Is this hypothyroidism?

[tinkerbell22]

Hello, a friend just had some thyroid blood tests back from Blue Horizon and I wanted to check with you if you think they're hypothyroid. I'll ask permission from her to post the results in detail but for now I can give a basic overview. Background info, she's often tired and cold, and has mental health issues that remind me of the effect of hypothyroidism on mental health. She has a lot of body pain as well. Her gp test results have repeatedly shown over the years deficiencies in B12, folate and vit D which for me was setting off hypothyroidism flags. Her iron is often high in range or just good in range. There's history of Graves disease in two female relatives.

Getting a full thyroid panel from her gp would be impossible so I suggested Blue Horizon. This came with a cortisol blood test and magnesium test.

Here's the basic overview. I'll add result details when I have her permission.

TSH mid-range (0-4).

T4 really low in range

T3 about halfway in range

Antibodies TPO and thyroglobulin both present but below range. Does that mean definitely not autoimmune?

Cortisol high

Magnesium high in range.

To me the T4 is a big red flag, but with the T3 not so bad I wonder if she's converting T4 to T3 ok. But surely the T4 shouldn't be this low in a thyroid-healthy person.

TSH of mid-range, I know I struggle a lot when my TSH is mid-range and did for many years when the doctors wouldn't accept I was hypothyroid.

Any thoughts? She didn't have b12, folate, vit D or iron tested this time around, but they are always as described consistently.

She took the blood test first thing in the morning before food or any other medication.

Oh she has colostyromine twice daily (I'll check that name is right) after having her gall bladder removed years ago. This is known to affect the thyroid. She last had this after dinner and then blood test the next morning before her next dose. Her hypothyroid symptoms were there before she started these meds tho years ago.

Thank you!

[greygoose]

Antibodies TPO and thyroglobulin both present but below range. Does that mean definitely not autoimmune?

No, it doesn't. Antibodies fluctuate all the time, so you can't completely rule it out on the basis of one negative test. They should be tested at least three times, but even then, she could still have Hashi's without ever having raised antibodies.

To me the T4 is a big red flag, but with the T3 not so bad I wonder if she's converting T4 to T3 ok. But surely the T4 shouldn't be this low in a thyroid-healthy person.

It's nothing to do with conversion. When the thyroid is failing for any reason, it will produce more T3 and less T4 to help you to survive, as T3 is more important than T4.

A euthyroid FT4 would be around mid-range, with an FT3 slightly lower in range. TSH would be around 1. But, the problem is, doctors won't diagnose in the UK unless the TSH has risen to over 10 - or is at least consistantly over-range, even if technically, you're hypo when it reaches 3.

[tinkerbell22 in reply to greygoose]

Thank you greygoose! So based on what you've said do you think this might mean she has hypothyroidism? To me that low in range T4 is the biggest sign and fits with what you're saying I think. (Regardless of whether she can convince a doctor of this)That's interesting about the antibodies too!

Thanks

[greygoose in reply to tinkerbell22]

I think she probably has, but she does need more than one test to show it because levels can jump around due to external factors like infections, etc. Impossible to say anything for certain at this point.

[tinkerbell22 in reply to greygoose]

That's my feeling too, thanks!

[greygoose in reply to tinkerbell22]

You're welcome.

[RButus in reply to greygoose]

Greygoose, I'm interested in your comments as in 2010 an ENT in the US told me I was hypo, based on bloods and symptoms, prescribed Armour and raised it by 30mg every 2 weeks until I felt well, which was achieved at 90mg, and he was pleased that my TSH was below 1. I returned to the UK and the doctor freaked at the bloods and took me off them, and I struggled again but coped (the total loss of battery power in 2007 coincided with menopause, which I've read, is common). I found HU, bought my own and felt well again for a couple of years, but a DEXA scan shows osteoporosis so, in terror, I stopped again and I fall asleep on the floor after a few bone strengthening exercises.

Tink's Blue Horizon results are quite similar to my own most recent BH test, and I wonder if you could comment at all?

The BH ranges are the same as Tink's, so mine:

TSH 1.85; TT4 76.5; FT4 14.4; FT3 4.65; TPO <9.0; TGAbs 10

It's all a mystery to me and I hate my body.

Thanks, greygoose.

[greygoose in reply to RButus]

There's not much I can say that I haven't already said. You don't happen to have a copy of the test done in the US that got you a diagnosis, do you?

How long ago did you come off Armour?

Why did the DEXA scan make you stop your Armour?

[RButus in reply to greygoose]

Thanks, greygoose, tests back in 2010 were almost the same . (The doctor who prescribed Armour ranted that doctors relied 100% on tests to the neglect of the patient's symptoms; I didn't understand what he was talking about at the time, didn't even know what a thyroid was; he was very much old-school, a doctor who genuinely cared how his patients were faring.) I stopped NP Thyroid last summer when given the DEXA score because I believed what the doctor in the UK had told me - and others that NDT had caused osteoporosis (I was ignorant of the fact that menopause does, too - that's a whole other story!). I've tried to get to the bottom of whether low TSH through supplementation IS a direct cause of osteoporosis but not with any great success, other than that all medical folk seem to say so, including the ROS. Given your comments to Tinks, would you think some supplementation with NDT would be appropriate? Thank you for your time, greygoose.

[greygoose in reply to RButus]

I do wonder if British doctors aren't the worst in the world when it comes to thyroid! They just parrot what they learnt in med school without ever considering the illogicality of it all. TSH has nothing to do with bones or hearts. It's job is to stimulate the thyroid to make hormones, and initiate conversion of T4 to T3. You are in far more danger of osteoporosis if your FT3 is too low. But doctors are very ignorant about T3, they have no idea what it is or what it does and they're terrified of it! NDT contains T3 and is therefore demonised.

On the other hand, they're quite happy to stuff you full of calcium for your bones, based on the idea that bones contain calcium, without a clue that too much calcium can make things worse. And calcium supplements - which are very badly absorbed - can not only cause brittle bones, but cause heart attacks by clogging up the arteries! Something for which they blame cholesterol without having a clue what cholesterol is. It's truly terrifying situation.

Magnesium is far more important to bones than calcium. But, testing magnesium is not helpful due to the way the body handles magnesium. Just take some, excess will be excreted. And vit D is very, very important, too. Have you had that tested? Very often doctors will refuse to test that! All the other nutrients need to be optimal, too, because bones are a conglomination of them all.

If NDT helps you then take it. As long as you don't let your FT3 get too high - but you probably wouldn't, anyway, because that would make you feel too bad. Been there, done that. But, it didn't kill me and I'm still here to say that it's not a good idea. But, getting adequate T3 for your needs is.

[tinkerbell22 in reply to RButus]

I'm so sorry you're going through this RButus, yes your results are similar to my friend's whose results these are. I've been through times over the years myself where I've needed to go off levothyroxine treatment and back on, because of scares in my health and because of supply issues during covid first year. Going from being quite well medicated to zero is Terrible. It makes you feel so awful, I really sympathise. I understand the fear of osteo problems from low TSH. People here seems to document that this is just scaremongering by doctors. I do worry about this as well though. Is there anything you can do to help your bones but stay on your thyroid meds so you don't feel this awful? Could the osteo issue be down to menopause/HRT rather than your thyroid meds?

[RButus in reply to tinkerbell22]

Thanks, Tinks (if I may address you thus), that's a very kind and supportive thing to say, I do appreciate your sympathy. I could be taking bisphosphanates for bone-strengthening but too scary as they can have such frightful side effects. (I had a private REMS scan with Osteoscan, supplementally to DEXA which examines bone quality and that puts me back into the osteopoenia bracket. Nick Birch, the spine consultant who runs Osteoscan prefers Vitamin D and calcium from the diet with appropriate exercise; he describes bisphosphanates as 'drain cleaner'.) Menopause has an awful lot to answer for, and I was told by my female GP that women should only take HRT for 3 years - turns out they know diddly-squat about menopause as I've found to my great discomfort, so I've never had HRT but wish the hell I had or my bones would've been better, and menopause wouldn't have been the nightmare it was, and I'm too old now, dammit. So, yes, the bones are very likely oestrogen-starved. It appears from greygoose's comments that your friend and my thyroid results show something's not right, so have asked her if that would point to a top-up from NDT. I know she's not a doctor, but her opinion's still very valuable.

[tinkerbell22 in reply to RButus]

Lol yes Tinks is funny. The drain cleaner doesn't sound a fun option! If vit D and calcium and exercise can help, then that sounds more friendly. I definitely think it's worth trying that route.

GPs seem to know diddly squat about a lot of things sadly. I'm sorry you've suffered through menopause without support.

I think a lot goes on experience and feeling as well as the test results. If you felt better on NDT then maybe you need some.

[RButus in reply to tinkerbell22]

Thanks, Tinks Been on Vit D+K, magnesium and dietary calcium for years, but exercise is difficult because I get so exhausted and I've excruciating back pain. Re: GP menopause ignorance - after months of cystitis (at my age!) and so much discomfort I couldn't even bear underwear (=going commando in skirts - even in winter) and godawful antibiotics that never cleared the infection but produced side effects that persist a year later, it was only thanks to a forum on Facebook that told me I should tell my GP I needed topical oestrogen - which hadn't occurred to her! (Thank God for patient-to-patient support, where would we be without it?!) She prescribed it without question and I was cured - within a couple of weeks! I've since read an article by a GP explaining that they only have ONE lecture on menopause in med school (which they could miss if they felt like it) and his was devoted entirely to telling them how dangerous HRT is. To say I was shocked and stunned...I wonder what they get about the thyroid - if any.

[vocalEK in reply to RButus]

I take 10,000 iu of Vitamin D daily, along with Vitamin K2-MK7. I'm pretty sure I couldn't raise my levels of Vitamin D from food alone. grassrootshealth.net/

[tinkerbell22 in reply to vocalEK]

She tried vit D tablets but they caused aches and pains. I can't get her to take the spray vit D (also with vit K) which is easier on the body. She eats eggs tho and hope there's good vit D from that

[vocalEK in reply to tinkerbell22]

I've never taken D in tablets. Mine comes in tiny liquid capsules. Perhaps she had a reaction to the binders that they use to hold tablets together. Thorne is a good brand: Thorne Vitamin D-5000 - Vitamin D3 Supplement - 5,000 IU - Support Healthy Bones, Teeth, Muscles, Cardiovascular, and Immune Function

[tinkerbell22 in reply to vocalEK]

Thanks for this! I'd not heard of liquid capsules for vit D.

[RButus in reply to tinkerbell22]

Tinks, is this your friend or me you're referring to? If me, it was the bisphosphonates that cause pain as a known side effect; I've been taking Vit D+K happily for years, and magnesium; and calcium's from the diet

[tinkerbell22 in reply to RButus]

Ah it was my friend I was referring to, sorry! Glad you've been able to take some vit D

[RButus in reply to tinkerbell22]

Thanks, Tink - once the conversation goes beyond 2-way it's hard to navigate who's saying what to whom (at least for me!). How is your friend, by the way?

[RButus in reply to vocalEK]

Hello, and no it's only calcium that's from diet

[greygoose in reply to RButus]

Ah, just one point there! NDT does not 'top up' your thyroid hormones. It replaces them. When you start taking thyroid hormones - especially T3 - the pituitary will be satisfied with the levels in the blood and reduce its TSH output. The more you take, the less TSH it makes until it makes none at all. When there is not TSH to stimulate the thyroid, it stops making thyroid hormone, so you will be 100% reliant on the thyroid hormone replacement you're taking. It's not like vitamin supplements that 'top up' your vit D or B12 levels. So, you must be aware of that. That's how it works.

[RButus in reply to greygoose]

Thanks for the clarification, greygoose, much appreciated

[greygoose in reply to RButus]

You're welcome.

[tinkerbell22]

Here are test result detailsBiochemistry

Magnesium 0.95 (0.7 - 1.0) mmol/L

Hormones

Cortisol (Random) H 673.0 (6am - 10am 166 - 507 nmol/L, 4pm - 8pm 73.8 - 291)

She did the cortisol test on waking up, early morning.

Thyroid Function

TSH 2.73 (0.27 - 4.20 mU/L)

T4 Total 97.5 (66 - 181 nmol/L)

Free T4 13.4 (12.0 - 22.0 pmol/L)

Free T3 4.65 (3.1 - 6.8) pmol/L

Immunology

Anti-Thyroidperoxidase abs <9.0 (<34) IU/mL

Anti-Thyroglobulin Abs 11 (<115) IU/mL

Thank you

[buddy99 in reply to tinkerbell22]

FT3 is just under 42% through range and FT4 is really low. TSH could be lower going more towards 1. How does your friend feel? Because regardless of her blood values her wellbeing also determinates whether she needs to be treated, I would say. Technically, if the doctor treats by numbers and not symptoms, she is not hypo with those blood values.

[tinkerbell22 in reply to buddy99]

Thank you buddy99 for your reply. My friend whose test results these are has been feeling a lot of fatigue and mental health problems that I see occur in myself and others with hypothyroidism. She's often cold and has pains and dry skin. These symptoms have gone on for years.I'm not sure the T4 level could be anything but hypothyroid from this test. But it sounds like more testing is needed in future months to see if it's consistently low. Surely a T4 this low consistently would indicate hypothyroid.

I know tho, convincing a doctor is another thing when the results are in range.

She also has b12, folate and vit D deficiencies consistently over the years too and struggles to raise these above really low in range. These nutrient deficiencies we often see with hypothyroidism.

There's also Graves in her family in two female relatives. Though I've no idea if that can lead to hypothyroidism in her.

Thanks

[buddy99 in reply to tinkerbell22]

Definitely several areas needing attention. Is her ferritin low, as well?

[tinkerbell22 in reply to buddy99]

Thankfully ferritin ok!