Low TSH

[CarolineCaroline]

Hi I’m a newbie who has had some noticeable symptom's. Weight loss was my main prompt to seek advice from my GP, along with a family history on my maternal side of thyroid problems and my younger sister has a thyroid disorder.m, overactive I think.

I have issues with feeling either very cold and having to wear extra layers Or going to opposite problem of being overly hot and having to peel clothes off. My concentration is shocking and my energy levels have reduced. I’m normally full of beans, doing resistance training 3 or 4 times a week and walking every day. My blood results show

Serum TSH level 0.01 miu/L [0.34 - 5.6]

FREE T3 6.4 pmol/L [3.8 - 6.8]

Serum free T4 level 18.6 pmol/L [7.5 - 21.1]

Has anyone had these experiences or suggest what to expect? My GP has booked further blood tests in 4 weeks.

[SlowDragon Administrator]

Autoimmune HYPOthyroid (hashimoto’s) frequently starts with transient hyperthyroid results and symptoms before becoming increasingly hypothyroid

Ft4 and Ft3 not over range so looking more like Hashimoto’s than Graves’ disease

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.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

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...

Just Thyroid includes BOTH TPO and TG antibodies -£49

randoxhealth.com/at-home/Th...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£32 (via NHS private service ) and 10% off if go on thyroid uk for code

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

monitormyhealth.org.uk/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

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

NHS easy postal kit vitamin D test £31 via

vitamindtest.org.uk

Only do private testing early Monday or Tuesday morning. 

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

20% of Hashimoto's patients never have raised antibodies 

healthunlocked.com/thyroidu...

 

Paul Robson on atrophied thyroid - especially if no TPO antibodies 

 paulrobinsonthyroid.com/cou...

Gluten intolerance is often a hidden issue too.

Request coeliac blood test BEFORE considering trial on strictly gluten free diet

Link about Graves’ disease

thyroiduk.org/hyperthyroid-...

Graves Disease antibodies test

medichecks.com/products/tsh...

[CarolineCaroline in reply to SlowDragon]

Thank you for this detail. This has given me plenty to take on board. I will ask GP for those additional blood tests

[PurpleNails Administrator]

GP is right to repeat test, before assuming your hyper is continuous- the FT4 & FT3 are currently not over range. 

The TSH is a pituitary hormone which decreases if the thyroid levels are high, it’s a signal for the thyroid to reduce / stop producing more hormone. The TSH can be slow to respond/ unreliable.  Doctors often tend to think they know everything from TSH but FT4 & FT3 are what is important & this is what affects symptoms.  

So your Thyroid levels might be / or might have been a little higher than usual for you but in a few weeks it might be different.  See if with next blood test if they will add thyroid antibodies.  GP can usually arrange TPO ab and labs test TG antibodies if TPO high.

Request this before you attend appointment, as nurse drawing blood won’t be able to add at time.  

If your result continue to show high / over range FT4 & FT3 you would need a referral to specialist & they could arrange TSI or TRab which signify Graves.

With autoimmune thyroiditis (Hashimoto’s) the immune system attacks thyroid and the damage causes the hormone to be released, causing a transient rise, but at the damage progresses the function decreases (hypothyroid) This can be a gradual process so your levels might look normal on next test but if levels decide will be low on subsequent tests.  

[CarolineCaroline in reply to PurpleNails]

Thank you for the detail, I will ask GP for those additional tests to prompt all other possible diagnosis. It’s possible this was a one off. Although I’m having a range of symptoms that are affecting my normally busy lifestyle.