What to ask GP?

[Amtired]

Hello All

After years of slightly abnormal TSH levels, not enough to worry about etc according to GP, I decided to have a private Full Thyroid Profile blood test taken. The results are:

Thyroid Stimulating Hormone (TSH) 3.9 uIU/mL

Free T3 (triiodothyronine) 3.8 pmol/L

Free T4 (thyroxine) 11 pmol/L

Thyroid Peroxidase Antibodies 798.4 IU/mL

Antithyroglobulin Antibodies 78.7 IU/mL

I feel very tired, am able to do a short activity then need to sleep.

I have a GP phone call booked and wondered what I should be asking them or what I should expect.

Thanks for your help!

[SlowDragon Administrator]

Please add ranges on Ft4 and Ft3

Or say which company did test

Email GP copy of these results

GP will want to repeat tests on NHS

Request they also include vitamin D, folate, B12 and full iron panel test including ferritin

Plus coeliac blood test too

Was test done early morning? (Gives highest TSH)

Approx how old are you

Female?

Pre or post menopause

high thyroid antibodies confirms autoimmune thyroid disease

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)

[Amtired in reply to SlowDragon]

Thank you for your reply.

The blood test was done by London Medical laboratory at 10.30am.

I am 60 year old female, on HRT for menopause symptoms.

I will email results to my GP before our call and will ask for the blood tests that you mentioned. Interested in the suggestions for coeliac blood test, I have cut down the amount of gluten I eat. Should I eat more gluten before the test?

Have added the reference ranges I was given ( I assumed that all ref. ranges were the same!)

Thyroid Stimulating Hormone (TSH) Units 3.9 uIU/mL Ref. Range 0.35 - 4.94

Free T3 (triiodothyronine) Units 3.8 pmol/L Ref. Range 2.4 - 6

Free T4 (thyroxine) Units 11 pmol/L Ref. Range 9 - 19

Thyroid Peroxidase Antibodies Units 798.4 IU/mL Ref. Range 0 - 5.61 H

Antithyroglobulin Antibodies Units 78.7 IU/mL Ref. Range 0 - 4.11 H

Thank you!

[SlowDragon Administrator in reply to Amtired]

So TSH would have been a bit higher if tested at 9am (plus only water between waking and test)

FT4: 11 pmol/l (Range 9 - 19)

Ft4 only 20.00% through range

FT3: 3.8 pmol/l (Range 2.4 - 6)

Ft3 bit better at 38.89% through range

Helpful calculator for working out percentage

thyroid.dopiaza.org/

Both antibodies high

coeliac test

If you feel better without gluten….up to you if you think it worth going back to eating high levels gluten 6 weeks before testing

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

[RedApple Administrator]

Amtired, Can you please add the reference ranges for those test results. This helps us to understand where you are in relation to the ranges for the lab that did the test.

[SlowDragon Administrator]

Ft4 and Ft3 look low ……but without ranges we can’t discuss

Typically Ft4 range is 12 -22

Therefore Ft4 would be below range

Some labs might have Ft4 range of 7-14 ……in which case Ft4 would be mid range

[Bearo]

As a worst case scenario your GP might not take much notice of private blood tests and will probably not want to diagnose hypothyroidism as your TSH, although too high, is still in range. But your antibodies tests show you have autoimmune thyroid disease and you have symptoms. I would be pressing the GP to repeat the blood tests and perhaps test folate, vits d and b12 and ferritin at the same time as these are often low in hypothyroid people.

While you are waiting for a diagnosis you can be getting vitamins mentioned above to optimal and you may want to try going gluten free, as some people find this helps a lot.

[Amtired in reply to Bearo]

Thanks Bearo

I don’t think GP will want to diagnose hypothyroidism as they’ve not been interested before, although never had information on my antibody levels before. Wait and see with fingers crossed!

I have recently cut down, but not completely cut out, the amount of gluten I eat and find it interesting that this helps.

With regard to getting vitamins to optimal levels is there a brand that you would recommend?

[TiggerMe in reply to Amtired]

I'd wait and see how your results come back and then we'll get you on the supplements... it could be that your B12 is under range or you have anaemia which the GP should treat 😉

[TiggerMe]

Aim low... a blood test and follow the protocol to get the highest TSH, I would have thought with one before 9am you will likely get over the top of range 🤞what you really want and they will probably offer is a full blood count, full iron panel, ferritin, B12 & folate and you could try your luck for Vit D.... sounds a lot but it's a standard bank of tests if you are fatigued 🤗

They generally love handing out blood tests to start with so they can try to placate you!

Likely they will request you wait another 3 months for a retest, you could mention your latest results but maybe miss off the TSH or maybe misread your answer to sound like 5.9 rather than 3.9 as they don't understand that later in the day it drops down😉 antibodies show you have Hashi's but no doubt they will have to retest for that too as you couldn't possibly have worked this out 😬

[Amtired in reply to TiggerMe]

Thanks. Aiming low means the only way is up!

Will see what blood tests I can get done before 9am 😀

[TiggerMe in reply to Amtired]

That's the way... it is a bit of a slow slog to get what you need sometimes, you might strike lucky with a good one GP's get Hashi's too! 🤗 persistence is key.... keep coming back here and we'll give you all the help we can 😉