Hubby's MOT

[Lottyplum]

So my husband, aged 79, was called into GP surgery for MOT as not been seen since before COVID. Bloods taken, BP, weight etc. so I suggested he get a printout+ low+ behold lots of tests taken not discussed (even tho told all ok) - it was a phone call. One test was thyroid function test : TSH, T4 but of course, no T3. The results were TSH 4.48 (0.35-5.00); T4 14.3 (11.00-23.00). Do you think it would be worth getting Medichecks to do a proper Thyroid function test? There's no thyroid issues on his side of the family but wondered if his thyroid is slowing down somewhat due to age. He has no medical issues but I do make sure he gets his daily supplements+eats healthily (whether he likes it or or not🤐). Any thoughts my lovely people?

[FallingInReverse]

Hi! Anxious to hear replies to this.

My mom is 80-something and I made her get a full thyroid panel done.

In doing that, and doing a deep dive. I learned that TSH “ranges” rise with age. I think I read that Ts are also expected to be slightly lower than what we would judge for those in “middle age”.

Two charts/tables/studies I screenshot shared below. It helped me feel less urgent about my moms results but it’s still in the back of my head to revisit.

[Lottyplum in reply to FallingInReverse]

Thank you. I read all the emails that come through+read quite a number I read to my husband. He is active, has no health issues+want it to stay that way so thought having a T3 level would be helpful seeing how his brain+heart uses up so much.

[FallingInReverse]

Here’s one for TSH

Tsh by age

[FallingInReverse]

and here’s another for TSH, plus FT4 and FT3.

Age chart

[Lottyplum in reply to FallingInReverse]

Sorry to sound thick but could you explain these two charts for his age group?

[FallingInReverse in reply to Lottyplum]

My quick assessment was, when one eyeballs the low/highs of the ranges across all the studies and all the age groups…. There is a slight shift higher for TSH the older you get.

Now, we know that ranges in many regards mean absolutely nothing.

But the very high level gist shows:

- For TSH, scan left to right across age groups for each line. Upper range just keeps increasing with age.

- FT3 is a ever so slight decrease in the range with age, again scanning the column from the youngest down to oldest line

-FT4 - this chart is a mixed bag and I don’t draw any conclusions from it.

So - eyeballing is just that, as I said I have not had time to revisit.

But in a world where tenths of a point matter for how far through a range we are… and these 80+ ranges are also tenths/hundredths of a point varied. Well I draw the broadest of first impressions that 1) if I had my moms numbers I’d be worried, but because she’s old I shouldn’t jump to conclusions yet based on how I analyze my own numbers. And 2) I can’t wait to hear from the 70-80 year old set on this forum to get the real feel for how to evaluate!

[Lottyplum in reply to FallingInReverse]

Thankyou. I thought it was me being stupid not fully understanding the graphs, but you're right, it's broad impressions. He watches videos online from some v knowledgeable drs, esp from the USA, so does understand a lot of things about nutrition+areas of specific interest to him, ie tinnitus following a vertigo episode, insulin resistance, which he believes he suffers from, so looking at ways to counter this. And then i come along with all the stuff I'm learning on this forum! But we don't want to be a couple of old dodderers with Zimmer frames so we research, keep active, and keep learning!

[humanbean in reply to FallingInReverse]

FallingInReverse

Would you give the links to those two pictures you've posted, please.

I haven't studied all the numbers or columns, but I notice in the second table which gives TSH/Free T4/Free T3 the numbers for Free T3 show that 95% of people they tested had a range for Free T3 substantially tighter than the commonest range used in the UK ( which is 3.1 - 6.8)

[SlowDragon Administrator]

worth testing vitamin levels at least annually

Check that supplements are doing their job

[Lottyplum in reply to SlowDragon]

Thankyou. I've said this to him but think using Medichecks+blood draw is the way forward as used MMH for some other blood test, finger prick, and you'd think he was being assaulted with a deadly weapon!! So Medichecks it is then! Will get that sorted this week.

[greygoose]

It's true that with age, TSH rises. Slightly. Not that much! A euthyroid TSH is around 1 for most people. For the elderly it's a few points higher, but not over four. However, doctors now make that an excuse not to treat elderly people. Let's get rid of all the oldies, eh?

I'm 79, too. My TSH is zero. Has been for years. And god help any doctor that tried to tell me it should be higher! Of course, I've been on T3 mono-therapy for years, so it's not surprising. But even so...

T4 14.3 (11.00-23.00) 27.50%

That's pretty low. And it's only that high because the pituitary is flogging the thyroid hard with the TSH. Yes, I think you do need to see what his FT3 is, because that's the most important number.

I do make sure he gets his daily supplements

What supplements are you giving him? Has he has his nutrients tested?

Well, I've just had a quick look at those charts below, supplied by FallingInReverse and I have to say I don't 100% understand what they're getting at, but I find them rather worrying. And I'm just very, very thankful that I don't have to get diagnosed over-again using them. Feel sorry for anyone that does.

[FallingInReverse in reply to greygoose]

The charts are just aggregated studies comparing various ranges across all age groups. No more of less useful than any range, and certainly as damaging as any broad range you have to rely on for diagnosis and treatment). But found them when seeing if a 1.89 TSH for my 80 year old euthyroid-to-date mom was any more or less of a red flag than it would be for me. Less conclusive than a 4.48 tho!

[Cornwaller in reply to FallingInReverse]

But there is a flaw in this argument. If a metric changes with age it doesn't follow that the change is fine or benign. I would argue that the change is likely an indicator of declining health and a wise decision is to minimise that change. In the case of your husband some would argue that he is borderline Hypothyroid. Does he have any symptoms and would it be worth checking them off against a list? See thyroid UK for full list.

The other flaw is that a metric which just scrapes into the standard range may well not be optimal. This is where our health system is, it doesn't seek optimal health, it appears to seek to do as little as possible. So your GP says it's fine! I wouldn't be so sure.

[radd]

Lottyplum,

At 79 years old, if he feels well I would leave him alone 😁 unless he is prepared to self-medicate, as even if thyroid hormones are low it might prove difficult in getting a hypo diagnosis.

There has always appeared to be reluctance in treating newly diagnosed hypothyroidism in elderly patients as a drop in thyroid hormone performance is generally expected and being elderly makes coexisting comorbidities more likely.

It is thought conditions such as angina and diabetes (for example) can worsen with the initiation of Levothyroxine which increases all metabolism, and could be tricky to re-stabilise.

There have been members who have complained of their elderly parents lifelong Levothyroxine being reduced or even stopped in old people’s homes, making them symptomatic.

I think it’s cruel to deny elderly patients medication that could increase their mortality and quality of life, as existing conditions could easily be monitored. I assume it comes down to the cost of the extra care and tests required.

[Lottyplum in reply to radd]

He is on no meds. The only issue was high BP+he hated taking pharma meds for that so found pure olive leaf extract +beetroot extract worked as well as big pharma meds so he kicked those into touch. At his recent check up told them taking those for high BP +was told to keep on doing that as it's working!

[radd in reply to Lottyplum]

Great, I use the Cherry Active juice for high BP and found that a very effective alternative to mainstream meds also 👍

[rjb112]

What does MOT stand for? Thanks.

[radd in reply to rjb112]

Some say a health MOT stands for "Measurements, Observations, and Tests". Some say its been appropriated from the vehicle roadworthiness tests introduced many years ago by the Ministry of Transport, and is still named the same today.

MOT basically means a checkover to ensure functionality.

[rjb112]

Thanks very much. Much appreciated.

[FallingInReverse]

 humanbean asked for links, and I’m sharing here as it helped me get organized and I do want to go back and read the sources more carefully.

I’ll also say - I completely and totally 100% agree with  Cornwaller and  greygoose on the value and harm to come from ranges, and I know you know I agree with you (because you are both right 😃 )…I’m not in any way saying that these ranges should be used for a diagnostic threshold by an inflexible medical system or undereducated doctor. That’s a different “policy” type analysis. Also - the ranges go from 2.5-97.5 and shame on anyone who takes that as a normal one size fits all!! When I do this research it’s so I can, in my quieter moments, really figure out whether my 80 year old mom (or in other cases, my 17 year old daughter) actually need treatment.

Although I still have to advocate for myself, and choose doctors wisely, and do a little dance around egos and billing codes and incompetence… there is still a clearer path to asking for treatment (even if I have to pay for it) and I am taking the research for all it’s worth to make an educated decision about them.

By the way - in the same way, this forum talked me off the ledge from starting my daughter on Levo. I could have, it might end up she needs to, but you amazing people helped me take the data, and eyes wide open make the best treatment decision for her for this moment in time. Which was no Levo, for now, and that story continues.

So - one TSH is not enough to “diagnose”, but with this one canary in the coal mine, it was helpful to know that with my 80 year old mom’s TSH just around 2, that it’s not exactly the same as if a 40 year olds TSH was 2.

Here are the links, plus an extra:

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Thyroid Function across the Lifespan: Do Age-Related Changes Matter?

Includes the yellowish chart titled “Table 2. Age-Related Reference Ranges for Thyrotropin in Older People, with Young Adults as the Comparator Group”

Link: ncbi.nlm.nih.gov/pmc/articl...

The conclusion, for reference:

This review highlights the considerable changes which occur physiologically in HPT axis function across the lifespan. Setpoints for thyroid function are to a large degree heritable and probably established in utero, but much of the underlying genetic architecture remains undescribed, and an understanding of epigenetic influences is only beginning to emerge. There are complex, dynamic changes in thyroid function tests across childhood and adolescence and also in adulthood, such that in older people TSH increases with aging without an accompanying fall in free T4. Age-related reference ranges for thyroid function tests should be routinely used for children and adolescents. There is a strong case for implementing age-related reference ranges for TSH in adults to prevent inappropriate diagnosis of subclinical hypothyroidism in older people and to discourage unnecessary levothyroxine prescribing.

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Relationship of gender and age on thyroid hormone parameters in a large Chinese population

The one with the much more detailed chart.

Link: researchgate.net/publicatio...

Study Objective, for reference: This study aimed to present the impact of age and gender on thyroid hormone levels in a large Chinese population with sufficient iodine intake. Subjects and methods: A total of 83643 individuals were included and were stratified by age and gender. The median, 2.5th and 97.5th of thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and FT3/FT4 ratio were calculated for both genders for every decade from 18 to over 80 years.

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Didn’t quote this one earlier, but also some interesting charts visually showing distribution beyond range and average, and how it clusters different by age and gender.

Reference intervals for thyroid hormones for the elderly population and their influence on the diagnosis of subclinical hypothyroidism

Link: researchgate.net/publicatio...

[Lottyplum in reply to FallingInReverse]

Thankyou for the links and summary. Presently working in the garden but will read this evening. I still think a TSH, T4+T3 blood test needs to be done under a much stricter regime than my husband's blood tests were taken (as we didn't know what was entailed by the so-called MOT) so should get a more accurate picture. Just reread the investigation results, which cover urine albumin:creatine ratio, HbA1c, serum lipids, liver function urea+electrolytes, full blood count. No D3, folate, ferritin or B12 so that's another private blood test+Superdrug draw! Without this forum I wouldn't have been asking for a printout or have any idea how to understand the results. Mind you I did tell him that if my T4 was only 14.3, I'd be the Michelin Woman+crawling on the floor,! Thank you all again for your help.👌

[Anthea55]

Hi Lottyplum, just my thoughts about your 79 year old husband.

Most doctors in the UK have very little training or understanding of nutrition, yet it is one of the first things to look into. Getting tested by a qualified nutritionist can be worthwhile. A nutritional doctor who helped me said that when you get nutrition right, then any medical condition will present more clearly. We also know that this helps any thyroid problem too.

I have a book 'Nutritional Medicine' by Dr Stephen Davies and Dr Alan Stewart which I find useful. There is a section on Nutrition in Old Age. It mentions among other things that as we get older our bodies may not absorb as much as they did before and we may also need more of various nutrients.

You can find a nutritionist by going to the website of BANT, the British Association for Nutrition and Lifestyle Medicine. Their main website is at bant.org.uk

There you can search for a practitioner by various options including location and one I've just noticed which is 'Healthy Aging'.

I am 85 and have looked for help at various times of my life. When my joints started seizing up I got myself tested for food intolerances; my main ones were wheat and oats; within a couple of months of my changed diet my joints were much improved and my lifelong indigestion had cleared up. I've found that some brands of levo bring back problems with my joints so I know what to look for.

I'm sure you can find help for your hubby. Well worth doing.

[Lottyplum in reply to Anthea55]

Thank you for your info. I will investigate . 👌