Can someone please help me understand my sister's thyroid blood results?

[MartaXs]

Hi everyone! As per the subject line of this post, my sister has recently done a blood test and her results are as follows:

TSH - 0.008 (norms 0,350-4,940)

FT4 - 1,37 (norms 0,7-1,48)

FT3 - 4,60 (norms 1,58-3,91)

ATPO - 545,09

Does it look like hyperthyroidism? She has her appointment with an endo booked for tomorrow, but we're still wondering what her results could possibly mean? Thank you in advance!

[Charlie-Farley]

Hi Marta

Honestly the most important bit are symptoms. Blood tests are there to aid a diagnosis and symptoms should always be a very important consideration also any other health problems. Trouble is doctors fall into the trap of treating the blood work and we need to push back on this.

Does she have any overt symptoms and does she have any other health issues?

TPO antibodies are a marker for hypothyroidism and sometimes hyperthyroidism (graves) if only it were clear cut. It could be a Hashimoto’s swing or Graves or the result from a reaction to an infection that might clear up. Symptoms and history family history etc are all extremely important. 🤗

[MartaXs in reply to Charlie-Farley]

Hi Charlie! Thanks so much for taking the time and responding. The main symptoms my sister's dealing with are similar to peri-menopause - in the last year, her cycles have been a bit out of whack - irregular, vaginal dryness, it seems like her body's struggling to ovulate. Sometimes she also experiences hot flashes and fatigue. She thought it could be menopause, but she checked it and it's not, so started digging into it, and it seems it's all caused by her thyroid problems. She has no other symptoms as such as far as I am aware of. Also, her ferritin levels are pretty low (8 ng/mL) but it could be due to her cervix being removed last year due to HPV and pre-cancerous cells that were found during her pap smear test (I assume her low iron levels could be due to a few surgeries/procedures she had to undergo last year). There's nothing else I can think of. Thanks so much again for your reply!

[pennyannie]

Hello MartaXs and welcome to the forum :

So we have a very low TSH but a T4 in range with a T3 slightly over range - and presume the

ATPO to be TPO antibodies which would appear to be over range by most ranges - and likely a diagnosis of Hashimoto's is forthcoming.

With this Auto Immune disease the immune system attacks the thyroid and causes peaks in over range T3 and T4 levels and symptoms of hyperthyroidism -

but these attacks are transient and the T3 and T4 fall back down into range by themselves -

but the thyroid gland becomes progressively damaged and thyroid hormone production becomes reduced with the patient becoming hypothyroid and requiring thyroid hormone replacement medication.

There is another AI disease that starts off in a similar way but with Graves Disease the T3 and T4 keep rising higher and higher and it is considered life threatening if not medicated with an Anti Thyroid drug to semi-block thyroid hormones while we wait for the immune system response to calm down.

The eyes can also be affected by both of these AI diseases;

Graves is diagnosed by a separate antibody blood test usually detailed as a TSH Receptor or TRab / TSI antibody.

Graves and Hashimoto's can run together and Graves treatment will take precedence:

What symptoms is your sister dealing with and for how long has this all been going on ?

[MartaXs in reply to pennyannie]

Hi Penny! Thanks so much for taking the time and responding. The main symptoms my sister's dealing with are kind of similar to peri-menopause ones - in the last year, her cycles have been a bit out of whack - irregular, vaginal dryness, it seems like her body's struggling to ovulate. Sometimes she also experiences hot flashes and fatigue. She thought it could be menopause, but she checked it and it's not, so started digging into it, and it seems it's all caused by her thyroid problems. She has no other symptoms as such as far as I am aware of. Also, her ferritin levels are pretty low (8 ng/mL) but it could be due to her cervix being removed last year due to HPV and pre-cancerous cells that were found during her pap smear test (I assume her low iron levels could be due to a few surgeries/procedures she had to undergo last year). There's nothing else I can think of. Thanks so much again for your reply!

[pennyannie in reply to MartaXs]

Well, this ferritin level alone needs investigation as currently she is classed as suffering with iron deficiency anaemia and this in itself is debilitating, has she had any investigations already into this and if given the all clear - maybe an iron infusion the fastest short term solution ?

No thyroid hormone replacement works well until core strength vitamins and mineral - those of ferritin, folate, B12 and vitamin D are up and maintained at optimal levels -

I now aim to maintain my ferritin at around 100 - folate around 20 - active B12 75 ++ and vitamin D up at around 100:

Ok - keep us in the loop, good luck at the appointment - and guess you are going with ?

[MartaXs in reply to pennyannie]

Thanks so much. She's been prescribed iron tablets and needs to take it for one month, then have another blood test, which will be more detailed. She has her appointment with an endo tomorrow, but unfortunately I can't go since I live in another city, however, I'll let you know how it goes after I speak with her. I guess it'd be a good idea for her to also test her folate, B12, and vit D. Thanks so much for your help!

[MartaXs in reply to pennyannie]

Btw, isn't it Hashimoto when TSH levels are high? My sister's are pretty low. It seems like Graves could be more probable in her case.

[pennyannie]

A TSH over 3 is a case of hypothyroidism - which may have been caused by Hashimoto's AI thyroid disease if we see over range and positive TPO antibodies as this is the medical evidence of diagnosis.

In the UK currently one needs 2 TSH readings over 10 - months apart - before thyroid hormone replacement is meant to be prescribed - but if with severe symptoms and positive antibodies I believe doctors have some leeway when having to work within the NICE guidelines.

For Graves Disease the medical evidence is a TSH Thyroid Receptor antibody reading being positive and over range - which currently we do not have - and generally a low suppressed TSH.

The TSH can be low suppressed for several reasons - including both Graves and Hashimoto's

but without the Graves antibody having been tested - we can't say anything for sure - and as explained above Graves and Hashimoto's can run together - with Graves Disease treatment taking precendence.

It reads as though your sister has been quite poorly and Graves can be triggered by stress and anxiety - not that I'm wishing this AI disease on her - I was diagnosed Graves a few months after being attacked by a work ' colleague ' - my only symptom was insomnia - I had one visual obvious symptom - a shaky middle finger - any help ?

We can all read everything you are writing - there is no need to keep repeating yourself.

[MartaXs in reply to pennyannie]

Thanks, Penny! You've been very helpful. I'm sorry to hear about the incident with your work colleague - it sounds awful, and no wonder you developed anxiety afterwards. Yes, my sister has gone through lots and lots of stress for the past year (it was exactly one year ago in February when she received her abnormal pap smear results that was followed by other exams, surgeries, and hospital visits). You may be right that stress and anxiety may have an impact on her thyroid, hence the current results. Extremely low iron levels don't help here either. Anyway, I'll keep you posted. You're very kind, all the best!

[pennyannie in reply to MartaXs]

Okey doke - no worries - I can't believe an iron infusion hasn't been instigated -

I found the NHS iron tablets upset my stomach too much and I wasn't offered an alternative so purchased my own supplements.

I found Gentle Iron much better tolerated - so any iron bisglycinate product will be kinder on her stomach and bowel but it does take time for ferritin stores to build - I'm afraid there's no quick fix other than the obvious - an iron infusion.

[Charlie-Farley]

Wow, sounds like your sister had been through the mill.

Pennyannie has covered quite a lot but I would draw your attention to a pinned post that could be very useful. There are links within to information that I would encourage you and your sister to read. You might not be able to be with her but by discussing you can certainly help her prepare.

healthunlocked.com/thyroidu...

There are lots of replies to other posters on here with regards to supplements and blood tests SlowDragon is an incredible source for information. If you look up her profile and view replies you will find lots of useful info. Get your sister to read posts and start learning from lived experience as well as getting a good book to read - see the Thyroid UK for suggestions. The best outcomes are a result of time and effort put into learning and self advocacy. This is something I would encourage. It is what most people who land here do for the sake of their own health. I did and wrote my bio as a case study to help others. If you click on my icon at the top left of my reply it will take you to my profile.

Hope this helps xx