Hi I hope this is ok. I am looking for some advice on my thyroid test results. I have had 3 blood tests over the past year. My first test result shown my serum free T4 level was low at 9.0 but my TSH was normal at 3.06 miu/L .
The doctor wanted to test again 2 months later. I had similar results but this time he said he thought it was an error in the testing but he will send me for another blood test again in 6 months. So my test results came back similar again T4 9.4 and TSH 1.97 but this time they also did a cholesterol test and it came back high which I am very concerned about as I am only 39. I have read hypothyroidism can cause high cholesterol. I have an appointment with the doctor in 2 weeks.
My questions are:
Is 9.4 low?
Has anyone been diagnosed with hypothyroidism at that level and normal TSH level?
I also feel like I have hypothyroidism symptoms I often have to drag myself through the day.
Hope this isnt too long. Thankyou.
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Moviegeek7
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Can you supply the ranges for your blood tests, as laboratories vary. This will allow members to offer better advice.
Key vitamins are essential to thyroid health, so I would ask your GP to check ferritin, folate, B12 and Vit D, or look to do this privately (as many forum members do).
As all FT4 tests are under range, central hypothyroidism may be the issue. SeasideSusie is more knowledgeable than I in this area, so I will tag her know your ranges are available.
Hard to say without the reference range, ranges vary from lab to lab. With my NHS test the range is 7-17 so you'd be in range but only 24% through range. But if your FT4 is below range then your GP is procrastinating if you've had 2 x below range FT4 results and he wants to test again in a few months. If he thinks there has been an error in testing then he should be repeating it now!
Your GP probably hasn't heard of it but a normal TSH with a below range FT4 suggests central hypothyroidism which is where the problem lies with the pituitary or the hypothalamus rather than the thyroid gland.
Raised cholesterol is a symptom of hypothyroidism.
Thankyou that is what I have found doing research. I have a doctors appointment in 2 weeks and I wanted to be prepared as much as possible as I don't feel well at all.
So as your FT4 has been below range on 3 occasions then here is some information about central hypothyroidism that you can look into and be prepared to discuss with your GP:
With Central Hypothyroidism the TSH can be low, normal or slightly raised, and the FT4 will be low/below range.
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.
You may need to be referred to an endocrinologist (in fact I would push for this). If so then please make absolutely sure that it is a thyroid specialist that you see. 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 to be sent to you in a private message on any that you can get to. Then if your GP refers you, 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 area which you'll have to mention of course.
I am not medically trained so I am not diagnosing, just pointing out the possibility that central hypothyroidism could be your problem.
Well, actually, a TSH of 3.06 is not 'normal'. It's in range, yes, but it's the range that is wrong. A 'normal' (euthyroid) TSH is around 1, never over 2, and you're hypo when the TSH reaches 3. And, an under-range FT4, and high cholesterol should clinch the deal - high cholesterol indicates low FT3. But, doctors only tend to look at the TSH, and have been taught that it should be over 10 before they need to diagnose.
Don't worry about the cholesterol - it's a symptom, not a disease. It has nothing to do with your age, nor with your diet. And is certainly not due to statin deficiency! So, don't let them talk you into taking statins, which would probably do more harm than good, and are not recommended for women or people with hypothyroidism.
“If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.”
Doctor wrong to assume results must be wrong & leave you untreated for months. Either should be commence treatment based on under range FT4 or refer to endocrinology. (Or at least discussing with specialist on how to proceed).
They likely not acted as assumed endocrinology won’t accept referral as TSH in range, and unsure how to proceed with treatment when TSH not over range.
Secondary hypothyroidism is where there is an issue with the pituitary gland and does not produce sufficient TSH to stimulate thyroid. So TSH would not rise in response to low levels.
In tertiary hypothyroidism, inadequate secretion of thyrotropin-releasing hormone (TRH) from the hypothalamus leads to insufficient release of TSH, which in turn causes inadequate thyroid stimulation.Both are referred to as central hypothyroidism.
All forms of hypothyroidism is treated by same, - replacing low thyroid hormones with levo. It can be difficult to diagnose central hypothyroidism - as normal (in range) TSH is assumed normal, but under range / low FT4 & FT3 needs treatment.
Thyrotropin-releasing hormone (TRH) is a hormone from hypothalamus that stimulates the release of thyroid-stimulating hormone (TSH) and prolactin from the pituitary.
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