Blood test interpretation help

[Jessica7878]

Hi everyone. I’m so glad I’ve found this site! I hope someone can help me with interpreting my blood tests.

I was living abroad until recently and went to see the Dr as was struggling to lose weight. He did bloods which all came back as normal except for my TSH which was reported as < 0.0083 (normal range 0.35-4.994)

He then requested further thyroid blood tests and also an US and nuclear medicine scan of my thyroid.

The scans came back as normal. The other blood tests show

ANTI TPO 329.54 (normal < 5.61)

FT3 6.67 (normal 2.63 - 5.69)

FT4 15.66 (normal 9- 19)

TSH Receptor Abs 2.980 (normal < 1.8)

TSH < 0.0083 (normal 0.35 - 4.994)

He told me I had Graves’ disease and started me on Carbimazole 5mg daily and told me to get my bloods checked once I came back to UK as this was just before I moved back

I’ve now been referred to an endocrinologist at my local hospital and am waiting for an appointment to see them.

I just wondered if anyone could tell me are my blood results normal for someone with Graves’ disease? I’m really struggling with my weight which is why I went to the doctor in the first place but everything I’ve read seems to indicate I should have lost weight but I am very obese and feel as if the carbimazole is making it worse! I’m wondering if I got the wrong diagnosis!

Any help or advice would be greatly appreciated.

Thank you.

[greygoose]

Well, I'm no expert, but from what I've seen on here, those don't look like Graves' results at all. Are those results from before you started carbi?

Your TPO antibodies are pretty high, so I suspect you have Hashi's, rather than Graves'.

With Graves', both FT4 and FT3 would be very much over-range. Your FT3 is only slightly over-range, and FT4 is nicely in-range.

With Graves' you are always hyper, but with Hashi's you can swing between hypo and false 'hyper'.

I expect that doctor was only looking at the TSH, which is suppressed, and jumped to the conclusion that it was Graves' - they don't really know the difference.

And, of course, you do have positive TRAB, but you can have that with Hashi's, too.

So, no, those results aren't typical for Graves', and yes, I do think you've been given the wrong diagnosis. It often happens.

[Jessica7878 in reply to greygoose]

Hi Greygoose

Thank you so much for your reply. Yes all these results are from before I started on the carbimazole.

I will hopefully get appointment soon to see Endocrinologist so will show them all these bloods and see what they say. I think Hashimotos makes more sense but I am very new to all this and still learning a lot but definitely not feeling great on the carbimazole so didn’t think it was right.

[greygoose in reply to Jessica7878]

We never stop learning about thyroid. There's always something new to take on board.

[PurpleNails Administrator]

Welcome to forum

Graves is confirmed with positive TRab. Yours are at a positive level. So yes you do have Graves. Your immune system over stimulates thyroid.

Low TSH & high FT4 & or FT3 it what you’d usually see &

It is typical levels go very high with Graves & yours are more elevated with FT4 still being in range & FT3 being fractional over range. This is why you been given a very low dose of carbimazole.

You do have very high TPO and that is often positive with Graves too but very high level might mean you have both Graves & Hashimoto’s (autoimmune thyroiditis) which causes damage to thyroid and lowers the ability to function.

The ultrasound & nuclear uptake scan is going to be much more accurate at confirming diagnosis as the uptake pattern is distinctive showing if function is consistent through thyroid.

You will need to closely monitor FT4 & FT3 as the dose may need to be altered. If you do have both autoimmune conditions you may experience greater fluctuations.

Obtain copies of scan report to share with new doctors.

Weight loss is common with very high thyroid level. 10 % are said to gain weight. With more mildly elevated levels, our appetite goes crazy & energy is poor & we don’t present seriously unwell with weightloss - so it can be missed for a prolonged time. I have a nodules & this cause elevated level missed for many years.

[greygoose in reply to PurpleNails]

Have you seen this article:

thyroidpatients.ca/2020/04/...

It says that Hashi's people can have TRAB, too.

[SlowDragon Administrator]

Suggest you get FULL thyroid and vitamin testing BEFORE seeing endocrinologist

Request GP retest thyroid and also test vitamin levels

You also need coeliac blood test too

if you have BOTH Graves’ disease and Hashimoto’s then treatment is BLOCK with Carbimazole and REPLACE with Levothyroxine

Known as block and replace

Bloods should be retested 6-8 weeks after any change

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

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.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease - Graves or Hashimoto’s

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

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

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG 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

[FallingInReverse]

 Jessica7878 Welcome to the forum!

It’s all very confusing and the information we need to learn can be overwhelming. All the while feeling pretty terrible as a result of our sub-optimal hormones.

The one actionable thing I take away from the above is this:

You will need to closely monitor FT4 & FT3 as the dose may need to be altered. If you do have both autoimmune conditions you may experience greater fluctuations.

The other thing I will say is that doctors all over the world are likely to be under-educated on thyroid issues. There are exceptions but I say so just to give you a heads up that you shouldn’t let your head spin when you hear conflicting information as you start your journey.

For future reference, and if you need to test private, here is a good check list of the things to test for a view if your total thyroid health:

1) TSH

2) Free T3

3) Free T4

Plus these vitamins

4) ferritin

5) folate

6) B12

7)Vit D3

Given your confirmed autoimmune thyroid diagnosis (either/both Hashimotos (underactive) or graves (overactive)), but middling free Ts… and knowing it’s the Free Ts that are the most indicative/correlated to symptoms…

You may find yourself wanting to private blood test those before you are able to wrangle the NHS into doing it for you.

I wish I had your Free T results! So just like I says above, monitoring the impact of the carbi is probably going to serve you well.

[Fernsmum]

Hello Jessica, I have Graves, have had it years , when I was first diagnosed I had lost a stupid amount of weight and like you went for help ,I don't understand blood test results even now ,but I also had a bulging eye ,(another symptom), I have not heard of the meds your on but was started on Thyroxine and am still , dosage go up and down depending on Thyroid ,I am now taking 150mg daily ,sorry can't be more helpful , but I'm sure you'll hear from others on here who know more , good luck

[Jessica7878]

Thank you all so much for replying and all the information you have provided. I will definitely look into getting private testing before seeing the endocrinologist and will do some further reading. I really do appreciate all your help. 😃