4 9.2

SeasideSusie profile image
SeasideSusieAdministrator in reply to Harlie2020

Harlie2020

Please add the reference ranges (eg FT4: 15 [12-22]), your FT4 result looks suspiciously low in range. We frequently see ranges here that are 7-17, 9-19, 11-23, 12-22 and others, so we need the range that came with your results to interpret them but I would imagine your FT4 is very low in range, as will be your FT3 if it was tested, and that suggests undermedication.

shaws profile image
shawsAdministrator

We also need the ranges to respond about your results. The reason being that labs use different machines and therefore ranges can also be different.

To amend your results above, press the down arrow next to More and select edit and put in the ranges.

Are you taking a bit of T3 a few times a day?? I take 2.5mcg mid - morning, mid-day and mid - evening and find that helps a lot with the symptons you are having. This is in addition to my daily, one time, early morning dose of T4.

Harlie2020 profile image
Harlie2020 in reply to playtime2

I’m not on any medication. I’m told I’m normal and don’t need it!

SlowDragon profile image
SlowDragonAdministrator in reply to Harlie2020

Just testing TSH and Ft4 is completely inadequate

Next step is to get FULL thyroid and vitamin testing done privately

Details in my first reply

Come back with new post once you get results

Lots of people find that helpful but others, like me, prefer to single or double dose so the cells are saturated

The problem I have is getting the medication. My doctor won’t give me any!

That’s not uncommon. You may have to source it yourself

Do you know how? Also - I’m a bit worried about self diagnosing - what if I get some levothyroxine and overdo it!

SlowDragon profile image
SlowDragonAdministrator in reply to playtime2

playtime2 and MorecambeBay these replies are inappropriate

Harlie2020 is not diagnosed as hypothyroid or on any thyroid medication and TSH and Ft4 don’t suggest she has thyroid problem

My apologies for my misunderstanding SD. Her FT4 is below range. The fact that her doctor is taking the ‘normality’ of her TSH as an indicator that she doesn’t have thyroid problems doesn’t make sense. I’d appreciate some help in getting to grips with this. Thank you

Edit

We realise that a thyroid vitamin panel is an excellent test, but surely the only criteria according to NICE are TSH and FT4 (T4 if you’re lucky and FT3 if it’s your birthday.) Negatives in other tests are concerning as they will help us to get our levels optimal - but they won’t negate the criteria which a doctor should be using

SlowDragon profile image
SlowDragonAdministrator in reply to MorecambeBay

Her Ft4 is NOT below range

Range is 7.7-15.1

Underlines, yet again why it’s so important to always include ranges on results.

Low vitamin levels and fluoxetine may be affecting levels too

My apologies. I didn’t look at the graph and there was no range given. I don’t think any of us would call this result ‘normal’ though SD.

That’s ‘Doctor talk’ which we try to get away from on this forum.

I hope we’re not going to fall out about 2 points 😉

Happy New Year

SlowDragon profile image
SlowDragonAdministrator in reply to MorecambeBay

28% through range……not that unusual for someone not on replacement thyroid hormones

Obviously need vitamins, Ft3 and thyroid antibodies tested

Which is what Harlie2020 is doing next

SD. I’m sure Harlie is very grateful for your advice and information. I still can’t rationalise the information you’ve given to her but as long as she can that’s the main thing. 😉

I really appreciate all your contributions. I have a cortisol and thyroid peroxidase antibody test on Tuesday. vitD and ferrin good/normal. Should I have anything else?

A nice cup of tea 😉

really appreciate all your contributions. I have a cortisol and thyroid peroxidase antibody test on Tuesday. vitD and ferrin good/normal. Should I have anything else?

This is my result and range

This is my result and range - does that help? Sorry I’m new to this

See below

Again my result and range. No T3 check
SlowDragon profile image
SlowDragonAdministrator in reply to Harlie2020

These results are “normal “

Any ideas?

SlowDragon profile image
SlowDragonAdministrator in reply to Harlie2020

Low vitamin D, low B12 …..low iron/ferritin

What’s your diet like

Are you picky eater, vegetarian or vegan

Are you taking any other medications

Any other illness

My vita d was tested and good. I take supplements. I do eat well. I do drink daily although I wouldn’t say heavily. I exercise daily.

I’m taking fluoxetine as well

SeasideSusie profile image
SeasideSusieAdministrator in reply to Harlie2020

Harlie2020

I’m taking fluoxetine as well

I do drink daily although I wouldn’t say heavily

Are you aware that drinking alchohol is not recommended when taking fluoxetine and this may be causing your fatigue and brain fog/confusion. See

healthline.com/health/depre... alcohol

Interactions

The ingredients in Prozac are designed to help calm your mood. One of the side effects of the drug is tiredness. Prozac can interfere with coordinated movement and alertness, like alcohol does. Combining Prozac with alcohol can quickly lead to increased sedation. Having even one drink while you take Prozac can cause extreme drowsiness. This effect can lead to potentially dangerous situations. These include poor decision-making, impaired driving, and an increased risk of falls and injuries.

Mixing alcohol and Prozac can also lead to other side effects. These can include:

dizziness

sudden fatigue and weakness

feelings of hopelessness

suicidal thoughts

Mixing Prozac and alcohol may cause fatigue and weakness.............

So maybe, before going to the expense of private testing of all that has been suggested and the cost of seeing an endo privately, you could stop the alcohol whilst taking fluoxetine and see if things improve.

Ok. I’ll try that

Although I had the tiredness issue before I was on Fluoxetine. The symptoms are the same.

SlowDragon profile image
SlowDragonAdministrator

A TSH of 1-1.5 is absolutely “normal “

healthunlocked.com/thyroidu...

Suggest you test thyroid, cortisol, vitamin D, folate, ferritin and B12 via Blue Horizon

When you say test thyroid. What do you mean?

SlowDragon profile image
SlowDragonAdministrator in reply to Harlie2020

Just testing TSH and Ft4 is incomplete

Full thyroid testing is TSH, Ft4 and Ft3 plus BOTH TPO and TG antibodies

Your TSH and Ft4 don’t suggest a problem

But you might have raised thyroid antibodies

Low vitamins can make you feel very unwell, especially low iron/ferritin

Anxiety can affect cortisol levels

Cheapest way to test vitamin D, folate, ferritin B12 and cortisol levels is by testing along with thyroid Via Blue horizon

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 all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thank you that is great. Sorry I missed your original post. I’ll get onto that.

SlowDragon profile image
SlowDragonAdministrator in reply to Harlie2020

Come back with new post once you get results

Only do private testing early Monday or Tuesday morning and then post back via tracked postal service

greygoose profile image
greygoose in reply to SlowDragon

But the FT4 isn't! Since when did you condone diagnosing and dosing by the TSH?

SlowDragon profile image
SlowDragonAdministrator in reply to greygoose

Ft4 is 28% through range

greygoose profile image
greygoose in reply to SlowDragon

Yes? And you think that's normal??? Pretty certain is isn't. There was a time when you wouldn't have thought that, either. What happened? And, if her FT4 is that low, could be that her FT3 is lower - and if it's higher, then that's pretty conclusive proof that her thyroid is struggling.

Harlie2020 profile image
Harlie2020 in reply to greygoose

Thanks for the comments.

I am due to have a cortisol and thyroid peroxidase antibody test on Tuesday. vitD and ferrin good/normal. Should I have anything else?

greygoose profile image
greygoose in reply to Harlie2020

What do you call good/normal? Whose opinion is that? If it's your doctors then he could be wrong - they very often are. Always best to give the exact numbers: results and ranges. 'Good/normal' is meaningless.

Is it your doctor doing these tests on Tuesday? Because, if it is, he won't be aware that there are two Hashi's antibodies: TPOab and TgAB. Ideally, you want them both tested, because the TPOab can be low, and your TgAB could be high, and both mean that you have Hashi's.

You also need vit B12 and folate. tested. :)

Harlie2020 profile image
Harlie2020 in reply to greygoose

That’s great. I’ll ask for this to be added.

greygoose profile image
greygoose in reply to Harlie2020

And FT3, of course! :)

Harlie2020 profile image
Harlie2020 in reply to greygoose

Is TGab the one that they are not testing for? The form says thyroid peroxdaise antibody - what do I need to add? B12 and folate too

Harlie2020 profile image
Harlie2020 in reply to greygoose

These are my other results

Result
SlowDragon profile image
SlowDragonAdministrator in reply to Harlie2020

Ferritin is not deficient….but it’s still pretty poor

Was obviously very low/deficient in past tests

Have you been working on improving low iron/ferritin

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first

Medichecks iron panel test

medichecks.com/products/iro...

Low iron/ferritin and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Harlie2020 profile image
Harlie2020 in reply to greygoose

See below

Vit d
greygoose profile image
greygoose in reply to Harlie2020

Oh, I hate those stupid graphs! Can never make head nor tail of them! Can't even see them clearly on here.

Much prefer that information is given in the following way:

Date:

Name of test: result (range).

That way, we can see all the important info at a glance. :)

SlowDragon profile image
SlowDragonAdministrator in reply to Harlie2020

So vitamin D is pretty good

Do you supplement?

Yes

Hi Harlie2020,

SlowDragon makes a very good point about the term ‘normal’ (note my use of the inverted commas). It is a misused term that you should be wary of. What should be aimed for is OPTIMAL.

Only two little words, but they mean very different things. In fact one could say ‘normal’ is meaningless. GPs who don’t know what they are doing generally tell you that you are ‘normal’ if you are in range.

The trouble is the majority of GPs don’t understand what the range is there for - it’s a guide only! Sadly most think the range is a ‘cup’ and that the patient is a ‘ping-pong ball’ and if they get the ping-pong ball in the cup they win a prize.

They simply do not understand that you can be on completely different doses at either end of the range and be hypo (at the lower end) and be optimal and well (at the upper end) OR, heaven forbid, because of other confounding factors you may sit outside the top of the range before you feel well OR (panic stations) the range might not apply at all! 😱😂.

Symptoms should be the most important diagnostic tool, but it sits at the bottom of the list as an annoyance. Nothing annoys a doctor more than having a lovely set of blood results, all ‘normal’ and the damned patient goes and spoils it all by having symptoms! 😂

Ever been told by a GP “Your symptoms should have cleared up by now” or something similar and made to feel the failure for not having responded to their rubbish treatment??

Vitamins need to be higher than just in the bottom of the range SlowDragon has provided loads of info on this - work through it - it is worth it. GPs in the main have no idea on this either - refer back to cup/ping-ping ball scenario.

If you take the advice from seasidesuzie and drop alcohol

Then get vitamins and thyroid checked as advised by SlowDragon you will have a better idea of what is going on. And get PRINTED results don’t rely on Patient Access- my Patient Access is patchy and things have been altered/disappeared (yes really). I have screenshots 🤔. I also have my complete set of tests- get copies of everything keep records 😊👍.

Sometimes other medication and lifestyle can suppress TSH and it’s not even a direct measure of something your thyroid makes.. TSH is a really unreliable measure in isolation and adds very little to diagnosis or management compared to getting FT4 and FT3 results and getting your vitamins optimal (not normal).

The forum came to my rescue about a year ago. I’m well and here as a result of their support and advice.

There’s lots to get your head around but plod through it at your own pace - it is worth the effort (from one who has been plodding my way through too and in a better place as a result).

Thank you. That is really helpful. I agree optimal should be the aim. It is so frustrating to be told - I’m not sure we can do anything for you when they haven’t done the right tests and/ or read the result correctly. The impact on my life is no joke and yet I’m getting ‘computer says no!’. Sooooo frustrating. Thanks again x

Hi again Harlie2020

Don’t forget they also have the competing motivations of saving money and getting paid to push certain medications. It’s true you really do have to be your own health/thyroid advocate. The scales gave dropped from my eyes 👀😱

SlowDragon profile image
SlowDragonAdministrator in reply to Harlie2020

Please add actual results and ranges for vitamin D and ferritin

We regularly see what a GP says are “normal” vitamin results….that are far from OPTIMAL

Optimal vitamin levels are

Vitamin D at least around 80nmol and around 100nmol maybe better

Serum B12 at least over 500

Folate and ferritin at least half way through range

Extraordinary how often a GP will say ferritin is normal when it’s under 30

cks.nice.org.uk/topics/anae...

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency

There are two thyroid antibodies for autoimmune thyroid disease

TPO and TG antibodies. NHS only tests TG antibodies if TPO antibodies are high. Significant minority of Hashimoto’s patients only have high TG antibodies and struggle to get diagnosed

SlowDragon profile image
SlowDragonAdministrator in reply to greygoose

Which is why I suggest that she gets FULL thyroid and vitamin and cortisol testing

I agree it’s on low side….but there’s zero point taking these results to an endocrinologist

I have a friend, similar results….stuck on SSRI antidepressant over 35 years….low energy etc. A year ago they got FULL thyroid and vitamin testing done via BH - showed deficient folate, very low vitamin D, low B12….lowish Ft4 and lowish Ft3….but no raised antibodies.

After 9 months improving all four vitamins to GOOD levels was able to successfully ween off SSRI with very little difficulty …..subsequent full thyroid testing 3 months later now shows excellent Ft4 and Ft3

Another friend…..has lichen planus…..and an impeccable diet. She had full thyroid and vitamin testing done…..was utterly astonished to see low folate, very low vitamin D, only average B12 and ferritin. Lowish Ft4 and Ft3…..but no raised thyroid antibodies. Improving low vitamin levels by supplementing significantly improved thyroid levels. As lichen Planus is autoimmune she has gone strictly gluten free and seen dramatic improvement in lichen symptoms

Thanks. That’s really helpful

SlowDragon profile image
SlowDragonAdministrator in reply to Harlie2020

It’s not always the thyroid that’s causing the problem

greygoose profile image
greygoose in reply to SlowDragon

I agree it’s on low side….but there’s zero point taking these results to an endocrinologist

Agreed. But there's zero point in telling the OP that her results are 'normal', either.

SlowDragon profile image
SlowDragonAdministrator in reply to greygoose

Her ferritin was dire/deficient…..now improving ….but still got long way to go to optimal

Be interesting to see what B12 and folate are

greygoose profile image
greygoose in reply to SlowDragon

Yes. But so has her FT4!

SlowDragon profile image
SlowDragonAdministrator in reply to greygoose

Ft4 is 9.2 (7.7-15.1)

That’s 28% through range

greygoose profile image
greygoose in reply to SlowDragon

Yes, so you have pointed out several time, and I have seen for myself, and I still say that is NOT normal.

radd profile image
radd in reply to SlowDragon

SD,

TSH - 1.19

FT4 - 9.2 [7.7 -15.1]

Even without ranges TSH appears too low with FT4 of only 20% through range (not 28% 😉), for someone unmedicated.

I would not call this 'normal' either. Even with the likely iron/nutrient deficiencies, TSH should be higher encouraging wholly inadequate FT4 levels to raise, and based on these results & O/P's symptoms FT3 is likely to be inadequate also.

SlowDragon profile image
SlowDragonAdministrator in reply to radd

Sorry yes 20% through range

But low TSH and extremely low ferritin likely linked

Improving low vitamin levels and testing for BOTH thyroid antibodies, folate and B12 levels next step

SSRI often seem to dampen TSH response

Wishing you all a Happy New Year, bursting with fulfilling and exciting opportunities. And remember, if opportunity doesn't knock, build a door! 😂😂😂😂

😅🤣😂 love that.....I think a lot of us are quite good at building doors thankfully! Happy New Year to you! Xx

💥💥💥

I’ve just been looking at your question, Harlie, the question which started this thread.

The symptoms you’ve described can be associated with very many conditions. I’ve said on here before that we just rule anything out or anything in, you should have a thorough investigation which should go beyond blood tests.

There are many members on the HU forums who would confirm that their final diagnosis was far from that they first considered. Menopause, Diabetes etc.

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