I have an enlarged thyroid & tremor which my GP suspected was Graves’ disease however my results are apparently normal
Serum free T4 level: 15.3 pmol/L (normal range: 11.0 - 21.2)
Serum free T3 level: 4.2 pmol/L (normal range: 3.1 - 6.8)
Serum TSH level: 1.75 mlU/L (normal range: 0.27 - 4.20)
has anyone been diagnosed despite an apparent normal thyroid result?
Welcome to the group.
What time was this test taken? TSH is highest at 9am.
For diagnosis in the UK you need 2 consecutive tests with your TSH over range or one with TSH 10+. At the moment your TSH looks relatively normal although both your FT4 and FT3 are under 50% of their range.
You could ask your GP to test your thyroid antibodies.
Do you have any other symptoms?
thank you for your response - it was 5pm so quite late in the day. I have had an eye twitch for 2 months, an increased appetite with no weight gain, palpitations previously diagnosed as anxiety. I have also been referred for a thyroid ultrasound within the next 3 weeks so hoping that will shed some more light.
Yes 5pm was late. If the restest then book it for as close as poss to 9am as you can and do it fasting. Ask also for thyroid antibodies and key vitamins - ferritin, folate, B12 & D3.
Get back to us once you have the ultrasound results and good luck.
Hi Kellyellen - I think you need to wait for the ultra scan results. In addition to other suggestions as your GP to test your B12 & folate. Tremors can be a sign of b12 deficiency too. Best check everything. Your GP sounds more on the ball than others.... Post back after you get your results.
I’ve just checked and my GP did put down Thyroid antibodies to be checked but I can’t see this on my NHS app. Do you know if it would go by another name as there are quite a few results on the app.
It could be TPO Ab. Not sure which ones the NHS test but pretty sure TPO is one of them. Do you have the vitamin results?
This is what was on the form so I’m not sure the vitamin tests were done - ESR, Full Blood Count (FBC)
ESR, TQH
Bone Profile, Liver Profile, Thyroid Function Tests, Thyroid Antibodies (anti Thyroid Peroxidase), Full Thyroid Function (incl
FT3), Renal Profile (UE incl eGFR)
3, 2, 9, 77, FT3P, 1
Thyroid antibodies take I think a week or so to come back, so if you got the other results today they might not be in yet.
There are other antibodies the NHS doesn;t test called Thyroglobulin antibodies but you would need to test privately for those. They have tested your TPO's by the looks of it though.
There are several different antibodies at play when the thyroid is involved :
You may see initials / words - TPO - Thyroid Peroxidase : TgAB - Thyroglobulin : and both these are generally associated with Hashimoto's auto immune thyroid disease :
and for Graves Disease that is not just thyroid specific the unique antibodies are either expressed as a TR ab - a Thyroid Receptor Blocking or a TSI - a Thyroid Stimulating antibody:
Jaydee, unless things have changed recently, that's not strictly true.
I was offered a trial of Levothyroxine as soon as my TSH breached 5, due to the symptoms I was having. My GP was certain I was hypothyroid, but my TSH lingered sub-5. She rang me, almost jubilant when it went over 5.
Apparently, NICE allow a trial of Levothyroxine in such circumstances.
And the rest is, as they say, history.
I think you have been very lucky with your GP, and sadly many people have to wait for 2 tests above reference range and even a TSH above 10 to begin treatment. Count yourself very lucky indeed.
I did, but then she moved to Lincolnshire!, she was excellent, and really took an interest in all her patients.
Your GP ordered a lot of blood tests. If he/she says thyroid 'normal' given your results then I'd be asking if the other results shed any light on your symptoms. It may not be due to thyroid on this occasion? Keep an open mind and ask plenty of questions. I speak only from personal experience.
the only thing that was under was my red blood but it says no action so I’m guessing no cause for concern
Total white cell count: 6.4 X10^9/L (normal range: 3.9 - 11.1)
Red blood cell (RBC) count: 3.78 ×10^12/L (normal range: 3.88 - 4.99)
Haemoglobin estimation: 119.0 g/L (normal range: 118 - 148)
Haematocrit: 36.2 % (normal range: 36 - 46)
Was Ferritin tested? Your hemoglobin and RBC and hematocrit may indicate iron deficiency anemia.
Yes we can get very focussed can’t we. This is good advice for Lulu2607
Request retest 6-8 weeks after original test
Book test for just before 9am if possible
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Hashimoto’s frequently starts with transient hyperthyroid results and/or symptoms before becoming increasingly hypothyroid
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Or with Graves’ disease too (autoimmune hyperthyroid)
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test
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...
Ideally do private testing early Monday or Tuesday morning.
Watch out for postal strikes
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
Hello Kellyellen and welcome to the forum :
The antibodies unique to Graves Disease are generally expressed as either :-
TR ab - a Thyroid Receptor Blocking antibody or a TSI - a Thyroid Stimulating Immunoglobulin with a range usually detailing a number with either under or over markers :- < :
These results do not look like Graves :
When diagnosed Graves back in 2004 my results with the relevant antibodies were back in around 48 hours as the doctor phoned me at work to return to the surgery where a box of Anti Thyroid medication - Carbimazole - was waiting for me.
Obviously something is going on but I think we can rule out this auto immune disease.
Do you sense the swelling when eating or drinking - is there any pain ?
Just as an update I had my ultrasound and the lump is a large cyst with several other small ones. It has definitely got bigger since I initially went to the GP so I’m quite worried it’ll continue growing . Have to call my GP to get an emergency appointment next week as the one I have booked is a few weeks away.
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