Thyroid Testing

[jacjlc]

My husband, almost 72, just had blood work with everything good except cholesterol (little high 227) and high TSH 7.93, slightly low T4. He has no symptoms of hypothyroidism! Since he has no symptoms, we're waiting 3 months to retest and T3 also, and he works 45 hours a week loading and unloading yard materials, mulch, soil, pavers, etc. My question is, is it better to fast or not for thyroid tests? I've read it is best in the morning to test but was wondering about fasting. Thank you!

[Hollins]

Hi

Welcome to the forum.

I googled TSH and fasting. TSH seems to be reduced by food, T4 doesn't seem to be.

Is it 'normal' to be fasting or eating?

I imagine the sensible thing is to have all tests done at the same time of day and either on an empty stomach or after food.

If you're taking thyroxine the advice is to be as consistent as possible before all tests ( no 'drug', no food, same time of day). Seems very sensible.

Hope this helps.

[SlowDragon Administrator]

He needs vitamin D, folate, B12 and ferritin levels tested too

Low vitamin levels more common as we get older

Plus thyroid antibodies for autoimmune hypothyroid at next test …or now

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and if on levothyroxine……last dose levothyroxine 24 hours before test

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

[jacjlc in reply to SlowDragon]

I'm sorry I didn't give enough details or was unclear about my statement that he has no symptoms. In 2022 he had a TSH reading of 5.02, not bad when range is 4.50 to 5.0 depending on where you check, but his B12 was 300, way too low. In 2023, he had a TSH of 3.98, within range and a B12 of 804. What I meant was that he did not have any physical symptoms associated with hypothyroidism and has never been on medication for hypothyroidism. I have requested the tests to thoroughly test hopefully, the doctor orders all the important ones needed. Hope this is clearer and again, my apologies. Thanks for your input, it is greatly appreciated from everyone!

[DippyDame]

Raised cholesterol is a symptom of hypothyroidism as further indicated by his other symptoms, raised TSH and low FT4.

Correct thyroid medication usually lowers cholesterol level

Statins are not advised....optimising thyroid hormone levels is

thyroiduk.org/related-condi...

How many of these symptoms on the following listcan he tick off

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

Good that his next test is to include FT3...this is the most important result followed by FT4

Test at 9am, at least an hour away from food and drinks and, if medicated, 24 hours after last dose of levothyroxine (12 hrs gap for T3)

His next test should confirm if he needs levothyroxine