Advice Please

[Purple450]

I had a left lobectomy in August 2022 due to nodules, which were an incidental finding back in December 2021. Blood results for then are

TSH 2.17 (0.27-4.2)

Free thyroxine 16.5 (11.5-22.7)

Free T3 5.6 (3.3-6.1)

10/8/22

TSH 1.46 (0.27-4.2)

Operation on 24/8/22

14/12/22

TSH 6.19 (0.27-4.2)

Free thyroxine 15.0 (11.5-22.7)

13/4/23

TSH 4.15 (0.27-4.2)

Free thyroxine 15.3 (11.5-22.7)

28/9/23

TSH 5.28 (0.27-4.2)

Free thyroxine 14.2 (11.5-22.7)

I had been having the same symptoms since the operation:- tired and lack of energy, cold, weight gain (1/2 a stone), aching, muscles, and weakness, and cramps in legs, dry skin, brittle nails and hair falling out. Also back ache and muscles spasms.

Got started on teva Levothyroxine 50 micrograms for 3 months. As it wasn’t improving and I was told (for the first time) that there was a background thyroiditis on the respected specimen.

I think I messed up at blood test as I had had my medication at 6:15 am and had breakfast. The test was at 9:30 am.

3/1/24

TSH 0.89 (0.27-4.2)

Free thyroxine 19.5 (11.5-22.7)

Free T3 5.9 (3.3-6.1)

I also had vitamin D tested because I trying to find out what is causing the back ache and muscle spasms. Still waiting for that results.

I now have 2 months of accord levothyroxine still at 50 micrograms.

So that’s the history, I’m still cold with very dry skin and hair falling out ( not menopausal as still having periods occasionally). Leg cramps, tiredness. But the thing that causing the most problems is my back ache and the muscles spasms.

Is the back problems caused by the hypothyroidism?

Can you have thyroiditis without knowing?

Should my levothyroxine have been increased?

Thank you for any help.

[PurpleNails Administrator]

The back problems could be thyroid related, they could also be to low nutrients (often these become low before replacement introduced)

Have Folate, ferritin & B12 been tested?

Nodules can occur with thyroid autoimmune. Might be worth testing TPO & TG antibodies. The doctor may say unnecessary as the treatment (replacement hormone) is the same no matter the cause of hypothyroidism.

“I had had my medication at 6:15 am and had breakfast. The test was at 9:30 am.”

Having replacement prior to test shows a daily peak of FT4. It’s falsely high - You need to know what’s is like when Levo due. Eating breakfast & having test after 9. lowers TSH, although probably not significantly. You TSH will likely still be in range.

Based on the January results the doctor would not conclude you need an increase. 50mcg generally a started dose. So it might be with worth retesting as recommended. It may show you have room for an increase. FT3 does look healthy. Most feel symptoms stem from FT3 levels.

Many arrange private tests if GP won’t test everything.

Private testing:

Order a kit online and sample can be taken by fingerprick test, (extra fee for clinic visit / home visit venous draw) sample posted back & results available online often very quickly.

Sample recommended to be taken at 09.00 fast overnight, avoid biotin 3 days before test.

See link for private companies with discounts with many packages & options.

thyroiduk.org/testing/priva...

Medichecks thyroid advanced is as good option.

[Purple450 in reply to PurpleNails]

Thanks for your reply, I’m glad that I didn’t mess up the blood test too much. I have only had vitamin D tested, I’m thinking about getting a kit to test the rest then I would have the full picture.

[SlowDragon Administrator in reply to Purple450]

Recommend getting FULL thyroid including thyroid antibodies and vitamins

Test correctly …..ALL thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Likely to see you have room to increase dose and/or low vitamin levels

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

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/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

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

[Purple450]

Thanks for the reply, I’m going to get a test.

Vitamin D results in at 48 now of to chemist for some vitamin D

[Purple450]

More results back

Vitamin D 49 (50-200) insufficient

Magnesium 1.07 (0.66-0.99) high

CRP 1.71 (<5.0)

Active B12 40 (37.5-150)

TSH 1.59 (0.27-4.20)

Free T4 20.4 (12.0-22.0)

Free T3 4.8(3.1-6.8)

T4 Total 123.0 (66-181)

Anti-Thyroglobulin Abs 447 (<115) high

Anti-Thyroidperoxidase Abs 154.0 (<34) high

Cortisol (Random) 172.0 (166-507)

Any advice on these blood result would be great.

Thank you