Am I right in thinking I’m slightly hypothyroid? (Updated post)

[BeCaw93]

Hi all,

I’m likely due for thyroidectomy soon for my goitre. Following a hemithyroidectomy as a child. These are my most recent bloods, am I right in thinking I’m slightly hypo anyway? It might help me feel a bit better about surgery:

September 2022:

TSH 2.01/mIUL (range 0.27- 4.20 mIU/L)

T4 9.8 pmol/L (range 12.0- 22.0 pmol/L)

Medichecks July 2022:

CRP HS 2.44 mg (range 0-5)

Ferritin 74.0 ug (range 13-150)

Folate-serum 11.04 ug (Range >3.89)

Vitamin B12 80.2 pmol/ (range 37.5-150)

Vitamin D 107 nmol/ (75- 200 optimal range)

TSH 2.63mU/L (range 0.27 - 4.2)

Free T3 6.28pmol/L (range 3.1-6.8)

Free Thyroxine 8.2 pmol/ (range 12- 22)

Thyroglobulin Antibodies 14 IU/ml (range >115)

Peroxidase Antibodies 10 IU/ml  (range <34)

My most recent test results prior to this show:

25/02/2021 TSH 1.42 mu/L, T4 8.8 pmol/L (range 0.35-3.50 TSH, 8-21 for T4)

04/07/2019 TSH 1.86 mu/L, T4 10 pmol/L, T3 4pmol/1.7 (ranges not known)

23/04/2019 TSH 1.76 mu/L, T4 12 pmol/L (range 0.35-3.50 TSH, 8-21 for T4)

15/04/2016 TSH 1.96 mu/L, T4 12 pmol/L (range 0.35-3.50 TSH, 8-21 for T4)

My vitamin D was also 19 nmol/L (range 50-120) this was following a summer I spent mostly indoors due to depression. I now take a daily 2000IU tablet

Looks like my T4 has been low since February last year most likely? In terms of symptoms I have a large goitre but that’s about it. No weight gain or coldness, periods regular. I do get tired a lot but I often have late nights and have a busy job so I’ve been attributing it to that. I have had depression previously but this has been very circumstantial and easily explained, I don’t feel low in mood normally.

Any answers would be appreciated, thanks.

[SeasideSusie Remembering]

BeCaw93

Can you please add the reference ranges for all your results as these vary from lab to lab.

Do you take any supplements?

Presumably the B12 test with Medichecks is an Active B12 test?

[BeCaw93 in reply to SeasideSusie]

I’ve updated my post

[mistydog]

without ramges and a T3 result its almost impossible to say.

[BeCaw93 in reply to mistydog]

I’ve updated my post

[BeCaw93]

Thanks all, I’ve updated with the ranges I know, I’m afraid I don’t know the ranges for the earlier blood tests. The ones that are more interesting are:

September 2022:

TSH 2.01/mIUL (range 0.27- 4.20 mIU/L)

T4 9.8 pmol/L (range 12.0- 22.0 pmol/L)

July 2022:

TSH 2.63mU/L (range 0.27 - 4.2)

Free T3 6.28pmol/L (range 3.1-6.8)

Free Thyroxine 8.2 pmol/L (range 12- 22)

It looks to me that I now have a consistent T4 deficiency despite my TSH being technically within normal ranges. If the older blood tests also use similar T4 ranges it looks like I’ve been deficient since 2021? I also take a daily vitamin D tablet of 2000IU as I was found to have a severe vitamin D deficiency February 2021.

If my T4 is low am I right in thinking I’m now hypothyroid?

Thanks

[PurpleNails Administrator]

It’s very unusual to have below range FT4 but high in range FT3. Something is affecting thyroid.

  It’s said sometimes if the thyroid is failing the body prioritises FT3 level over FT4 so that might be what’s going on here & why TSH is hovering in range.

 Was your thyroid function abnormal prior to your sub total surgery?    If you were hyper the TSH can become down regulated.  Doesn’t rise when thyroid levels low.  

Not everyone manages to compensate with thyroid levels afterwards many do need replacement.  

I have a family member who had a partial many years ago, but very soon took what you would calculate a full replacement dose.  I am very suspicious about It though as the scar is one of the longest I’ve even seen for it’s type.

[BeCaw93 in reply to PurpleNails]

Thank you for the detailed reply. I’m not sure what my levels were like before my hemithyroidectomy as this happened when I was 12. I remember though that my levels were considered ‘borderline’ for a while but they did not put me on replacement as they wanted to see if my thyroid would compensate, which it apparently eventually did.

When I was 16 nobody seemed bothered in measuring my levels much anymore, other than the occasional blood tests I had due to tiredness as they thought I might be anaemic . And as I always took it that my thyroid was fine I haven’t started investigating until recently.

The fact that it’s grown a large goitre in the last few years may be indicating that it’s failing then perhaps? Especially as I don’t seem to have a lot of other symptoms and if anything I’m slightly underweight

[PurpleNails Administrator in reply to BeCaw93]

But did it compensate?

The TSH might have looked in range but was a full test taken?  

The TSH can be quite unreliable & if you had borderline high TSH it likely means you were / are hypo.  The range is wider than what really normal for most.  

Trusting doctors are completing the right tests, that the lab complete them, send back results for doctor to correctly check &  following them up is why most of us are here.  - Often they don’t, lots go amiss.  

A struggling thyroid can swell as it’s inflamed or what remaining thyroid tissue is there is over stimulated making it strained & work harder - usually high TSH is present and increased vascularity can be indicated on scans. 

 By the sound of it you have had symptoms but attributed them to something else.  When symptoms develop gradually you’d be surprised how you physically & mentally adapt to them.

  Weight isn’t always a symptom.  I was hyper many years & gained weight.  Didn’t loose any until I was mid range. 

[BeCaw93 in reply to PurpleNails]

Date of surgery 2nd March 2006 when I was 12. My right nodule was overactive. Right hemi-thyroidectomy for a solitary hyperplastic nodule of 3cm (colloid goitre) Several enlarged cervical lymph nodes removed. Mild hypocalcemia in hospital. A week after surgery I became slightly under active.

13th March 2006 T4 8.9pmol/L (range 10-22) TSH 11.93 mIU/L (range 0.4-4)

May 2006 T4 12.5pmol/L (range 10-22) TSH 5.53miu/T (range 0.4-4.0)

December 2006 when I was 13.8yrs T4 14.4 and TSH 5.45. Slightly hypothyroid.

Feb 2007 T4 was 13.6 pmol/L and raised TSH of 5.30 mu/L which was slightly lower than a previous measurement of 5.45 and no thyroxine indicated

June 2007 T4 was 13.6 (range 10-22) and TSH 5.3 (range 0.4-4) they said my TSH was still marginally raised but I would not need thyroxine as clinically well

March 2008 letter suggests my free T4 was 14.5 and TSH 5.5 and thyroxine not recommended as I was clinically well

Letter from 2009 ?sub-clinical hypothyroidism with raised TSH of 7.09 (range 0.4-4) and reduced T4, however a letter from June that year suggests my TSH then normalised. T4 13.4pmol/L (range 10-22)

April 2012 T4 17.7pmol/L (range 12-22) TSH 7.67 mu/L (range 0.4-4.0)

October 2014 T4 17.7pmol/L (range 12-22) TSH 4.21 mu/L (range 0.4-4.0)

August 2015 T4 18.0 pmol/L (range 12-22) TSH 1.41 mu/L (range 0.4-4.0)

These are all my earlier results (sorry for typing them all out if it’s a bit hard to read, it’s more for my reference later as I didn’t realise I had so many, I’m planning on tracking this on a graph) I’ve also found the ranges for my other blood tests so I’ve edited my original post again.

I probably have adapted, I can’t really remember life before I had my op and I’ve always been a slightly ‘lethargic’ child according to my parents so perhaps I’ve had an issue all along. I also remember getting very depressed in my early teens but attributed that to growing up.

My parents have always trusted the health system, it’s only recently that I’ve managed to get hold of my medical records from my GP to start investigating this myself.

[PurpleNails Administrator in reply to BeCaw93]

Were you well? Clinically or otherwise -  because according to the results you were technically hypothyroid, and as there no FT3 to compare so we cant really say how much it would have affected you.

Around 2015 your TSH is Lower & FT4 higher.  One theory could be you have an underlying low functioning thyroid (after surgery) with unusual results ( high FT3) from erratic FT3 producing nodule?

Have you had antibodies tested?

You would only learn what function is like throughout thyroid by a uptake scan, but as your surgery is separate to function your doctors aren’t going to be looking at that aspect.

It sounds like once you were past 16 the care wasn’t great. I think you’d benefit from replacement.