Need Help with Diagnosis

[Thyroid_Newbie]

I'm new to investigating thyroid issues, so I need some help from experts please. My husband has been suffering increasing fatigue for several years now, and he's always much colder than anyone else in the room. I understand that both of these can be symptoms of thyroid issues. Thyroid problems also run in his family, with his three siblings all receiving some form of treatment.

However, his standard serum thyroid test results always come back as normal:

T4 free - Range: 9 - 19.1 pmol/L. Last Result: 133

TSH - Range: 0.35 - 4.94 mIU/L. Last Result: 1.36

Are there other tests that will more accurately confirm if he has thyroid problems? He's due to have a blood test soon for other issues, and it would be great to get any further tests included in that.

Thanks for any help.

[Thyroid_Newbie]

Sorry, last T4 result was 13.3

[greygoose]

Hi Thyroid_Newbie, welcome to the forum.

Are there other tests that will more accurately confirm if he has thyroid problems?

Well... whilst the TSH isn't 100% reliable, you can't argue with an FT4 reading. His is slightly low, but that could be his norm. It's 42.57% through the range. 'Normal' (euthyroid) is usually around 50%. But no doctor is going to consider his result abnormal, not with a euthyroid TSH.

There's nothing more 'accurate', but you can add more detail to the picture by getting FT3 tested, and TPO/Tg antibodies. Also vit D, vit B12, folate and ferritin.

Whilst fatigue and cold-intolerance can be hypo symptoms, they could also be caused by other things. And doctors don't tend to take much notice of hypo symptoms because they're all non-specific. So, on the information you have, he would not get any sort of thyroid diagnosis.

[Thyroid_Newbie in reply to greygoose]

Thank you, Greygoose. I've included the TPO/Tg antibodies on the list for the tests he'll request, as well as the vitamins and iron panel. How should we interpret the TPO results when we get them? Like, what would raise a red flag? Also, did I read somewhere here about ultrasound/MRI scans helping with diagnosis? What does that show?

I know it may sound like I'm really trying to push for hypo diagnosis, and I realise there could easily be other pathologies involved. It's just that his family history makes the thyroid a likely suspect for him.

Thank you for your help.

[greygoose in reply to Thyroid_Newbie]

It's very simple with the antibody tests if they're positive - i.e. over-range - it means he has Autoimmune Thyroiditis - aka Hashi's. Do you know much about Hashi's?

However, the problem is that you cannot rule Hashi's out on the basis of one negative test result. They need to be tested about three times - although the NHS won't do that! The reason for that is that antibodies fluctuate all the time, so you have to catch them when they're high. Also, some Hashi's people never even have over-range antibodies.

And that's where the ultrasound comes in. It will show up any damage done by the disease and confirm diagnosis.

[Thyroid_Newbie in reply to greygoose]

Ok, he had blood drawn this morning, and was told the thyroid results should be back in 2 weeks. I'll get back to this thread then. Many thanks.

[greygoose in reply to Thyroid_Newbie]

It would be better to start a new thread with new results so that more people will see it.

[SlowDragon Administrator]

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

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

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)

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

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

Post all about what time of day to test

healthunlocked.com/thyroidu...

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

come back with new post once he gets results

[Thyroid_Newbie in reply to SlowDragon]

Thank you SlowDragon. I'm working through those links now and will come back in about 2 weeks, which is when the test results should be in.

[arTistapple]

Is he on any other medication? E.g. some beta blockers cause patients to be extra cold. Hands and feet etc.

[Thyroid_Newbie]

No, no other medications. The only other serious health problem was prostate cancer, but it was caught early, and prostate removal cured it.