What do you think about these results

[Needleandthread44]

Tsh 2.44

T4 10.9

Not on any levo / not diagnosed

[PurpleNails Administrator]

please add range

Was this Free T4

what was time of test.

Was this GP or private test

[Needleandthread44 in reply to PurpleNails]

So it's a friend of mine who had it done through her GP, 9am test. Gp said results were normal but that T4 looks low to me?

Tsh 2.45 ( 0.27 - 4.20)

T4 10.9 (12 - 20)

[SeasideSusie Remembering in reply to Needleandthread44]

Needleandthread44

Is this their first test? If so it will probably need repeating to confirm the findings.

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 their GP hasn't come across it before.

The 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/...

Your friend could do some more research, print out anything that may help and show your GP.

They may need to be referred to an endocrinologist. If so then please tell them to make absolutely sure that it is a thyroid specialist that they 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 they can get to. Or your friend can join the forum themselves.

Then if the GP refers them, 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 the area they live which you'll have to mention of course.

[PurpleNails Administrator in reply to Needleandthread44]

yes it’s low, it’s under range.

Does your friend have symptoms?

Your friend needs another test. GP likely won’t repeat for 2-3 months, as NHS say 2 abnormal test a few months apart.

I would be arranging a test with FT3 & thyroid antibodies & nutrients in mean time.

How can GP say normal?

Doctor may be one of those who operates on assumption that unless TSH over 10 they don’t need to look any further. Can your friend see another GP?

[Hedgeree in reply to PurpleNails]

I know from my own experience of having a below range FT4 over many months and the gp being unwilling to treat. It is a difficult situation to be in also made worse when you are symptomatic and feel very unwell.

[PurpleNails Administrator in reply to Hedgeree]

terrible

How does doctor justify leaving low FT4 untreated?

[Hedgeree in reply to PurpleNails]

Hi PurpleNails,

The gp had continued to say I didn't have a thyroid problem and put my symptoms down to anxiety. But I persevered.

It took two years and a few polite letters to the surgery to get a referral to an NHS endo. I was found to have a suspicious nodule and am now six weeks post partial thyroidectomy and on levo. Looking forward to feeling well.

[SlowDragon Administrator]

suggest she gets FULL thyroid and vitamin testing done

Privately if GP won’t

What’s her diet like

Vegetarian? Vegan?

Food intolerances?

Is she currently taking any vitamin supplements, if so what

all thyroid blood tests early morning, ideally just before 9am

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...