Any red flags in these results or am I barking up wrong tree?

[ducky1971]

Hello everyone, I am 52 and on HRT (as have been post menopausal for 2 years now). I have the Mirena fitted and am currently on 3 pumps oestrogen.

My issue is that I am extremely fatigued and struggling to cope with the activities of a normal day and have been feeling this way for several months.

Due to a family history of hashimotos and underactive thyroid (both siblings and one parent), I have been keeping an eye recently on my Thyroid with blood tests via Thriva.

Everything looks normal and within range, so it's entirely possible that my symptoms are not related to my thyroid at all, but I wondered whether I could share my results here for someone to cast an eye on?

Some other background info is that I now self inject B12 as I seem to be really bad at absorbing this. My Ferratin levels are within range but I tend to feel better when higher so I have switched from Ferrous Sulphate (which did nothing despite taking for months), to a Heme Iron suppliment. My Vit D is also in range at 60 nmol/l (50 to 250), but I am taking a high strength suppliment now to try and get that higher. Folate levels currently nice and high. I also take a good dose of Magnesium at night (Mag Enhance), which has transformed my sleep!

I have results from November 22 and May 23

November 22

TSH 2.61 (0.27 to 4.2)

FT4 21.9 (12 to 22)

FT3 5.1 (3.1 to 6.8)

TPOAb 9.6 (0 to 34)

T4 140 (59 to 154)

TgAB 12.7 (0 to 115)

May 23

TSH 2.53 (0.27 to 4.2)

FT4 18.7 (12 to 22)

FT3 3.9 (3.1 to 6.8)

TPOAb 16.7 (0 to 34)

T4 130 (59 to 154)

TgAB 14.3 (0 to 115)

My gut feeling is that all my symptoms (lethargy, brain fog, aches and pains) are meno related, and I will be speaking to GP about starting testosterone once oestrogen levels optimised. But I am trying to take a systematic approach to tackling this, hence also keeping an eye on my thyroid.

So, if anyone is able to comment on above results, I'd be so greatful. Could my thyroid be the cause of some of my symptoms or with the above results can I safely rule this out for now?

Thank you so much everyone.

[Alanna012]

Hi,

Have you taken these tests at the same time of day after fasting? Your FT4 and FT3 seem to have dropped significantly by the second test although antibodies within range.

[ducky1971 in reply to Alanna012]

No, I don't think I did unfortunately (wasn't aware of this). It was a finger prick test from Thriva. Due to test again end of this month. So should this be first thing in morning? Also, can you explain significance of the FT4 and FT3 dropping? I'm unsure if I need them to keep going up or down and my brain fog issues are not helping when I try to research this

Thank you for your answer x

[SeasideSusie Remembering in reply to ducky1971]

ducky1971

Always advised here, when having thyroid tests:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.

In fact, 9am is the perfect time, see first graph in attached image, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm.

If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.

[* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw. If taking NDT or T3 then last dose should be 8-12 hours before blood draw, split dose and adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.]

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 3-7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

All three hormones fluctuate to some extent during the day so we suggest always testing at the same time to compare results accurately. You can see from the image I've added the daily rhythm of all three hormones.

[SlowDragon Administrator]

Essential to test vitamin D, folate, B12 and ferritin levels too

Low vitamin levels can result in fatigue, especially low iron/ferritin

[Alanna012]

Thyroid hormones fluctuate throughout the day as SeasideSusie says, which is why it's important to keep testing conditions similar, but a drop down too far of either FT4 or FT3 (especially the latter) can be a sign that the thyroid or your system is struggling and that may happen before it starts to show in an elevated TSH or elevated antibodies on tests. It could be the beginning of sub-clinical thyroid illness or due to other factors like vitamin deficiencies or in your case hormone fluctuations arising from menopause.

It's important to test for vitamin deficiencies including

Iron

Folate

B12 - some people need to inject more frequently

Vitamin D

And test Ferritin

As these play a role in conversion of thyroid hormones.

I would do another two tests including vitamins a few months apart using the testing protocol above for proper comparison of results.