Potential underactive thyroid

[LLWaltz]

hi,

I’ve had to go private for fertility investigations after loss and have had some more intensive thyroid testing done after the NHS advised no concerns. I’m hoping someone can give me some guidance based on my results as I’m quite lost with what to do/where to go next.

TSH levels

Oct 2019: 4.18

Nov 2019: 5.45

March 2020: 2.20

Nov 2021: 4.69

Sept 2022: 0.95

April 2023: 5.17

Free T3

April 2023: 4.1

Free Thyroxine

Nov 2019: 16.7

Nov2021: 15.0

April 2023: 15.3

Thyroglobulin antibodies 

April 2023: 19.1

Thyroid Peroxidase antibodies 

April 2023: 13.3

Iron

Oct 2019: 203

Nov 2019: 184

April 2023: 157

Folate

April 2023: Unable to determine

B12 - Active

April 2023: >150

Vitamin d

April 2023: 135

C Reactive Protein High sensitivity 

April 2023: 1.05

Non HDL cholesterol 

Dec 2022: 4.2

Cholesterol

Dec 2022: 5.5

Total cholesterol/HDL ratio

Dev 2022: 4.23

[GlowCoach Administrator]

Welcome to the group and I'm sorry for your loss.

When quoting blood results we do need to see the reference range (numbers in brackets after each result) as they vary from lab to lab.

That said, I can see that your TSH has at times been just above the reference range.

Did you do the test as per the protocol recommended here? Test at 9am, fasting, & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process)? This gives highest TSH level as it runs on a circadian pattern and varioes throughout the day.

Was the last test a private one? If so I'd recommend taking the results to your GP and asking for a repeat test and ongoing monitoringing with bloods every 3-4 months.

To get a diagnosis and begin treatment on the NHS you need 2 consecutive TSH results above the range.

I believe that the threshhold might be different in fertility clinics and may be lower.

Your vitamins look good so I assume you are supplementing?

No result for ferritin.

fertilityexeter.co.uk/wp-co...

[LLWaltz in reply to GlowCoach]

thank you!

All my bloods pre the ones in April 23 were done as a mixture through my GP and through the Centre for Life in newcastle. But it would have been coinsidence if they were 9am, fasted and no biotin. The most recent ones were medichecks and done before 9am fasted with no biotin.

That also means I only have the ranges for the medichecks ones as my GP didn’t provide them when i asked for all my results. Their reference ranges were

TSH - 0.27-4.2

T3 - 3.1-6.8

T4 - 12-22

Thyroglobulin - 0-115

thyroid peroxidase -0-34

Iron (ferritin) - 30-150

I’ll make sure to take the most recent results to my GP and request repeat monitoring.

All the iron results are ferritin, which seem to have gradually decreased over the years.

I do supplement with a B complex and Vitamin D3 so not surprised they are fine.

[GlowCoach Administrator in reply to LLWaltz]

So currently your antibodies are negative. They can and do fluctuate so worth retesting them when you can although a percentage of people with autoimmune hypothyroidism never have positive antibodies.

Do stress to your GP that you are trying to conceive/maintain a pregnancy. TSH is therefore best at 2.5 at highest.

thyroiduk.org/having-a-baby...

[PurpleNails Administrator]

Welcome to forum

Sorry to hear of your loss & difficulties. 

Do you have the ranges for the results?

Each result might have a different range (even for same test) as different labs can have different ranges. 

I can see that your TSH was low in September & then high again.   This is often seen in early stages of autoimmune thyroiditis as thyroid level fluctuates. 

By most ranges the antibodies are not at a positive level but we need the range to confirm.  

FT4 of 15-16 are within most ranges but free thyroxine is not the only thyroid hormone you also need FT3 tested this is the most powerful & active hormone.  

[LLWaltz in reply to PurpleNails]

thank you, my GP tests didn’t come with the ranges (even though requested), but the April 23 tests from medichecks did which was:

TSH - 0.27-4.2

FT3 - 3.1-6.8

T4 - 12-22

Thyroglobulin - 0-115

thyroid peroxidase -0-34

Iron (ferritin) - 30-150

My results from the GP did have *’s next to the TSH levels over 4.18. And a * next to Free Thyroxine of 16.7.

[PurpleNails Administrator in reply to LLWaltz]

TSH - 5.17 (0.27-4.2) 

FT3: 4.1 pmol/l (Range 3.1 - 6.8) 27.03%

FT4: 15.3 pmol/l (Range 12 - 22) 33.00%

Thyroglobulin - 19.1 (0-115) negative

thyroid peroxidase 13.3  (0-34) negative

Iron (ferritin) - 157 (30-150) 

April test shows TSH over range, your thyroid is struggling to maintain levels, currently the FT4, FT3 low, but in range.  With FT4 at 33% of range & FT3 at 27%.  

2x above range TSH - 3 months apart should prompt commencement of treatment.  You’ve had higher TSH before but previous level in lower part of range. 

Usually this is 50mcg levothyoxine as standard starter dose, then gradual increases by 25mcg every 6 - 8 weeks until levels “good” & you feel well - Doctors say until in range.  Most feel best when TSH in lower part of range eg 1 & FT4 top 3rd, FT3 at least half way. 

High ferritin can be sign of inflammation although CRP a common inflammation marker looks in range.  Ferritin is iron stores, iron can still be low, you might want  to arrange an iron panel.  

[LLWaltz in reply to PurpleNails]

thank you so much, this is incredibly helpful

[flosslechops]

sometimes not enough progesterone is made by the ovaries to maintain a pregnancy-the NHS uses cyclogest for this-it might be worth asking your doctors about it

[LLWaltz]

thank you. Ive used cyclogest in the last but unfortunately it didn’t help.