Advice about daughters thyroid test please.

[De8813]

Hi these are my 21 yr olds results. She isn't diagnosed with hypothyroidism but is suffering from depression, anxiety and fatigue. The message with the results says they are unusual and she should see a gp. So thought before we do should ask your advice. Thanks.

[SeasideSusie Remembering]

De8813

Is this her first test? First time with below range FT4?

GP may want to repeat tests, if so then do test as we advise and get thyroid antibodies tested as well:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.

In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:

healthunlocked.com/thyroidu...

If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.

[* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.]

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin). See

thyroid.org/patient-thyroid...

biotin use can result in falsely high levels of T4 and T3 and falsely low levels of TSH

These are patient to patient tips which we don't discuss with phlebotomists or doctor

If another test comes back with below range FT4:

I am not medically trained, and I am not diagnosing, but 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:

bestpractice.bmj.com/topics...

and another article which explains it:

ncbi.nlm.nih.gov/pmc/articl...

and another here:

endocrinologyadvisor.com/ho...

and another one:

academic.oup.com/jcem/artic...

A long read which you might find useful:

thyroidpatients.ca/2020/01/...

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. 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

[e-mail]

for the list of thyroid friendly endos. Then ask on the forum for feedback 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.

[De8813 in reply to SeasideSusie]

Thank you SeasideSusie will have a good read though all your helpful information before tackling the gp. Thank you so much

[SlowDragon Administrator]

have you also tested thyroid antibodies, vitamin D, folate, ferritin and B12

If not request these are tested

[De8813 in reply to SlowDragon]

Thanks SlowDragon will try to get gp to do this. X

[SlowDragon Administrator in reply to De8813]

what’s her diet like ?

Is she vegetarian or vegan

Or dairy intolerant or gluten intolerant

[De8813]

She's not vegetarian or vegan, but a very picky eater. Lives on bread practically. Don't know of any intolerance. Has gerds ,extremely anxious about everything to the point that her hands shake. Went to see the dr 3 years ago about painful wrists and her hands were shaking so badly her gave her propranolol.

[SlowDragon Administrator in reply to De8813]

is she still on propranolol

Propranolol slows uptake and conversion of thyroid hormones….can affect blood test results….

Anxiety is common hypothyroid symptom

Painful wrists - carpal tunnel…..extremely common hypothyroid symptom

Gerd is extremely common too

When hypothyroid we frequently develop LOW stomach acid. This leads to poor nutrient absorption and low vitamin levels

Low vitamin levels tend to lower TSH, making it harder to get diagnosed as there’s an over reliance on test results over and above patient symptoms

Does she wear a Fitbit or equivalent. Can be helpful to show slow heart rate (and activity levels)

[De8813 in reply to SlowDragon]

Thanks SlowDragon she is still taking propranolol when she leaves the house, is also on Sertraline now after changing from a different one ,can't remember the name but piled on so much weight which made her more depressed. She also had trouble sleeping. So do you think that propranolol has caused the conversion issue. Have just got an appointment at the doctors for today, think they will repeat the blood test. Thanks.

[De8813 in reply to De8813]

forgot the mention she hardly moves anywhere. Its a struggle to get her out the bedroom but will be going back to uni soon. Doesn't were her fitness watch . Always trying to encourage her .

[SlowDragon Administrator in reply to De8813]

would suspect her vitamin levels are very poor …and likely upsetting her thyroid

Or thyroid is resulting in low vitamin levels

Either way …likely an underlying physical issue

Request/insist on vitamins and thyroid antibodies tested

Or test privately

[SlowDragon Administrator in reply to De8813]

make sure blood test is early morning…ideally around 9am….this gets highest TSH ….all most medics look at

[Litatamon]

Getting her b12 levels checked is very important. As is understanding that most doctors do not fully understand b12 deficiency. And that is. generous way of putting it.

Informative and concise overview -

stichtingb12tekort.nl/engli...

All the best to you both.

[De8813 in reply to Litatamon]

Thank you Litatamon. X

[HashiFedUp]

Ask for thyroid antibodies and if they are high, you know that it’s hashimoto’s.

[samaja]

I would also test her sex hormons because there is a good chance they may be messed up too and influencing the thyroid and/or vice versa. And I don't know if you have seen the latest research saying that antidepressants don't really work on raising whatever they are supposed to raise and mostly have placebo effect at best with a lot of possible side effects. I found fish oil working much better for my depession than anything else.

She might find working on calming the nervous system beneficial, I think. Do you know Irene Lyon or dr Kim D'Eramo - both on YouTube or FB? IF not maybe look them up. Best of luck for your daugther.

[De8813 in reply to samaja]

Thanks samaja , I haven't heard of them. Will have a look . Antidepressants do have terrible side affects but my daughter felt she needed them. Sad that once on them you are just left to get on with it x