I'm looking for some advice as to potential next steps.
My private blood test indicated TSH of 4.82, followed by an NHS one which came back at 2.5. I've since read on this forum that time of day might affect result. My symptoms match with subclinical hypo, but really I just want to find out why I am so tired. I have never been this exhausted. Initially thought it was depression, but the depression has since lifted and the other symptoms remained. Suffering from tiredness, aching, irregular periods, carpal tunnel, coldness, bloating, constipation, headaches & dizziness.
I can't upload all of the blood tests on to health unlocked so have put them on an image upload site.(admin, pls let me know if not allowed)
Any advice appreciated as to next steps. I'm not sure my NHS GP will want to look into it further after having a normal range TSH back. Is it something I should pursue privately- is it worth it?
Welcome to the group. If you could fill out your profile, click on your image icon top right of screen, it helps members here to know your situation better.
I'm not happy to click on links that I don't know. Do you know if you have tested positive for thyroid antibodies? If these haven't been tested yet then worth doing, ask GP or pay for a private test.
Which country are you in?
In the early stages of thyroid disease TSH can change rapidly either way as the thyroid struggles to put out the hormones required. We recommend taking test at 9am or as close as possible as that is when TSH is highest. Fast that day before the test for consistence of results.
The early stages of thyroid disease can be very prolonged, over many years. During which you will likely be suffering from low stomach acid and not able to absorb vitamins from your food well. This is regardless of a fantastic diet. Its recommended to test levels of ferritin, folate, B12 & D3 and then supplement these individually to OPTIMAL - upper quarter of range).
Next steps:
Retest every 3-4 months as described above.
Get thyroid antibodies tested, there are two types, TPO & TG.
Get vitamin levels tested and post results in a new post.
TSH 4.82 followed by NHS retest of 2.5. (Is it normal to fluctuate this much?)
Prior to any treatment yes this is quite normal. There may be times when your thyroid manages to put on a bit of a spurt. Also different labs at very similar times have been known to come up with pretty different numbers. See the graph I have attached. TSH runs on a circadian rhythm and varies throughout the day so the timing of your blood test is important. Were these test taken at different times of the day?
Free T4 (fT4) 15.6 pmol/L (12 - 22) 36.0%
Free T3 (fT3) 4.6 pmol/L (3.1 - 6.8) 40.5%
Both FT4 and FT3 are under 50% of their range. perhaps make a spreadsheet document to keep track of these numbers each time they are tested. Use this calculator to work out % through range.
Your TPO antibodies were negative on that test. They can fluctuate, also there is a different form of antibody called Thyroglobulin that the NHS doesn't recognise. You can get these tested privately, see link with different private blood tests available. Most popular are Monitor My Health, Medichecks and Blue Horizons. Discount codes are also in the link for Thyroid UK.
Ferritin is deficient. NICE guidelines state that a level of under 30 is deficiency. Make appointment with GP who may want to do their own tests and then hopefully prescribe iron. The level to aim for is 90-100 to be optimal and no symptoms. Some of your tiredness may well be due to this deficiency. Focus also on an iron rich diet.
No result for folate?
I won't write any more as probably enough to take on board at the moment. I ill leave you with a link about autoimmune thyroid disease in case it is relevant.
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