Blood test results, can anyone help?

[Whirlygig]

I have been having multiple symptoms which i thought were due to the start of the menopause. A hormone test came back indicating this was not the case but my TSH was right on the limit of normality at 4.2. As my symptoms also match an under active thyroid I paid for a blood test and my TSH came back at 4.33 and my T4 at 11.8. My question is these figures are only just outside the normal range yet I have multiple symptoms including low sodium and low folate. Is it likely that a underactive thyroid are causing my problems given they are only just out of the normal range. Thanks for any help.

[SlowDragon Administrator]

Please add ranges on these results

Just testing TSH and Ft4 is not enough

Did you do this test early morning, ideally before 9am

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

Did you test thyroid antibodies?

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

What are your actual vitamin results

Low folate - GP should prescribe folic acid

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 early morning, ideally before 9am

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 and money off codes

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

If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). Ord’s is autoimmune without goitre.

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

Gluten intolerance is often a hidden issue too. If you have high thyroid antibodies…..Request coeliac blood test BEFORE considering trial on strictly gluten free diet

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...

[Whirlygig in reply to SlowDragon]

THS is 4.33, normal range 0.27 - 4.2 and FT4 is 11.8, normal range 12 - 22.

I did a home test analysed my nhs lab. I was just hoping for a guide as to whether I could have symptoms at this level before I speak to a Doctor next week. I have been back and forth to the doctors with itching, muscle cramps and weakness, brain fog, irregular periods and hand pains so I'd be grateful for any advice.

[tattybogle in reply to Whirlygig]

fT4 11.8 [12-22]since your fT4 is already below range, you should show these result to your GP now . they will need to do their own tests to confirm.

Make sure your NHS blood test is as early as possible in the morning, when the TSH is naturally highest 8/9 am preferably.

(TSH is highest in middle of night, and falls gradually to it's lowest around 1/2pm ~ you want highest TSH ,to get diagnosis sooner)

Your GP should test now and then re test after a few weeks at least 6 ..but some may insist on 3 months .... but since your fT4 is already so low they may not be so strict about that .

They should also test your TPOab at some point.

[Whirlygig in reply to tattybogle]

Thanks for the tip on blood test timing. The first test with TSH at 4.2 was done at 14.30 and the home test I did was at 15.00 so my results may not be as borderline as I think. I have a phone appt with a doctor on Tues so hopefully I will finally get somewhere. Back in the summer my leg cramps and spasms were so severe i wasn't getting any rest, a blood test showed low sodium and folates so I was advised to take a folic acid tablet. I took a B12 supplement as well and the cramps are more manageable but I found it surprising at the time that nobody seemed interested into why I had these test results and symptoms. I actually felt relief when I read the thyroid test results, you start to think you are going mad.

[tattybogle in reply to Whirlygig]

No you're not going mad, I remember that weird feeling of relief that 'at least i'm not loosing my grip on reality'.I had suffered with really problematic symptoms . (exhaustion/fatigue mainly) for about 4 years before anybody thought to check my thyroid (symptoms were bad enough i'd already had to give up a job and home that went with it ) ......but My TSH was 'only' 5.7 [0.36-4.1] then 6.8 when retested 6 weeks later.

This was years ago when they didn't do FreeT4 tests , so i don't know if that was below range or not , but my TotalT4 was still within range 94[65-155] then 91 at retest. So it's possible i had better fT4 levels than you do nowI think i got treated largely because my TPOab were through the roof and it shocked the GP cos he'd never seen any so high... i suspect i may have been fobbed off for a lot longer if they were not so astonishingly high.

Don't let them have your arm for any blood in the afternoons again... Its not usually worth the hassle of trying to explain to them 'why not'... nobody teaches GP's (or receptionist's !) that TSH has a circadian rhythm ....so they think you're nuts if you say the time of test matters .. but it does .... So , if necessary just tell a fib.

I usually say "sorry , i cant get here for a test after 9am due to 'work commitments"... (i'm retired lol) .. and if they say "lets do the blood test straight after your appointment (in the middle of the afternoon) i suddenly develop an urgent need to catch a train straight after the appointment and say "sorry ,must dash , i will come back tomorrow." (in the morning)

[Sparklingsunshine in reply to Whirlygig]

HiI had weird symptoms early 2020, before covid and I got a whole raft of tests done including thyroid. Minecame back borderline, my TSH was higher than yours I think, about 5.6, can't remember what my T4 was or even if they tested it.

My GP said they usually retest after 3 months to make sure it's still abnormal as sometimes you can get a rogue thyroid result. Mine was tested again, TSH was even higher, now firmly in the "abnormal" range and my FT4 had dropped to 11. So got offered Levothyroxine and have been on it ever since.

I had breathlessness which is very unusual for me, I noticed it when walking around not doing anything very strenuous. I'm normally very active and was pretty fit so this wasn't normal. Hence going to get tested. Turns out it might have been my thyroid playing up.

One GP I saw said some people are sensitive to thyroid levels, even if their labs show they aren't seriously hypothyroid.

[tattybogle]

Hi Whirlygig. can you put the lab ranges for the TSH and fT4 test please ? (will be after the result in brackets).

But basically yes ... it is possible to have symptoms of hypothyroidism while TSH/fT4 are 'borderline'.

To make sure it really is hypothyroidism developing, and not just a transient finding due to something else , NHS GP's need "2 over range TSH results , (taken 3 months apart)" before they can consider prescribing Levo , but realistically they probably won't do anything until it's at least over 5.

If they then test Thyroid Peroxidase antibodies (TPOab) and they are positive ,this makes them more confident to prescribe sooner .. because it confirms an autoimmune cause for the hypothyroidism.

[JenniferW]

Hi WhirlygigI have symptoms when my thyroid levels are within the 'normal' range of values. My initial test was just outside the range and my GP at the time commented on how severe my symptoms were. According to the last GP I spoke to about my thyroid, GPs should be using symptoms for diagnosis and management these days, not just blood tests,, this was about three years ago.

Good luck with the GP and don't forget you can always ask to see another one at the practice if you feel the current one you are talking to isn't managing to get to the bottom of your symptoms.

Best Wishes

Jennifer

[Lulu2607]

Hi Whirlygig. I agree with Tattybogle about how Drs approach thyroid results as this was my experience. My results were borderline at the end of 2019 but I knew I already had antibodies too. No medication of course. It wasn't checked again during Covid etc but I started getting quite ill, reacting badly to BP meds as BP was spiking, and statins (cholesterol went to 14 but nobody suggested thyroid). Then I got really ill with severe symptoms, eg drastically thinning hair and skin flaking so badly you could see it around the waistband of my clothes, weird weight gain, all around my middle etc. Every textbook symptom. A lot of it was diagnosed as stress(!) or side effects of meds. I was having a physical and mental breakdown with extreme panic attacks and uncontrollable crying fits. Eventually, in April 21 thyroid was retested. TSH now 161 and no detectable T4. I was medicated then alright! Like Tattybogle, my advice would be to keep an eye on it. Your symptoms may be due to a hypothyroid problem getting worse or something else, or both. Hormone eruptions at pre and menopause stage do tend to be associated with a number of issues and can confuse the matter.