I am a 64 year old otherwise healthy man seeking to rule out a possible hypothyroid issue.
While my test results are within classic parameters (may even be enviable to many on this forum), and I take no meds, I do have thyroid signs and symptoms (elevated cholesterol, elevated creatinine, elevated bilirubin, bradycardia, low BP, hair loss, Hertoghe's sign, low mood, withdrawal, digestive problems, anxiety, dry skin, parathesia, elevated RDW, low platelets etc.).
But most of all I have lone paroxysmal atrial fibrillation. Which is to say I have suffered bouts of irregularly irregular rapid heartbeat on and off for no good reason for at least 14 years, but I have nothing wrong with my heart otherwise (bar some LA dilatation - cause and effect).
Here are my latest entirely 'normal' results. It was a Medichecks fasting 8.30am finger-prick test and I had ceased all vitamins for at least a week prior:
Last time I had a TDL test in February (also morning, fasting) my TSH was 0.8 and my FT4 and FT3 16.7 and 4.0 respectively. And this relative relationship has been typical over the past dozen years.
I was found to have low B12 last year (129 197-771 ng/L) which was not due to diet but probably malabsorption and which I raised easily with oral methylcobalamin. This may still have left a mark in folate which is below the middle of the range. And digestive issues persist. I am using betaine to combat likely homocysteine accumulation.
But the principal area of thyroid suspicion is only consistently upper range fT4 and flagging fT3. Which may intimate poor conversion.
I am active and on no special diet, but it is full and healthy, and I have been supplementing with e.g. selenium and zinc, B vitamins etc.. It is conceivable I have suffered chronic stress but I have not had cortisol tested. And I do have hyprbilirubinemia (Gilbert's) which at least intimates liver detox issues, that would exacerbate gut dysbiosis in conversion along lines e.g. described here: drhagmeyer.com/the-causes-b...
What do you think? might my problem be in my mitochondria, or just plain hypochondria?
I am almost tempted to give a modest dose of T3 a trial to see if it helps. But it seems prudent to try to correct other potential e.g. gut issues first, to the extent there is not a chicken and egg issue.
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Yes, it's a good thought. There are almost too many moving parts. But it might explain a lot. Last time I had testosterone tested was 2018 and it was better than two-thirds through the range, but not especially out of kilter (19.9 6.7-25.7nmol/L).
Thyroid levels do rather look 'perfect'. But especially given the raised homocysteine, parathesia, elevated RDW, this sounds a lot like pernicious anemia (PA) / b12 deficiency. It would also explain the gut problems & most of your other issues. For some of us, B12 tablets raise our serum levels but are in fact ineffective at addressing symptoms, resulting in progressive worsening.
Are you vegan/vegetarian or do you take PPIs or metformin? Those can all lower B12. Have you ever tested intrinsic factor antibodies? Have relatives with PA/b12D or have gotten b12 or "red" shots in the past? PA tends to run in families.
You might consider posting on the PA group healthunlocked.com/pasoc it's late here now and i'm unable type out a longer reply.
I'm very grateful for your thoughts. Food for thought! I have browsed the PA site. And the next step is to see whether I can put a finger on any gut issues, as you say. I am not avoiding any foods presently nor have I had B12 shots. But I do just seem to be low on stomach acid. And the question is whether this is just age or whether there is more to it. And what's the direction of causation. No PPIs or Metformin. But funnily enough I did have long remission from AF following a few rounds of antibiotics for a UTI. The gut bacterial (H Pylori) basis for AF seems to have been discredited (unlike that for gastritis and ulcers) but that doesn't mean there's not some link. It's all a bit protean. But hypothyroidism, with or without Hashimotos (which is not my problem) will affect stomach acid and vitamin absorption, and probably vice versa. So, the principal smoking gun was getting so low in B12 when I really shouldn't have. I shall investigate possible food sensitivities or genetic issues, like MTHFR, which is key in methylation to combat Hcy. Meantime, I'm using Betaine HCL and pepsin to reboot digestion.
Note that pernicious anemia is also strongly linked to low stomach through autoimmune destruction of the parietal cells that make stomach acid. There is another test call anti gastric parietal cell antibody you might look into.
There is also a lot of misinformation out there about MTHFR so do beware. Not everyone that has the mutations needs methylfolate or methylb12 and may actually react badly to them. High homocysteine is linked to low b12 & low folate in general, and not so much the lack of the methylated forms.
I'm just mentioning all this to potentially save you going down the wrong path and ending up worse than where you started. Believe me, i've already been down your exact path - working on gut, chasing borderline labs, plenty of supplements, trying many different natural remedies, anti candida stuff, 23andme genetic testing, promethease etc, and only wisened up one day when i woke up with total numbness in both arms. Not once had I come across pernicious anemia in all my reading. I'm not saying all this to discount what you're doing, but to highlight an oft-missed, oft-misdiagnosed, and highly misunderstood disease. So apologies if i'm coming off a bit militant, but i've lost several decades of my life to this disease and i always wish just *one* person had insisted I at least investigate the possibility. I'm also writing this for lurkers out there reading posts trying to figure out their own issues.
Anyway all that said, betaine hcl & pepsin are good. Some use apple cider vinegar. I eventually switched to lime juice because betaine wasn't effective for me anymore.
Food sensitivities are another good avenue to investigate. Many here do well with going gluten free even if they don't get diagnosed with celiac.
All excellent advice and much appreciated. And, don't apologise, a little militancy is understandable, and very apposite. As the prevailing medical mentality is not one of enough screening, curiosity and diagnosis. It is, perforce, about waiting until things are serious. Which only ensures most everything will become so. We have clearly been moving down many parallel paths. Another wild-card in the mix for me is elevated bilirubin. It's one more of those GP blind-spots to which forums like this are necessarily devoted. Because it is routinely discounted as of no clinical significance.
But then, before I was diagnosed with lone PAF in 2009 (which clinicians DO get excited about), there wasn't much else of clinical significance about me either. So, GS may be significant after all. Because the truth seems to be that Gilbert's (hyperbilirubinemia) connotes problems with glucoronidation and phase II detox in the liver, which is where a lot of T3 is produced. So, a slow liver, with or without any added methylation impediment, and advancing age etc., might account for poor conversion to T3 (gilbertssyndrome.com/hypoth....
And this would only be compounded by any subclinical issues with the necessary cortisol to make that work, or any element of adrenal insufficiency. Of course, before thyroid testing came to define hypothyroidism, elevated cholesterol alone was taken as an intimation of it. The 'fingerprint' of all my blood tests for over 30 years has been above range bilirubin, cholesterol, creatinine, RDW and below range platelets. But all that a patient's raised cholesterol induces in a GP now is a Pavlovian statin scrip.
However, to your point about PA, I think my raised RDW may have caused one doc straight out of med school to suggest that B12 test last year. Unfortunately, GPs don't have time to do more than 'treat the test'. Nor money to follow through with MMA and Hcy testing. Whereas, discounting any possible lack of intrinsic factor, it may be just that latent hypothyroidism from Gilbert's is behind my digestion/absorption issues too. As well as that classic loss of the outer third of my eyebrows, non-male pattern hairloss, slow resting heartrate (in NSR), vagal triggers for AF and other familiar detriment which, like you, I am keen to understand and nip in the bud.
Years ago, again like you, it was the peripheral neuropathy that I first noticed. On long drives my arms and fingers would just go numb and I would have to shake them back to life. So, mercury was also another avenue of concern, as for any of my generation (drilled, filled and billed), which I have looked into extensively. It is hard to rule out!
And, of course, fluorine ought to be a red-flag to anyone with hypothyroidism - it has no proper place in the human body (which is why so many medicines incorporate it!). F is omnipresent but will eliminate iodine, by halogen substitution, which we all need. It is said that fluoride was put in prison camp drinking water to keep inmates docile.
I always start the day with a pot of hot water with half a lime squeezed in it. And, yes, looking into 23and Me was next on my list, along with testing for food sensitivities. I just wanted to see what people thought of my thyroid results to see if there may be a 'smoking gun' I had not thought of. There are of course reservations both about genetic testing and testing for sensitivities. And I take your point about MTHFR. These new things are the basis for quack industries among clienteles not well-served by mainstream medicine. A sensitivity need not be an allergy, just an 'acquaintance'.
And, as you also say, like many I have flirted with gluten-free diets etc.. But the trouble is often by the time the diet has been in force for a spell it becomes hard to recall exactly what it was like before! And there are just too many moving parts. So, my low B12 test (who knew?) last year was a wake-up call NOT to speculate but TEST. And with that in mind I am keen to check for other meaningful SNPs and gut probs. But also very tempted to cut to the chase and just see if a trial of low dose T3 helps.
All very well said! There's not much more I can add, sounds like you are on top of things I don't know anything about Gilbert's / liver issues, so can only send best wishes! After reading through other people's replies, perhaps indeed there is a thyroid issue. Good luck!
To be honest, your detailed post indicates youre "switched on" including careful with diet etc. But have you considered seeing a naturopathic practitioner? Your significant test results should give you a head start and minimise costs.
If subclinical hypo, it has been reported elsewhere that a natural approach can help.
PS seeing a medic would likely result in numerous drugs prescribed, as I think you know.
It is a good thought, for which I'm grateful. Of course, the problem is that something like AF pops above the parapet and gets GP's attention, engaging some pretty uncongenial, heavy duty, stereotypical and unjoined-up solutions. Whereas, the basic cause, as you intimate, can be, if not simple, then at least rather banal. So, a naturalpath might help, or a more than usually open-minded doc. I have used Dr Myhill in the past and she has been most helpful. It is her tragedy to have been so helpful and sensible as to get 'drummed out of the Brownies'! I shall continue my own researches too, because there is a lot to grasp. I just wanted to make sure the whole thing wasn't down to covert hypothyroid, making my whole system run slow. My resting heartrate is 38bpm. And while I am fit and have done endurance exercise I am not Usain Bolt. Whereas, I would as soon avoid another ablation, which is the medical way of dealing with AF. Equivalent to dealing with a house-fire by knocking off that irritating alarm!
Your thyroid results don't look enviable, I would say you are leaning towards subclinical hypothyroidism with a TSH level of 2.5. A euthyroid person will typically have a TSH of 1–1.5. Your T3 level explains your hypo symptoms too, I felt terrible even with a T3 level of 5.2, let alone 4.3. Maybe try to get a thyroid ultrasound to see if you have nodules since your antibodies don't look elevated.
Thank you. You're right, SCH gets ignored. I could barely function with a TSH of 4–6 but they claim you don't need to be medicated until it reaches 10. I think it's to save on costs.
Ah, very useful observations! I thought it was significant too that, whilst my TSH has gone from 0.8 to 2.5 on two recent tests, my fT4 has gone up some but my fT3 barely budged. Making for a fairly adverse conversion ratio. And, over 14 years, the one thing most medics measure (TSH) has invariably bounced around outside the 'typical' zone, one way or another. Almost like the 'tail' is wagging the dog. Nodules are a new thought to me and easily checked. So, I am grateful for that. Especially as on some accounts half the population may have them by age 60.
I think Zazbag could be correct. I have had the luxury of seeing my medical notes from twenty years ago. Subclinical definitely does not get the attention it deserves and it can take many years of knowing something is wrong before your ‘levels’ reach a point where you might be medicated. However, you have been given good info about PA which you should follow up on too.
Yes, subclinical hypothyroid has been my thought for years, which is why I am on the forum again now. Because (to the extent they look at blood tests at all!) Cardios rule out known diabetes and thyroid causes of AF a little too casually (the usual range fixation). Whereas, lone atrial fibrillation is a diagnosis of exclusion. Something must cause it. But its other name is 'idiopathic'. Which is ancient Greek and medic-speak for 'search me, it is all a bit too hard'.
Besides which, I have other signs and symptoms of things working a bit too slowly. T3 is front and centre there. And I have also followed with some concern the scandal of thyroid under and erroneous diagnosis in this country, and particularly the iniquity of first T3 pricing and then the NHS gambit to cut out the cost by cutting out the diagnosis. It's insane. But then the NHS is about achieving a blanket one-size clearing solution to a national cost/death minimisation problem, in which benefit to any individual patient is increasingly coincidental.
And it is increasingly being governed by the sorts of evidential algorithms and flowcharts which first insisted on anticoagulants for me at the drop of a hat, then wouldn't give me anticoagulants even on a PIP basis for love nor money until I had a TIA. And now that I have had a TIA (!) glibly insist on them again all the time, whether I'm in AF or not...
So, forums like this at least afford the opportunity to inform people and possibly deal with things while they are still subclinical and do not intrude on medical consciousness. Because too often, once you pass through the 'good news, Sir, it's serious' phase, to a child with a hammer everything is a nail.
Such a good post.... How are you getting on? Did you opt for the food intolerance testing, diet change to optimise conversion route or the rather more reckless... lets just try some T3 option ?
With such an incredibly low RHR I could well imagine your heart needs a little jig once in a while! What temperature do you tick over at?
No, afraid not. I'm still hesitating at the hurdle over testing, for all the reasons we've discussed. I'm all for testing to know things for sure. Don't get me wrong. But there is a danger of a sort of post hoc ergo propter hoc fallacy. Like thinking it is the uptick in consumer spending in early December which causes Christmas. Tricky business sorting out what we may just have come across previously from what is really causing a problem. I'm toying with hair analysis too. And hesitating for similar reasons.
I was all set on optimising all the prerequisites for sound thyroid function, before experimenting with T3. When it occurred to me that some of my issues were more to do with adrenal function, and I should deal with that first. It is easy to credit that stress on our adrenals may have a lot to answer for in detracting from sound thyroid function.
So, that is where I am. Optimising nutrition and vitamins and trialling ACE, or rather whole adrenal gland extract.
Like you, I have thought about cortisol testing, but there is a widespread feeling, as I remarked elsewhere , that it is not so easy and may be better evaluated through a reading of symptoms. And, yes, temperature testing. On that front I suppose it's no surprise that I used to consistently check in at least a degree under par on the old mercury clinical thermometer. I'm just putting some readings together, post ACE. Freezing weather hasn't helped!
With everything going slow (as a former recreational diver, I also have pretty good oxygen endurance), I think it's that 'little jig' that may go some way to explaining why my heart goes giddy-up. Cardios call it an escape rhythm. And one at least has talked about sick sinus syndrome (no doubt nursing notions of an interesting little pacemaker op...). But I have not given up trying to find other explanations, before the inevitable repeat ablation.
Many thanks for the link. Food for thought. It is more common for AF to be caused by hyper than hypo thyroidism, but my AF is more vagal than adrenergic (an episode is more likely after a meal, lying down, or straining at something, than running around). And, I guess it is trying to tell me something. So, I'm investing a spell trying to figure our what. Before I submit to another shot at just knocking the damn alarm off.
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I don't know anything about Gilbert's / liver issues, so can only send best wishes! After reading through other people's replies, perhaps indeed there is a thyroid issue. Good luck!
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