Look results

[Lastrolo]

Hello, I wonder if anyone might kindly advise what might happen, what I need to happen etc. High blood sugar resulted in a retest for Hbac1 (due to a different medication) Nurse ordered fbc and the following has been flagged as Subclinical Hyperthyroidism.

T4 - 13.9 (7.9-20.0)

TSH - 0.19 (0.38 - 5.33)

T3 - 5.6 (4 - 6.6)

(Also noted raised platelets and RBC, have no idea if any relevance)

Blood results ask for retest in 3 months. Surgery have booked retest in 1 month.

The doctor I saw yesterday spoke to me as if I knew all about it and when he asked about symptoms & rolled his eyes when I confirmed heat intolerance, shakes etc.

He says he felt no swelling in neck and sent me on my way.

What would ideally happen now please?

[SeasideSusie Remembering]

Lastrolo

Do you have a previously diagnosed thyroid condition and are you on any thyroid medication?

Do you have any previous thyroid results to compare?

[Lastrolo in reply to SeasideSusie]

No never been tested at all. This is out of the blue. Thanks

[SeasideSusie Remembering in reply to Lastrolo]

 Lastrolo

So like most of us you have no baseline to compare what your normal results would be. Generally in a normal healthy person TSH would be no more than 2, often around 1, with FT4 around mid-range-ish.

Without having any baseline results to know what your normal levels are, it's difficult to interpret these results. Personally I think they're jumping the gun to say this is subclinical hyperthyroidism on the basis of one test showing a low TSH and very normal FT4 and FT3. It would be prudent to see what your next test shows and according to NICE there should be 3 months between tests as this would then likely eliminate any unusual thyroid results due to other reasons:

bnf.nice.org.uk/treatment-s...

Subclinical hyperthyroidism

For patients who have 2 TSH readings lower than 0.1 mIU/litre at least 3 months apart and evidence of thyroid disease or symptoms of thyrotoxicosis, consider seeking specialist advice.

Consider measuring TSH every 6 months for patients with untreated subclinical hyperthyroidism. For further information on monitoring in subclinical hyperthyroidism, see NICE guideline: Thyroid disease (see Useful resources).

[Lastrolo in reply to SeasideSusie]

Thankyou very much. I will question & ask to delay the bloodtest to get a better informed result.

[PurpleNails Administrator]

Sub clinical because your TSH is low, but thyroid levels FT4 & FT3 are in range.

The TSH thyroid stimulating hormone is a pituitary hormone signalling the thyroid. When it low it telling the thyroid to slow down.

If your levels rise then 1) you need to investigate & find out why 2) if it’s continuous you need treat it. Low TSH can be treated only high FT4 / FT3.

Symptoms may arise slowly once levels are over range. sometimes they strike quickly when they are at top of range. Levels can also fluctuate, so you can have hyper symptoms but the test show “normal”

It all depends on how quickly levels fluctuate / rise & how your body adapts to symptoms.

I’m my case level rose very gradually over years & I did not notice symptoms my FT3 was nearly double normal range when diagnosed. Others say they were suddenly unwell & there levels were still just in range.

Some with Graves (autoimmune hyper) when the immune system stimulates the thyroid can have levels go above 3x or more what’s normal.

The immune system can also attack the thyroid, this initially causes the damaged cells to release hormone causing a rise but as it progresses the damage results in an under functioning thyroid.

Correct Antibody testing distinguishes between the two.

TPOab (Thyroid Peroxidase antibodies)

TGab (Thyroglobulin antibodies) TPO & TG “autoimmune” - Hashimoto’s (also present with Graves)

TRab (TSH receptor antibodies - measures stimulating, neural & blocking antibodies)

TSI (Thyroid-Stimulating Immunoglobulin) Graves.

Ask to have TPO antibodies tested with next test. Only specialist can arrange Trab & TSI.

Also important to test folate, ferritin, B12 & vitamin D.

The are private blood testing options if GP won’t test everything.

Full blood count is looked at in context of other FBC results. Elevated RBC might not be of any concern. Was haemoglobin ok? Has ferritin / iron been tested?

Terrible doctor assumed you knew when you hadn’t been advised. I have had similar, once than once, they don’t acknowledge or apologise, they brush over it & ideally make you feel as if it’s your fault.

Full list of symptoms can be read here

thyroiduk.org/if-you-are-un...

There can be a cross over with text book examples of hypothyroid symptoms.

thyroiduk.org/if-you-are-un...

in reality symptoms can be so varied and individual you can only know something if wrong by symptoms not what your levels are actually doing.

[SlowDragon Administrator]

Request retest in 6-8 weeks ….or 3 months max

Book early morning test around 9am for highest TSH

FT4: 13.9 pmol/l (Range 7.9 - 20)

Ft4 is only 49.59% through range

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once for autoimmune hypothyroid disease, also called Hashimoto’s

Hashimoto’s frequently starts with transient hyperthyroid results/symptoms

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

High blood sugar resulted in a retest for Hbac1 (due to a different medication)

What medication?

Metformin often lowers TSH

Approx How old are you

[Lastrolo in reply to SlowDragon]

Meds was a 6 mth course of Prostap injections to halt heavy bleeding/period pain. Last jab was in June. I'm 51. Haemoglobin was 32.1 (27-32) No iron or ferritin . Thankyou for replies. I hate how we are dismissed hence wanting to arm myself with reasonable expectations!

[SlowDragon Administrator in reply to Lastrolo]

suggest you get full thyroid and vitamin testing privately

Heavy blood loss leads to anaemia and low ferritin

Low ferritin increases risk of developing Hashimoto’s

See link

healthunlocked.com/thyroidu...

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Medichecks iron panel test

Test early morning, only drink water between waking and test

Don’t eat iron rich meal night before test

medichecks.com/products/iro...

Assuming ferritin is low

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Excellent article on iron and thyroid

cambridge.org/core/journals...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

healthunlocked.com/thyroidu...

We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes: 

Males 16-60: 30-400 ug/L

Female's: 16-60: 30-150

Both >60: 30-650 

The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘

[SlowDragon Administrator in reply to Lastrolo]

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...

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...

Tips on how to do DIY finger prick test

healthunlocked.com/thyroidu...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

[serenfach]

Did they test your potassium? Prostap drops the level of potassium in the blood, which in turn alters the insulin. This would then give high blood sugar levels. Your potassium would eventually regulate itself when you have stopped Prostap, but this needs checking.