Does this look more Euthyroid and less central hypo now?

[Bertiepuss]

Hello everyone,

This is my 4th thyroid test (all testing advice adhered to, tests between 9.00-9.40am) over the last 6 months since joining HU and asking for advice. It looks to me like T4 has started to raise. I've listed below all 4 tests for comparison. It's now 47% through the range which seems more euthyroid? T3 still lagging a bit behind at 27% through the range. I don't take any thyroid replacement.

It was suggested from my first test in November '23 there could be a possibility of central hypothyroidism but I'm wondering if these new results don't point to that?

Ferritin finally has raised to 80ug/L, vit B12, vit D and folate all optimal. Thyroid ultrasound showed no atrophy just a few colloid cysts consistent with age and I have never had positive thyroid antibodies.

I am awaiting an NHS endo appointment regarding my 'grey' area morning cortisol and very low blood pressure overnight. I also want to be prepared to discuss thyroid if this does look relevant in the overall pituitary picture but I'm not so sure now?

Wondering if it is worth measuring thyroid hormones later in the day to see what happens - if T4, T3 and TSH get a lot lower. Testing at 9am seems most relevant for detecting primary hypo (clearly this is not what I have) but maybe this testing regime doesn't work for detecting central hypo? I would very much appreciate feedback or pointers please?

----------------Nov '23----Jan '24----Feb '24------May '24

T4 - (12-22) -- 15 ----------15.9 -----15.2---------16.7

T3 - (3.1-6.8) -- 3.7--------- 4.1-------not tested---4.1

TSH - (0.27-4.2) -- 1.75----2.38------2.54----------2.84

[SlowDragon Administrator]

Well done on getting all vitamins optimal, especially ferritin

Have you done a full iron panel test recently

Are you on iron supplements

Thyroid hormones are slowly creeping upwards and thyroid working harder ….as seen by higher TSH

How do you feel

Retest again in another 3 months

[Bertiepuss in reply to SlowDragon]

Hi SlowDragon, thank for your reply,

I've been supplementing high dose iron and vitamin C since September when I started out with a ferritin of 8ug/L and I was anaemic. I've reversed both but it's taken time. My last iron panel was in March. I took my regular iron dose 1.5 hours before the test so I could check it was not too much iron for my system to handle/transport safely. All was fine with levels within range so I've continued supplementing that dose. I will continue until I reach 100-125 and then begin to cut back. I suspect I will need reasonably high doses to keep levels up but time will tell with regular testing.

I honestly don't feel hugely better despite raising my ferritin and haemoglobin. Less breathless going up the stairs but still have loads of other symptoms. I am pursuing other potential issues like venous congestion and vestibular disorders that also have some overlapping symptoms with hypothyroid. It's really difficult to tease apart what is causing what but I think I have more than one thing going on.

I will recheck thyroid in 3 months and see if anything has improved as ferritin hopefully remains within an optimal range for a period of time.

Thyroid hormones are slowly creeping upwards and thyroid working harder ….as seen by higher TSH

I'm assuming this is a positive?

[SlowDragon Administrator in reply to Bertiepuss]

I'm assuming this is a positive?

Yes I would suggest your thyroid levels are starting to improve now you are getting vitamin levels optimal….

Especially important to have good iron/ferritin

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

[Bertiepuss in reply to SlowDragon]

OK great, thank you, will keep going and see how things look in 3 months time 😊

[PixieElv]

hello

Are you on any medication, or supplements, which could explain why your T4 or T3 are rising?

[Bertiepuss in reply to PixieElv]

Hi PixieElv,

I take a lot of supplements, have done for years, but the newest ones are iron (hence increased ferritin levels, I was anaemic last September), vit A, vit E, B12 injections, calcium AKG.

Would these have any effect?

I've been on an antidepressant for years, so no change there. I did increase my HRT oestrogen in January '24 from 50mg to 75mg.

[PixieElv in reply to Bertiepuss]

But no Levothyroxine or similar? Then it most likely it’s down to improved vitamin & minerals levels

As Slowdragon says, optimal vitamin & minerals levels will have a positive impact.

May that continue for you!

[Bertiepuss in reply to PixieElv]

No thyroid meds. I've been trying to improve my terrible ferritin levels, which finally I have, just not really feeling much better symptom wise. I'm not sure if fT3 not budging beyond 4.1 is good enough. I guess I will just give it another 3 months and see where I'm at then.

[PixieElv in reply to Bertiepuss]

Are you against thyroid meds? Or can you not tolerate them?

[Bertiepuss in reply to PixieElv]

Oh no, I have nothing against them, I just haven't been diagnosed. GP thinks all is well according to TSH. It's me who's been trying to work out what's going on with me. You kindly spoke to me on the chat facility about private endo's as I was beginning to think I would have to go down this route but then I managed to get a referral on the NHS due to slightly low cortisol and terribly low overnight blood pressure which the GP thought could point to Addison's. I don't think it's that but I do wonder about pituitary issues.

In the meantime I did this most recent test (partly to check vitamin levels and partly to check thyroid to see if anything had changed in the last 3 months) and saw my T4 was a bit higher so wondered if I was barking up the wrong tree regarding central hypo and should concentrate my efforts elsewhere. I did wonder if testing at a different time of day would produce totally different results as testing in the morning seems most relevant to primary hypo but I'm not so sure about secondary? Did you test in the morning?

Ferritin I can now tick off, but trying to work out is there is a mild pituitary insufficiency is harder to determine. I want to be prepared for this endo appointment to steer the conversation the way I want it to go. It is at least with someone on the Thyroid UK list. I don't want to waste time talking about thyroid issues if there really isn't one.

[PixieElv]

Hello

Yes I remember. 😊

NHS Endos don’t treat you like private Endos. They can’t prescribe the same meds and are strictly bound by NHS guidelines. So if you’re a borderline case, then an NHS Endo will tell you you’re within the range, so you must be ok.

Good luck!

[Bertiepuss in reply to PixieElv]

Thank you, how very unfair! I have asked for a referral to an endo on the Thyroid list who is local to me - he works privately and on the NHS. If I get nowhere then I know who to see thanks to you ✔️🤗 I'm just wondering if really thyroid is not my issue as now it seems fT4 has been improving. I will just have to bide my time over the coming months while I wait for the appointment. Take care x