New here, undiagnosed, Normal TSH Low T4

[Spritze]

Hi

Long story short - I have had many Hypothyroid symptoms for many years and after having had some private bloods done I finally managed to get my NHS GP to request a T4 test which she accepts is low and confusing for her as my TSH is normal.

She has said she will ask an endocrinologist for advice rather than refer me as that will be quicker.

Am wondering if anyone can tell me what I should hope for in terms of treatment/further testing from my GP ?

B12 was low but I have increased that with sublingual drops. MCH 33.9 (27-32) High but she wasn't bothered.

The antibody tests were negative and all other bloods in normal range.

Nov 2022 Private test

TSH 0.96 (0.27-4.2)

T4 11.4 (12-22) Borderline Low

T3 3.8 (3.1-6.8)

Feb 2023 Private test

TSH 2.16

T4 11.2 Borderline low

T3 3.6

23 Aug 2023 NHS test

TSH 1.4

T4 11.7 Borderline low

T3 3.9

Many thanks for advice 🙂

Thanks for all the tips so far! Edited to add : B12 raised to 463 with sublingual supplements, Thyroglobulin and Thyroid peroxidase antibody tests negative, not vegetarian. Being treated for osteoporosis. No other major illnesses just constant sinus congestion, loss of and distorted sense of smell, lethargy, lack of physical stamina, weak muscles, poor memory.

[GlowCoach Administrator]

Welcome to the group. If you could complete your profile it helps members understand your thyroid journey so far and be able to advise you better. Click on your image icon to start. Fill out the free text box at the top.

Being hypothyroid, even undiagnosed causes low stomach acid. This in turn means that we cannot absorb vitamin well from our food.

Its highly likely with such a low FT4 that you have low if not deficient vitamin levels which is causing your TSH to be lower than it would be otherwise.

If you can raise those vitamin levels then you will stand a better chance of getting a diagnosis. It will also help you feel a bit better.

Has GP checked your thyroid antibodies - TPOab? This would indicate if your thyroid probalem is autoimmune or not. The NHS only test one type but if you test privately you can also test Tg - thyroglobulin antibodies. Dont use the lab Monitor My Health as they are NHS and only offer TPO test.

Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost.thyroiduk.org/testing/priva...

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.

[Spritze in reply to GlowCoach]

Hi thanks for you reply. My private blood test show normal Thyroglobulin and normal Thyroid Peroxidase - are they what you mean ? B12 was 163ng/L (180-1000) in May 2022 but I have supplemented sublingual and raised it to 463 by Oct 2022. I supplement D3 as have osteoporosis and ferritin and folate within normal range but I take a good multi vit and mineral anyway.

[GlowCoach Administrator in reply to Spritze]

Are you vegan or vegetarian?

You likely need more B12 if GP isn't going to treat. Did they test you for pernicious anaemia?

What were the results for ferritin & folate. Within normal range isnt good enough, we need OPTIMAL which is usually top quarter of the range.

I'd recommend a good B complex which will contain folate as well as extra B12. Your B12 isnt high enough yet. When taking a b complex containing biotin you need to stop taking that for 3-5 days before your thyroid blood test as biotin is used in the testing process and can interfere with the results.

I will list 3 B complex that you can pick from.

amazon.co.uk/Liposomal-Soft...

amazon.co.uk/Yipmai-Liposom...

hempoutlet.co.uk/vitablosso...

Even with normal antibody results you can still have seronegative Hashimoto's.

[Spritze in reply to GlowCoach]

Thanks - meat eater, negative for pernicious anaemia, Folate 14ug/L (>4), Ferritin 113ug/L (13-150), I currently use Pink Tribe Liposomal Vitamin B Complex but will look at others

[GlowCoach Administrator in reply to Spritze]

We do recommend the Pink Tribe product. In that case a 1,000iu B12 would work.

The low B12 is probably keeping your TSH low.

cytoplan.co.uk/vitamin-b12-...

amazon.co.uk/Better-You-Boo...

[TiggerMe Ambassador in reply to GlowCoach]

Maybe ought to add a caveat about B6 type with Pink Tribe and Yipmai?

[GlowCoach Administrator in reply to TiggerMe]

I've added a link to helvellas B6 page with explanation & a different B complex with the P5P form of B6 to my list of options.

Its so difficult with vitamins as there are so many nuances. Most people passing through here it likely wouldn't make a huge difference to them which form they took. There's also the cost implication to factor in too.

[TiggerMe Ambassador in reply to GlowCoach]

It is tricky but we seem to be so bad at absorbing let alone converting things 🤷‍♀️ and pyridoxine is a proven issue but as you say for how many of us... who knows but I can't endorse a product once I know that it could actually be worse for some than not taking it 😕for the sake of a few pence a day. I recommend a better one taken less often...

Like you say with a caveat

[jimh111 in reply to GlowCoach]

B12 no longer low?

[GlowCoach Administrator in reply to jimh111]

Serum B12 needs to be over 500 to be more optimal.

[jimh111 in reply to GlowCoach]

It does seem that B12 numbers can look OK with some deficiency still existing although I personally dislike the term ‘optimal’ as it implies a target for everyone. Is there any evidence that B12 has an effect on TSH? I’ve never heard of it.

[GlowCoach Administrator in reply to jimh111]

According to the range given the OP's percentage through range is only 34.5% and was below range before supplementing.

The cut off for the B12 range in particular is too low so the numbers can be deceptive.

As far as vitamins go there are targets which could be described as 'optimal' and levels below which are not enough for good use of thyroid hormone.

I'm not sure that there is hard evidence regarding low B12 influencing TSH but its something that has been seen repeatedly in this group by a number of members.

[jimh111 in reply to GlowCoach]

OK

[Sparklingsunshine in reply to Spritze]

Just to say the B12 pernicious anaemia antibody test only picks up around 50% of cases, so its perfectly possible to have PA and yet not show up on the test. I'm on B12 injections every 2 months and yet my PA test was negative.

[Spritze in reply to Sparklingsunshine]

That's interesting thank you, I wasn't aware. Does it matter whether it is diagnosed or not, providing I can raise my B12 levels sufficiently with drops ?

[TiggerMe Ambassador in reply to Spritze]

I'd recommend Thorne Basic B or Igennus as they use the best form of B6 P-5-P

[Pinklotus1 in reply to GlowCoach]

Please can you advise at basic level the key vitamin deficiencies that can supress tsh? I am in the same position as the original poster, thank you.

[jimh111]

These results show your pituitary isn't producing as much TSH as it should. When TSH is very low anf fT3, fT4 not elevated it is called central hypothyroidism and there is often some damage to the pituitary. Your TSH isn't so low which suggests your pituitary is under secreting but perhaps not central hypothyroidism.Have you had any accidents which might involve whiplash? Do you have another severe concurrent illness? What medicines are you taking? Are you on a calorie restricted diet? These are things that could explain a low TSH.

[Spritze in reply to jimh111]

Hi thanks for your reply, no whiplash, I do watch what I eat carefully as am slowly putting on weight but I don't calorie count or go without anything, no illness, I'm on HRT and alendronic acid, Multi vitamin/mineral tablet, and supplements such as Omega 3, Magnesium, and Calcium.

[jimh111 in reply to Spritze]

All this should be fine. I see a lot of people on the forum with results like yours, they tend to be quite hypo. I would push to get treated with thyroid hormone. I suspect in the long term you will need some liothyronine but it's best not to mention it yet and try levothyroxine.

[greygoose]

Multi vitamin/mineral tablet, and supplements such as Omega 3, Magnesium, and Calcium.

We do not recommend multi-vits here for mulitple reasons. One of them being because they contain calcium. Taking calcium supplements is a very bad thing to do and usually doesn't help your bones, but makes them more fragile. And it's highly unlikely that you need it, anyway. Did you get it tested before supplementing?

Magnesium and vit D are far more important for bones than calcium - although you need the right levels of all nutrients. But are you taking vit K2-MK7 with your vit D? Take vit D increases absorption of calcium from food, and the K2 makes sure it gets into the bones and teeth, and doesn't build up in the soft tissues and arteries causing problems like kidney stones and heart attacks. If you haven't had your calcium levels checked for a while, I would get it done immediately, if I were you.

[Spritze in reply to greygoose]

I am prescribed calcium as I have osteoporosis. Magnesium and Vit D levels are good after supplementation. I will look into Vit K2 as I have K1 at the moment thank you.

[greygoose in reply to Spritze]

K1 is entirely different. I don't know if you need to take that, but you do need to take K2.

Yes, I understand that doctors prescribe calcium for osteoporosis, but they're still supposed to test it regularly because high calcium levels are a bad thing to have. Besides, it's absolutely the wrong thing to take for osteoporosis, it neither treats it, nor cures it, but puts the patient in danger of blocked arteries.

[radd in reply to greygoose]

We need a bit of Vit K1 and Vit K2 . Vit K1 can be converted to Vit K2, but is dependant upon good gut health which is often dodgy in Hashi sufferers. Basically Vit K2 MK-7 goes to the bones and liver as advocated on this forum but MK-4 is also important enough that supplements are now providing a bit of both. And sometimes MK-11 too.

[Spritze in reply to radd]

Thank you - do you know of a VitK2 supplement that contains MK4+7+11 by chance?

[radd in reply to Spritze]

Spritze,

Nope, it's just what I read (as always reading 😬) and am actually finishing up a bottle of Seeking Health Vit D3 drops with (only) Vit K2 MK 4! I would assume it is only high end supplements that would be in line with the very latest research.

The forum knows that when Vit D is taken the body creates Vit K2 dependant proteins that move calcium around to the right places, and dear SeasideSusie was the Vit D expert but she is now gone ☹️ and I'm actually a little hopeless on Vit D.

However, my own research has revealed that MK-4 and MK-7 act very differently but that both Vit K 1 & 2 inhibit osteoclast formation (bone breakdown) and promote osteoblast formation (bone forming cells). If you read my profile you will appreciate my interest in osteoporosis. Both also help heart issues, inappropriate calcification (kidney stones, etc) and cancer!

There is much research into Vit D status and particularly in connection with autoimmune issues such as Hashi and pro-inflammatory cytokines such as TNF-a (tumor necrosis factor- a). I need to do much more reading before commenting further but research developments are extremely interesting and there are now 17 known different Vit K dependant proteins .

[SlowDragon Administrator]

You need BOTH TPO and TG antibodies tested

Will have to test privately as NHS won’t test TG antibodies if TPO antibodies are negative

No vitamin D test result

How much vitamin D are you taking

Do you take a separate magnesium supplement

Did you stop all supplements that contain biotin 5-7 days before test. Biotin can falsely affect test results

Exactly which multivitamin are you taking

Multivitamins never recommended on here

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

[Spritze in reply to SlowDragon]

Both TPO and TG antibodies have been tested thank you. Yes I remembered to stop Biotin supplements before test