Potential secondary hypothyroidism - anything specific to ask the Dr/push for?

[QSLawrence]

I've had on-going symptoms for year (anxiety, palpitations, extreme fatigue, brittle nails, heavy periods, slow weight gain) and every time I have had blood tests I've had sub-normal TSH and low-ish but within range T4 which has been written off my the doctors as 'not what we expect, so we won't treat'. Over the last few months the symptoms have become unbearable so I've returned to the doctors to get it bottomed out once and for all. I had my bloods last week and have the following results:

Serum TSH: 0.21 mui/L (0.3-5.5)

Free T4: 13.1 pmol/L (12 - 22)

Free T3: 4.4 pmol/L (3.1-6.8)

and the following abnormal results:

Serum cholesterol: 7.4 mmol/L (no range given but note to say refer for investigation and management)

Serum HDL: 1.93 mmol/L (1.17 - 1.81)

Serum non high density lipoprotein cholesterol level 5.47 mml/L (no range given but note to say refer for investigation and management)

eGFR using cretinine (CKD-EPI) 83 mL/min/1.73m2 (eGFR 60-89 with a note of CKD stage G2 of other evidence of kidney damage)

Serum folate 3.7ug/L (3.8-26.8)

My thyroid result was similar to the past few years and somewhat expected but the high cholesterol and reduced kidney function were a surprise. Does this look like it might be secondary hypothyroidism and should I be pushing for an endocrinology referral? And could the high cholesterol and reduced kidney function be a result of my thyroid function, and will it improve if I am given medication?

I'm 43 years old, don't drink or smoke, and I'm not over weight but am at the higher end of my normal BMI.

I appreciate I could be barking up the wrong tree here so apologies I've I'm seeing things that aren't there.

[tattybogle]

yes .. you are on the right track about raised cholesterol being a result of hypothyroidism . ( and that correcting the hypothyroidism should reduce it ... the NHS do have a comment to this effect in their guidelines somewhere ~ i'll add it later if i find it )

There is lots of very useful information on pushing for central hypo diagnosis and treatment in some replies about half way down this post (and also , further on towards the bottom a link to a full copy of an excellent letter sent to the head of the endocinology dept that got the required result .

healthunlocked.com/thyroidu...

Click on this post and go down it to find all the replies written by "UKmale_ hypo"

The reply that has the link to his full letter starts "can you see this ? dropbox.com/s "

[QSLawrence in reply to tattybogle]

Thank you SO MUCH for your reply. I’ve read through the thread and will definitely use the letter if needed. I’m aiming to go into my appointment prepared and hopefully they’ll refer me.

[Zazbag]

Looks very much like secondary hypothyroidism to me. I would push for endocrinology referral!

[QSLawrence]

Stage 1 done! I had a follow up appointment with my GP and he brought up that potentially it’s my pituitary gland causing the issue and has referred me to an endocrinologist - I didn’t have quite the battle I thought I was going to . Actually he was refreshingly open and I really felt he listened to my concerns. I’m going to try and get it on my private health insurance as I suspect the wait for NHS would be rather long currently.

One thing he did flag though was that when the previous GP contacted the NHS endocrinologist, they advised it sounded like sub clinical hyperthyroidism rather than central hypothyroidism. Does this sound likely? It’s not really something I’ve come across in my research.

And another thank you for all those who answer; it’s been years I’ve been doubting my symptoms and bloods and even knowing that there are people out there who understand is a great comfort.

[tattybogle in reply to QSLawrence]

Hi again QSLawrence .....Glad 'stage one' was painfree

Serum TSH: 0.21 mui/L (0.3-5.5)

Free T4: 13.1 pmol/L (12 - 22)

Free T3: 4.4 pmol/L (3.1-6.8)

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"One thing he did flag though was that when the previous GP contacted the NHS endocrinologist, they advised it sounded like sub clinical hyperthyroidism rather than central hypothyroidism. Does this sound likely ? "

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

'sub-clinical hyperthyroidism ' ~ this means "TSH is under range, while fT4 /fT3 are high but still within range"

Was the endo that said that looking at these result .. or some other ones ?

If they ONLY had a TSH test ... (didn't have any FT4 result to look at) ... then central hypo can easily be mistaken for subclinical hyper ...... because both have a TSH that is below range ...... (but if a GP sent JUST a TSH result to an endo to ask for an opinion ~ then the GP is an idiot and the endo would hopefully tell him so ).

If they had a TSH test AND an fT4 test to look at , and they were like those above, (where the fT4 is plainly low end , NOT high end) ...... then it is patently obvious that it is not subclinical hyper (due to the low fT4 ) , and is potentially central hypo, ..... (and if an endo advised it was probably sub clinical hyper ~ then the endo is an idiot )

Does it sound likely ?

once upon a time i would have said noo , don't be silly there must be some misunderstanding somewhere .... but since reading what absolute tripe some of them have told people on here over the last a couple a years , i now think answer is : yes , it does sound likely that the endo was an idiot .

( ok ,... i know that wasn't really the question )