Hi all, I posting these results on behalf of my daughter who is hypothyroid with symptoms, but GP said he would retest in a year. I believe the GP is out of order here. He refused to check her FT3 so only have TSH and T4 numbers. What do you think? Any advice would be really appreciated.
TSH 11.3. 12.0 - 22
T4. 1.6 0.27 - 4.20
My daughter has not had her vitamin levels checked just yet, just need to know At this point in time if GP should be addressing the low T4.
Any feedback would be greatly appreciated.
Have a rewarding day...Thank you in advance
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DizzyD
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Hi slow Dragon thank you for your reply. She is not on any thyroid meds at the moment but she does have hypo symptoms. Her thyroid results came back as abnormal after standard blood test. No follow up investigations by GP. With those results do you think she should question her GP about results rather than wait a year for another thyroid test. I have advised her to get a private thyroid and vitamin test but she is reluctant to do so at this point in time. ISorry for repeating myself, but should she be concerned about her results?
Presumably she has autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
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
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 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
I am not medically trained, and I am not diagnosing, but as she has no diagnosis of hypothyroidism and not on any thyroid medication 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.
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). If there is enough hormone then there's no need for the pituitary to send the message to the thyroid so TSH remains low.
In Primary Hypothyroidism, which is where the thyroid fails, the TSH will be high.
However, with Central Hypothyroidism the signal isn't getting through for whatever reason so the message isn't getting through to the thyroid to produce hormone, hence low FT4. 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.
Your GP can look at BMJ Best Practice for information - here is something you can read without needing to be subscribed:
You could do some more research, print out anything that may help and show your GP.
Your daughter may need to be referred to an endocrinologist. If so then please make absolutely sure that it is a thyroid specialist that she sees. 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 ThyroidUK at
tukadmin@thyroiduk.org
for the list of thyroid friendly endos. Then ask on the forum for feedback on any that she can get to. Then if her GP refers her she should 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 could also ask on the forum if anyone has been successful in getting a diagnosis of Central Hypothyroidism, possibly in your daughter's area which you'll have to mention of course.
With such a low fT4 her TSH should be much higher. The GP is following guidelines so I wouldn't blame them, it's the endocrinologists who advise GPs that are to blame. TSH, fT3 and fT4 all work together. When fT3 or fT4 falls TSH should go up, so it's the whole system ("the axis") that has to work together. It's very important to get at least TSH, fT3 and fT4 measured as you will probably find her fT3 is low normal also, indicating the pituitary is under-performing. The term 'central hypothyroidism' is usually reserved for more obvious cases where TSH is near zero and damage to the pituitary but the effects of low normal fT3 AND fT4 (together) are much the same. The name doesn't matter. Persuade her to get a private blood test, it will be very informative.
Not sure if anyone has asked what your daughter's diet is like? Is she a vegetarian or vegan?
I'm asking as from my own experience I've had a below range FT4 for almost a year now. From reading posts on the forum and learning as much as I can my lack of iodine containing foods in my diet could have caused my hypothyroid symptoms or at least made them worse.
Though it's difficult to know as I've had symptoms since I was a teenager and I wasn't a vegetarian then.
My GP says the same, come back in a year to get tested again. They aren't really much help I have battled to get an endo referral but it's taken a long time.
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