Which tests please?

[Heyhop]

Hi there,

I’m meeting my NHS endocrinologist for a post natal check up.

I have an Underactive thyroid and the endocrinologist is happy to check if I have Hashimotos.

1. He has asked for TSH, T4 + Antibodies to be checked. My latest test shows a slightly below range TSH, because of this should I ask for T3 to be measured as well? (T4 has been measured and is in range). Antibodies results still to come.

2. Apart from the following on the below list, what other tests should I have done to check general thyroid health / conversion problem / potential antibodies issues?

3. And should anything come off my list below, ie unnecessary to test? (I’m quite new to all this!).

Liver function

Cortisol

Vitamin B

Vitamin D

Iodine

Ferritin

Folate

Gut Health (which tests?)

Magnesium

Zinc

Selenium

Many Thanks!

[Jaydee1507 Administrator]

FT3 should always be checked but the NHS don't seem to recognise this forcing members here to pay for private tests themselves.

If FT4 is in range then you really do need to know where FT3 is.

Liver function isn't required, I think you mean B12 which should be on your list.

An Endo is unlikely to be able to check your gut health. If you have specific functional issues you can try a gastroenterologist but honestly they aren't the best if the issue is functional. Better to go to a private nutritionist.

As this is an NHS appointment they will only check one type of antibody - TPO. There is another form that they won't check Tg - thyroglobulin. You would need to buy a private blood test for Tg antibodies should TPO be negative.

See link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...

There is also a new company offering walk in (includes free blood draw) & mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...

Only do private tests on a Monday or Tuesday to avoid postal delays.

[Heyhop]

Hi Jaydee1507!

Thank you so much for taking your time replying, this is so helpful, very much appreciated.

When you say “If FT4 is in range then you really do need to know where FT3 is” - Why do I need to know where FT3 is? Just trying to understand why I need to ask certain questions!

Latest results were:

THS 0.01 (0.27-4.20mIU/L)

FREE T4 22 (11-22pmol/L)

Liver function test - is this useful to see if I’m converting correctly?

Tg (thyroglobulin) - I see private companies offering ‘TgAb‘, presumably that’s the same thing?

The private companies also offer TSI and TrAb, should I ask for them on the NHS or again do them privately - are they vital to test?

Thanks again for the links and postal days recommendations!

Many Thanks.

[Jaydee1507 Administrator in reply to Heyhop]

Just a tip when using this group. If you want someone to get a notification of your reply then do use the reply button directly below where they have responded.

To understand if you are converting then you need a full thyroid panel - TSH, FT4 & FT3. You can then check the ratio of FT4 to FT3 to check conversion, also see where your FT3 % of range is. Liver tests won't show you anything useful. The NHS rarely does a full thyroid panel and often the lab vetoes FT3 requests.

For the recent blood test when was your most recent dose of Levo? Taking Levo just before the test will falsley elevate that FT4 result.

TgAb is thyroglobulin yes.

Unless you are hyperthyroid you don't need TSI & TrAb.

[Heyhop in reply to Jaydee1507]

Thanks again for your helpful reply and the tip to use the ‘reply’ button!

My NHS appointment went rather well I think. The Endocrinologist has agreed to test my FT3 + some of the bloods proposed on my list. (My latest thyroid test was taken fasting and with at least 15hrs between meds).

I’m Underactive and the TPO came back negative. My Endocrinologist said there was no point in testing TgAb, TSI, TrAb - thoughts?

He is open to let me try T3 and even NDT if my symptoms don’t improve but wants to take one step at the time.

Thanks for reading!

[Bearo]

If your FT4 was low there might not be much point in testing FT3 because you would still need to raise FT4 regardless.

But your FT4 is right at the top of the range - which might be ok or might be too high - you will only know by testing your FT3. Depending on how high FT3 is will determine whether or not to decrease your dose a little.

If your antibodies are high/positive on the NHS test then you don’t need the other test as you will know you have Hashimoto’s. But If antibodies are low you can’t be sure you don’t have it and you may need to take that test again at some point, or go for the other test.

I don’t know anything about being post partum (congratulations!) and how long things take to settle down.

[Heyhop in reply to Bearo]

Thank you Bearo!

That’s helpful advice regarding when to test FT3, the Endocrinologist has now agreed to do this.

My TPO test on the NHS came back negative so my Hypothyroidism is not caused by Hashimotos. But is there any point for me to test the other antibodies (TgAb, TSI, TrAb) — or is that only for people with Hyperthyroidism to test? (My Endocrinologist said there was no point for me to test these.) Any thoughts?

Many Thanks again!

[Bearo]

Yes, TgAb is the other test for Hashimoto’s. Some people test negative for TPO but test positive on the TgAb . 10% patients don’t test positive on either test but still have Hashis. Hashi’s is the most common form of hypothyroidism. The treatment is the same. It can be useful to know if you have it e.g many Hashi people find going gluten free beneficial.

It’s not vital to have the TgAb. You can always ask for another TPO test on the NHS at some point in the future and try to get TgAb added. If you ever need to test privately you could look for a test that includes both antibodies.

More important to know where your FT3 is as this is the most important hormone and your endo has agreed to do this. When you get the results post all three (TSH, FT4 and FT3) with their ranges in a new post and the experts on here will advise.

Hope all is going well at home with new littl’un.

[Bearo]

This is a post written the other day by Slow Dragon to someone else. I hope she won’t mind my reposting it here.

If both TPO and TG antibodies are negative for autoimmune disease

20% of Hashimoto's patients never have raised antibodies

Interesting post where ultrasound gave diagnosis

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Gluten intolerance is often a hidden issue too.

Request coeliac blood test BEFORE considering trial on strictly gluten free diet