New Gps opinion: I showed a different Gp my... - Thyroid UK

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New Gps opinion

GeorgeTD1710 profile image
54 Replies

I showed a different Gp my medichecks thyroid results blood sample taken 8 30am

TSH 3.54 range 0.27-4.2

Free T3 5.74 range 3.1-6.8

Free Thyroxine 17 3 range 12-22

Blood test 28th Aug test at 12.10am

TSH 1.6 (0.27-4.2)

Free T4 16.7 (12-22)

TSH has been tested regularly has not so far ever gone over range.I take propranolo 10mg 3x daily and have been on PPI long term(im under Gastro)

My symptoms are feeling wobbly,keep going suddenly hot,burning sensation,headache light peach fuzz facial hair,a bit blurred vision (with the headache) and sweating/overheating,irritability and anxiousness

GP examined my throat and said no lumps but thyroid feels slightly enlarged.

.However ENT examined me 3 days prior I asked if my sore throat was my thyroid she said no.

TPO antibodies normal

My usual GP who i trust said thyroid level normal but has referred me to Endocrinologist(no idea how long wait is)

Gp is checking my DHEA , Testosterone and homocysteine levels.Any idea what these will show?

New GP said that if those tests are negative she might put me on a low dose of thyroid meds to see if it helps.

Ferritin level was 65 range (13-150)

Iron panel iron 12.3 range 5.8-34.5

Tranferrin 2.48 range (2-3.6)

TIBC 62 range 50-90

%trans.saturation 20% range 16-40

FBC all normal

How do you know if the symptoms are thyroid or menopause I'm 49.

I have merina coil fitted so cant tell with periods etc

I dont want to take medication if its not my thyroid.

Any ideas??????

54 Replies
SlowDragon profile image
SlowDragonAdministrator

NHS rarely tests Thyroglobulin antibodies unless TPO antibodies are high and over range

Have you actually seen which antibodies have been tested

Please add results and ranges

20% of Hashimoto's patients never have raised antibodies 

healthunlocked.com/thyroidu...

 

Paul Robson on atrophied thyroid - especially if no TPO antibodies 

 paulrobinsonthyroid.com/cou...

Gluten intolerance is often a hidden issue too.

Request coeliac blood test BEFORE considering trial on strictly gluten free diet

Propranolol slows uptake and conversion of thyroid hormones

It will effectively hide low thyroid levels

How long have you been on propranolol. What’s the reason for propranolol

Propranolol 

pubmed.ncbi.nlm.nih.gov/168...

labtestsonline.org.uk/tests...

Drugs that may decrease PTH include cimetidine and propranolol.

rejuvagencenter.com/hypothy...

ESSENTIAL to test vitamin D

Are you currently taking any vitamin D supplements?

why are you on long term PPI

Are you taking any magnesium supplements

gov.uk/drug-safety-update/p...

webmd.com/heartburn-gerd/ne...

pharmacytimes.com/publicati...

PPI and increased risk T2 diabetes 

gut.bmj.com/content/early/2...

Iron Deficiency and PPI 

medpagetoday.com/resource-c...

futurity.org/anemia-proton-...

onlinelibrary.wiley.com/doi...

sciencedirect.com/science/a...

GeorgeTD1710 profile image
GeorgeTD1710 in reply to SlowDragon

I have seen results from GP TPO was tested.My result was less than 15 Range was less than 34. On long term PPI for hiatus hernia and GORD. Propranolol is for fast heartbeatCoeliac test normal twice.Not on magnesium Vit D was low.After supplementation is now 100.

SlowDragon profile image
SlowDragonAdministrator in reply to GeorgeTD1710

so you need to get BOTH thyroid antibodies tested privately via Medichecks or Blue horizon

When supplementing vitamin D we also need to supplement magnesium

This is ESPECIALLY important if on propranolol as it lowers magnesium

And especially if on PPI as PPI lowers magnesium too

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Great article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

2 good videos on magnesium

healthunlocked.com/thyroidu...

SlowDragon profile image
SlowDragonAdministrator

on propranolol your TSH is unlikely to respond correctly

Suggest you discuss with GP options for a different beta blocker that won’t affect thyroid levels

Many GP’s (and endocrinologists) unaware just how significantly propranolol affects thyroid levels

I was stuck on propranolol 20 years …more on my profile

Not one of 6 endocrinologists I saw over that time realised just how badly it was reducing thyroid hormones

GeorgeTD1710 profile image
GeorgeTD1710 in reply to SlowDragon

thank you.Would my TSH level cause my symptoms zyou have stated not to supplement iron without an iron panel.Does my iron panel look ok?

SlowDragon profile image
SlowDragonAdministrator in reply to GeorgeTD1710

will ping SeasideSusie and humanbean to comment on iron results

What were iron levels before starting on iron supplements

What are you currently taking

When were iron levels last tested

greygoose profile image
greygoose in reply to GeorgeTD1710

Would my TSH level cause my symptoms

No, TSH does not cause symptoms whether it's high or low. Hyper/hypo symptoms are caused by the level of the T3, and to a lesser extent by T4. :)

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

Going off my results do you think my symptoms are thyroid related?

greygoose profile image
greygoose in reply to GeorgeTD1710

They could be. Symptoms are such a personal thing, and don't always correspond to the levels of thyroid hormone in the blood. You're not obviously hypo, because your FT4 and FT3 are euthyroid - i.e. no thyroid problems - but your TSH is too high suggesting that your thyroid is having to work harder to make that euthyroid amount of hormone.

Trouble is that although your TSH if higher than what is strictly 'normal' (euthyroid), a doctor will just see that it's still in-range and therefore say you don't have a problem. Their understanding ot the thyroid and how it works is very limited.

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

All this started after having a ct with contrast dye.Dont feel good at all

greygoose profile image
greygoose in reply to GeorgeTD1710

Were you ever tested for thyroid before the CT with contrast?

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

Had w cts with contrast 1st 1 in April Thyroid TAH was 3.2 in July 8am test then 28th August TSH was 1.6 12.10pm bloods then 5th Sept TSH 8am draw TSH 3 54

greygoose profile image
greygoose in reply to GeorgeTD1710

OK, so you don't know what your TSH was before April. Could have been high, then, but the contrast die exacerbated symptoms. Thyroid problems do not come on over-night. They simmer away in the background until they become noticable. Something like that can make things worse, but doubt it was the cause.

In August the TSH was lower because it was tested at the time it was at its lowest point. Bound to be higher at 8 am. :)

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

Any idea where i go from here Symptoms are worsening.Must admit I dont fully understand what my levels mean,what further tests to ask for etc.Sat in A&E now feel so rotten Constantly burning up with no temprature sweatinv profusely.Throat at the front feels enlarged burning tongue its awful

greygoose profile image
greygoose in reply to GeorgeTD1710

Well, let's put it like this:

Someone with no thyroid problems would have a TSH of around 1, never over 2 (which means thyroid is struggling) and when it reaches 3, you're hypo. Strictly speaking. But, doctors are going to say well, your FT4 and FT3 (thyroid hormones) are 'normal'. Yes, they are. But, only because your TSH is extra high.

TSH - Thyroid Stimulating Hormone - is a pituitary hormone. When the pituitary senses that there's not enough thyroid hormone in the blood, it produces more TSH to stimulate the thyroid to make more thyroid hormone. Which is what is happening to you at the moment. But, it means that both your thyroid - which appears to be failing for some reason - and your pituitary are working extra hard to get those levels of thyroid hormone. That can't go on forever.

Your thyroid could very well be swollen - which would suggest some sort of infection, or Hashi's. As your TPO antibodies are negative - although you cannot rule out Hashi's on the basis of one negative antibody test, because antibodies fluctuate all the time - ask for an ultrasound of your thyroid. If you have Hashi's, and that damage is visible, that will get you a diagnosis and probably treatment.

And, don't turn down your GP's offer of putting you on thyroid hormone replacement on the grounds that you don't want to take 'medication' if it's not your thyroid. The odds are that it is your thyroid. And it's not 'medication' in the normal sense of that word. It's thyroid hormone replacement. And, if you ever get the proof that it isn't your thyroid - although I don't know how you would - you can always stop it, and your thyroid will go back to being it is right now. Which isn't great, right? Just one thing, though, when she says 'a low dose', it mustn't be too low, because that could make things worse rather than better, and muddy the waters. It must be at least 50 mcg. And, you need to give it at least a couple of months trial - possibly with an increase in dose. But give it a go. After all, you've got nothing to lose except your symptoms.

You say above: Gp is checking my DHEA , Testosterone and homocysteine levels.Any idea what these will show? Checking DHEA is to see how well your adrenals are coping - she should add cortisol to that list. Homocysteine, as far as I know, is a test for Pernicisou Anemia - when the body can't hold on to B12, because some of your symptoms sound like low B12. Have you had your B12 tested? Not sure why she's testing testosterone, though.

So, you're taking PPIs. Well, they're probably not doing you much good. But, PPIs appear to be one of the go-to drugs that all doctors prescribe at the drop of a hat. My ex had a haitus hernia in the days before PPIs were invented, and he just took... can't remember what it was called, but something like milk of magnesia, and it cleared up. Is that all they'er doing for your haitus hernia? What is GORD? Has anybody actually tested your stomach acid level? Symptoms of low stomach acid are the same as for high stomach acid, but nobody bothers to check. They just prescribe PPIs.

Low B12 can cause burning tongue. So can low iron and folate. PPIs will eventually lead to low nutrient levels. And, if you're hypo - which you almost certainly are - you will have already had low stomach acid. Which will cause low B12, which will cause low stomach acid, and round and round you go.

So, what other tests can you ask for: Well, SD has already mention Thyroglobulin Antibodies. And I added cortsil above - which should be done between 8 and 9 am, by the way. And, B12, folate, zinc and copper. And, ask if someone can check your stomach acid level.

Oh! Just remembered, my ex took Gaviston! lol

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

GORD is oesophgeal reflux disease.

Thanks for the advice see if they do any sort of scan.Its really hurting.

Im losing weight not gaining weight and feel hot anx clammy.I thought i had hyper is it hypo i have?

GeorgeTD1710 profile image
GeorgeTD1710 in reply to GeorgeTD1710

I have a fatty kiver and dont like taking meds that will eaise my LFTs.Dr said thyroid meds could affect my liver

greygoose profile image
greygoose in reply to GeorgeTD1710

Just because a doctor said it, doesn't mean it's true. Lots of hypos have fatty livers but they still have to take thyroid hormone replacement or they will die.

The 'meds' given for hypothyroidism are not drugs. They are hormones, just like the hormones your thyroid makes, exactly the same. They will not affect your liver any more than the hormones your thyroid makes.

At least, I assume you're talking about thyroid hormone replacement? Or did your doctor also think you were hyper, and was talking about anti-thyroid drugs? I'm a bit confused, now. :)

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

me too I could die???

greygoose profile image
greygoose in reply to GeorgeTD1710

Not immediatley, no. :) At the moment, you have so-called normal levels of thyroid hormone, thanks to the dedication of your pituitary and your thyroid.

But, imagine someone who has had their thyroid removed for some reason. They have no means of making thyroid hormone in their body. If they don't take thyroid hormone replacement, they will become more and more hypo until they go into myxodeama coma and die.

That's an extreme example, but the point is, you need thyroid hormones to live and be well, because every single cell in your body needs thyroid hormone to function correctly.

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

sorry for confusion i thouggt i was hyper Me trying to get my head around it.Still sat in A&E after 6 hours feeling worse Am concerned they will send me home especially after tge dying bit Im finding it all a bit of a minefield tbh

greygoose profile image
greygoose in reply to GeorgeTD1710

6 hours! Poor you! I don't think I would have the patience to wait that long. Think I would have gone home after two.

Thyroid things can seem very complicated at first. It is a complicated disease. But, most of us learn pretty quickly from reading on here. :)

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

youve been great thank you.Lets hope i get my throat checked dont know how in A&E they will do that dont think they have US machine

greygoose profile image
greygoose in reply to GeorgeTD1710

No, well, ask your GP for an ultrasound. S/he can arrange it.

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

would it show up on a CT scan ?

greygoose profile image
greygoose in reply to GeorgeTD1710

The damage done to the thyroid by Hashi's will show up on an ultrasound once it reaches a certain stage. Not in the begining, but eventually it will.

greygoose profile image
greygoose in reply to GeorgeTD1710

With a TSH over 3, it's hypothyroidism. Hyperthyroidism would have a suppressed TSH and FT4/3 very high over-range.

Losing weight can be a hypo symptom too. Not all hypos gain weight.

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

awe thanks.Do you get hot with hypo then get cold sweats.

B12 i have injections.Active B12 was 112 3 weeks ago.Intristic factor negative,FBC compketely normal.Dr ordered homocysteine test.If my iron/Ferritin lower end of normal will the thyroid meds still work?

greygoose profile image
greygoose in reply to GeorgeTD1710

You used to be hot all the time. Windows wide open even with snow on the ground. But, these days, I'm more cold than anything. Never have had cold sweats, though.

OK, so B12 is covered. How about folate? Do you take a good B complex daily as well as your B12 injections?

Having low iron/ferritin could very well affect your conversion of T4 - which is what you would be taking - to T3. But, you'll only know that once you start taking T4 (levo).

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

folate was low at 3.9 supplemented now 18.9

Just had bloods done.but dont know if at this time of night it will show up normal or high.Shes done FBC aswell

greygoose profile image
greygoose in reply to GeorgeTD1710

If they tested TSH, it will be high at midnight.

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

really ? Fingers crossed they are high.

Explains why ive been feeling crappy at night

greygoose profile image
greygoose in reply to GeorgeTD1710

No, it doesn't explain why you feel crappy at night because it's not the TSH that causes symptoms. It's low FT3. T3 levels don't change that much throughout the day whereas TSH does.

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

After 12 hours in A&E my Tsh was 3.4 and TSH4 19.5 was told was not my thyroid nor aas it enlarged.Apparantley with a TSH of 3 2 i would not have any symptoms.My TSH would be alot higher for thyroid symptoms to manifest.3 docs all with different opinions !!!!! Puzzled now

greygoose profile image
greygoose in reply to GeorgeTD1710

Yes, well, that's just rubbish. As I said before, it's not the TSH itself that causes symptoms. It's low T3 that causes hypo symptoms. And, as they didn't even bother to test that, how could they possibly know?!? TSH can be reasonable even when the FT3 is low.

On here we see all sorts of levels of TSH that - by doctors' standards - don't correspond to their symptoms. Someone with a TSH of 100 can be symptomless, whilst someone else with a TSH of 2 can have raging hypo symptoms. I'm afraid doctors are totally out of touch with the realities of thyroid disease, especially in A&E, because it's rarely hypothyroidism that takes patients there. So, whatever they said to you, don't take it as gospel, because they just don't know.

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

Got told at first it was a viral infection.Told him that was rubbish.Spoke to the boss she referred me to ENT clinic for sore throat.Guess i will just have to feel rubbish til i get this sorted

greygoose profile image
greygoose in reply to GeorgeTD1710

In my experience, ENT don't have much of a clue about thyroid and the symptoms. I had so many thyroid throat symptoms, and ENT told me there was absolutely nothing wrong with me! They didn't seem aware that the thyroid is right next door! And that, if it's swollen, that will affect the throat. Utterly useless.

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

if you dont mind me asking what symptoms did you have?

greygoose profile image
greygoose in reply to GeorgeTD1710

With my throat? Oh, sore throat, the impression of a lump in my throat, trouble swallowing, a persistant cough eminating from the throat rather than the lungs, loss of voice whilst talking, voice deepening, loss of my singing voice... There was obviously something not quite right and yet they ignored it all!

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

they did to me last night.Im going to wait for my blood test results then think im going to have to pay to see an endocrinologist Cant see any other way

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

can i ask a question? As i take propranolo 10mg 3x daily would this affect TSH. Could it be the medication rather than my thyroid.GP unsure if its my thyroid or menopause???

greygoose profile image
greygoose in reply to GeorgeTD1710

Indirectly the propranolo could raise TSH in that it affects conversion of T4 to T3. It would not have any direct effect on TSH, I don't think. And, you do not appear to have a conversion problem, going by results we've already seen. But interesting to see your next results, but, I think that's rather grasping at straws.

Has anybody tested your sex hormones? That will give you a clue as to whether your symptoms could be due to menopause. And, some of your symptoms could be due to menopause, of course. But, why does it have to be all one or the other? Has it never occurred to dear doctor that it could be a combination of the two? Or is that too complicated for their tiny brain? :)

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

I am talking to a different doctor on Wednesday so see what happens.Referral to Endo seems to be taking forever.My hubbie is reluctant to pay private due to the cost but im afraid of getting sicker in the meantime.Feel like its a viscous circle

greygoose profile image
greygoose in reply to GeorgeTD1710

Bit of a gamble, anyway, paying to see a private endo. In the main, they're just as ignorant as NHS endos, because they have the same training - or lack of it. It's just if you happen to find one that takes a special interest in thyroid. And, there aren't many of them!

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

ive booked to see private Endo.There are only 2 in Liverpool.This guys a professor.My GP was supposed to refer me 2 months ago to NHS but hasnt done it as per.Getting my eyes tested today to see if reason for blurred vision Cisting a fortune but have to keep chipping away at it

greygoose profile image
greygoose in reply to GeorgeTD1710

Well, good luck with the professor. Let us know how you get on. :)

GeorgeTD1710 profile image
GeorgeTD1710 in reply to greygoose

Thank you so much for your advice so appreciated Will post after consultation.Im hoping my blood test results are back by then of DHEA etc.x

greygoose profile image
greygoose in reply to GeorgeTD1710

You're very welcome. :)

SeasideSusie profile image
SeasideSusieAdministrator in reply to GeorgeTD1710

GeorgeTD1710

Ferritin level was 65 range (13-150)

Iron panel iron 12.3 range 5.8-34.5

Tranferrin 2.48 range (2-3.6)

TIBC 62 range 50-90

%trans.saturation 20% range 16-40

FBC all normal

The fact that your FBC is all normal suggests that you don't have anaemia.

When discussing iron results we tend to refer to optimal levels as suggested by rt3-adrenals.org/Iron_test_... which are:

Serum iron: 55 to 70% of the range, higher end for men - yours is 22.65% through range so on the low side

Saturation: optimal is 35 to 45%, higher end for men - yours is 20% so on the low side

Total Iron Binding Capacity (TIBC) or Transferrin: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - your TIBC is 30% through range and Transferrin is also 30% through range so at the lower end

Ferritin: Low level virtually always indicates need for iron supplementation; High level with low serum iron/low saturation indicates inflammation or infection.

Did you have an inflammation marker, eg CRP, tested at the same time. Ferritin can be raised when inflammation is present so if you had raised CRP then your actual normal ferritin level would be lower than measured.

As quite often happens you have a mixed bag, your serum iron and saturation are on the lowish side which suggests you need a bit more iron but your TIBC and Transferrin indicates you do not need more iron.

If we look at labtestsonline.org.uk/tests... they have the following table and the only thing that seems to fit with your results is "chronic illness" assuming that your ferritin result is reliable.

Iron is complicated and I have no medical training, I cannot suggest whether or not you should supplement with iron, if your serum iron, saturation and ferritin were dire it would be more obvious.

Iron studies
GeorgeTD1710 profile image
GeorgeTD1710 in reply to SeasideSusie

crp has been steady at either 2 or 3

GeorgeTD1710 profile image
GeorgeTD1710 in reply to SeasideSusie

chronic illness doesnt sound good.

SeasideSusie profile image
SeasideSusieAdministrator in reply to GeorgeTD1710

Chronic illness basically means long term, eg diabetes, arthritis, hypothyroidism.

As for CRP, the lower the better. No inflammation would probably close to zero, probably always below 1. I have lung disease and my CRP is never that low, when I'm fairly stable it's probably 2-3 but if I have an exacerbation it can be 6 or 7.

GeorgeTD1710 profile image
GeorgeTD1710 in reply to SeasideSusie

oh i see My CRP used to always be between 6 and 8 then i lost over 7 stone and its dropped to 1-3.

On a diagnostic path i guess.Had everything checked.They simply dont know what it is.Got chronic stomach and bowel issues and my calprotectin is raised dont know why as no IBD.Just feel rotten all the time.Had loads of blood tests.FBC compketely normal.I havd had a weakly positive ANA saw a rheumatologist lupus etc all ruled out.Its a mystery

GeorgeTD1710 profile image
GeorgeTD1710

not taking anything for iron.iron and ferritin last tested 2-3 weeks ago

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