Follow Up Test Results

[KCH651]

Good morning everyone,

I posted back in February when I was advised i was subclinical hyperthyroid. Blood results from 06/02/24 were:

TSH 0.1 (0.35-4.94)

Free T4 11.3 (9.0-19.0)

Free T3 4.7 (2.9-4.9)

Serum Folate 9.9 (3.1-20.0)

Serum B12 343 (190-883)

I paid for a private thyroid test from Medichecks in March which came back:

TSH 0.15 (0.27-4.2)

Free T4 14.4 (12-22)

Free T3 5.5 (3.1-6.8)

THYROGLOBULIN ANTIBODIES 39 (0-115)

THYROID PEROXIDASE ANTIBODIES 9.9 (0-34)

I spoke to my GP about the possibility of there being a pituitary disorder - when I had my hemithyroidectomy back in 2021 the surgeon said something about my thyroid not being the problem with my bloods but the way my pituitary and thyroid were talking to each other, I didn't ask more at the time because he's just said my nodules might be cancerous and that was the only thing I could take in. This time she retested my thyroid, cortisol and others to see if I was possibly going through early menopause (i'm 37), it doesn't look like the latter thankfully. Here are my latest blood results 28/03/24:

TSH 0.1 (0.35-4.94)

Free T4 11.7 (9.0-19.0)

Free T3 4.8 (2.9-4.9)

Serum Cortisol 252 (no reference range provided - states borderline but no further information)

Serum Ferritin 63 (30-200)

Serum total 25-hydroxy Vitamin D 104 (>75 optimal for bone health)

All bloods were done at approximately 9am.

I'm still struggling with fatigue and various other symptoms. I also saw my hairdresser last week who was surprised how much hair I had lost, she said it looks like I have psoriasis on my scalp (i don't usually suffer with dry skin). I have another GP appointment on the 15th April to go through my blood results. Should I be asking for a referral to an endocrinologist? I feel like the endo team at my local hospital are more diabetes orientated - she sent a letter to them a while back for advice and from their response they clearly hadn't looked at the letter she sent them properly by saying they didn't think i was on Levo which she clearly stated to them that i was not.

I suppose i'm just asking for some reassurance and advice as to what you would be pushing for in my situation. I'm struggling with feeling so rubbish and just going round in circles. I have to say though my GP has been really good which helps. Thanks in advance 🙂

[Jaydee1507 Administrator]

Have you changed the B12 you were taking to something with a higher dose and retested your level? Low B12 will make you feel tired and rubbish and your folate needs to be inproved which a good, high dose B complex would do.

Your FT4 is only 27% through range so its strange your TSH is low.

Can you get referred back to the Endo and see if you can get a thyroid ultrasound to investigate nodules?

Ferritin needs to be a little higher to be optimal.

Suggest increasing iron rich foods in diet and eating them often. Chicken livers, pate, red meat etc

Link with ideas for dietary iron:

dailyiron.net/https://three...

[KCH651 in reply to Jaydee1507]

Hi, Yes I purchased the P!nkTribe Liposomal Vitamin B Complex from Amazon which were recommended last time I posted back in Feb. She didn't retest B12 this time because she was happy with the test back from Feb.

I've never seen an endo before, I saw ENT originally for the nodules on the left which resulted in the Hemithyroidectomy. I know there are nodules on the right which were rescanned last year in Feb and the radiographer was happy that side was OK, I can ask if this can be redone though.

I tend to only eat red meat once a week so will look at increasing Iron rich foods.

Thank you for responding

[Jaydee1507 Administrator in reply to KCH651]

Unfortunately medics do tend to go off TSH results mainly which doesn;t always give a true reflection on thyroid activity. As yours is actually slightly below range yet your FT4 is only 27% through range its an odd picture.

Its possible that you have a nodule putting out a bit too much thyroid hormone intermittently, they can do strange things but probably an Endo might be next place to turn to.

In the mean time do keep on top of the vitamins.

[greygoose]

Well, that certainly looks like Central Hypo to me. The TSH is much too low and doesn't correspond to the Free levels. And, your cortisol does look to be low. The problem is, the majority of doctors have never heard of Central Hypo, so don't recognise it when they see it. So seeing just any old endo might not help. You need an endo that knows about Central Hypo. They do exist but are rather thin on the ground. If I were you, I'd write another post asking for recommendations for Pituitary-savvy endos from people who have already been diagnosed with the condition.

Another indicator that all is not right with your thyroid is that your FT3 is higher in-range than your FT4. Usually it's the other way around, but when there's some sort of problem the thyroid concentrates on the most important hormone - T3 - at the expense of the T4 to keep you alive.

[KCH651 in reply to greygoose]

Thank you greygoose, I've just looked up Central Hypo and my symptoms certainly do match. As you suggest I will write another post for recommendations. I will also suggest this to the GP when I see her again later this month. I really appreciate you sharing your expertise, I don't have much understanding of it and this really helps!

[greygoose in reply to KCH651]

Well, the symptoms would be due to the resulting hypo. But could also be due to other low hormone levels, because the pituitary makes quite a few hormones.

That said, it could be a pituitary problem or a hypothalamus problem. Pituitary being Secondary Hypo and hypothalamus being Tertiary Hypo. And you can't say which is at fault until further testing has been done. But you need an endo for that because your GP cannot order the necessary tests.