Hi im not on medication when bloods where taken but my gp referred me to a consultant and these are the resuts. Is this low?
Result today : Hi im not on medication when... - Thyroid UK
Result today
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Tinal25
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Results
Blood results
So since your first post a couple of years ago , your fT4 and TSH( Thyroid Stimulating Hormone) levels have remained pretty stable.
TSH hovering around bottom of range (so yes , it's a little lower than you would expect to find in the majority of people, but that doesn't necessarily mean there's a problem , 'most' people have their usual / normal/ healthy TSH sitting closer to 1 , but a few people do have their usual levels a bit higher or a bit lower, so you could just be one of them) .
and your fT4 has remained stable at around 41 % - 49% through range .
and TPOab , you had a negative thyroid peroxidase antibodies result at around that time
, has your GP done an fT3 test done yet ?
Hi thanks, no just these ones
"The gp said said i possibly have hyperthyroidism ?"
usually "hyperthyroidism" will have a high fT4 (and high fT3), which yours isn't , your fT4 is a little under midrange.
but occasionally the fT3 alone can be too high (and cause symptoms and low TSH) , with fT4 still in the normal range.
so yes , it is possible , but unusual, to be hyperthyroid when fT4 is in range .
this would be called 'T3 toxicosis' and a possible cause of this is an 'autonomous thyroid nodule' ~ (autonomous meaning it makes T4/T3 without being 'asked' to by TSH ~ Thyroid Stimulating Hormone).... if the nodule makes lots of T3 and not much T4 , you get T3 toxicoxis. ( low TSH/ normal fT4 / high fT3) .
So this is why you want them to test your fT3.. to see if your fT3 is too high.
If both your fT4 and fT3 are in range , and if TSH is consistently below range , then it is termed "subclinical hyperthyroidism".
( 'subclinical' in thyroid terms just means 'the TSH is out of range , but the actual thyroid hormones T4//T3 are not')
Hi yes subclinical hyperthyroidism, he said my tsh is low on the bloods for a long time.
yes , your TSH has been this level for at least 2 yrs first result on here is from when you were pregnant ,
it's important to bear in mind that (unless you have a previous TSH result from before this time that was higher than this ?) it is entirely possible this level of TSH is 'normal for you' so it doesn't necessarily mean you have too much thyroid hormone. ( T4 +T3)
the reference range is made by looking at TSH levels of 95% of the 'healthy' population, (they remove the lowest 2.5% and highest 2.5% to get the '95% population range' ) ... so there will be a few people with no thyroid problem who usually have their TSH at , or even slightly below , the 95% reference range.
if this is not your usual level for TSH then some of your symptoms could be explained by having T3 that is a bit too high for you. if this is the case then the high T3 would lower the usual TSH a bit, and cause mild symptoms of hyperthyroidism. But it's also important to remember that symptoms of hyper and hypo at milder levels can easily be confused for one another... eg some hyper patients can gain weight rather than loose it .... hypothyroidism can be responsible for heart palpitations even though they are more usually associated with hyper etc .
edit: i don't know how likely it is to have too much T3 when T4 is where yours is. SlowDragon , do you know what fT4 levels usually look like in T3 toxicosis ? are they usually high end but in range, or can they sometimes be as low as 41-48 % ? i've not seen many examples of T3 toxicosis so i'm not sure if i'm barking up the wrong tree entirely.
I been getting low tsh before i was pregnant, i had it few years. This tsh is the lowest it been and i have been getting few symptoms such has fast heart rate while doing things, headaches,muscle weakness,shaking and few more.
If GP had any brains/ curiosity he'd have tried to get fT3 tested by now.
SlowDragonAdministrator
looking at previous posts
You have pernicious anaemia or “just” low B12 and get B12 injections
How frequently are you getting these done
What other vitamin supplements are you taking
Are you taking a daily vitamin B complex
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)
you need to test vitamin D, folate and ferritin
Your results suggest possible central hypothyroidism
Low TSH and low Ft4
When thyroid levels are low…..low Ft4/low Ft3 …..TSH should rise
Hi thanks for the reply, im not having b12 injection has my b12 is mormal now. My vitamin d low. Folate and ferritin fine i think. The gp said said i possibly have hyperthyroidism ?
No you can’t be hyperthyroid with LOW Ft4
Free T4 (fT4) 15.7 pmol/L (9.5 - 22.7)
Ft4 is ONLY 47.0% through range
How low is vitamin D
Can you add actual B12, folate and ferritin results
Low vitamin levels tend to lower TSH
Have you been tested for coeliac
I had a coeliac and its was negative. My vitamin d is 48.
Bloods
So B12 and folate likely to be better at higher levels
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
A week later add a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Highly effective B12 drops
natureprovides.com/products...
Or
B12 sublingual lozenges
uk.iherb.com/pr/jarrow-form...
cytoplan.co.uk/shop-by-prod...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
Low folate
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
healthline.com/nutrition/fo...
B vitamins best taken after breakfast
Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose
Post discussing different B complex
healthunlocked.com/thyroidu...
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 until serum B12 over 500
Post discussing how biotin can affect test results
Low vitamin D
GP should prescribe 1600iu vitamin D everyday for 6 months
NHS Guidelines on dose vitamin D required
panmerseyapc.nhs.uk/media/2...
GP will often only prescribe to bring vitamin D levels to 50nmol.
Some areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But, improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly when supplementing
Can test via NHS private testing service
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Vitamin D may prevent Autoimmune disease
newscientist.com/article/23...
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Recipe ideas
bbc.co.uk/food/articles/mag...
Interesting article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
Also need BOTH TPO and TG antibodies tested for autoimmune hypothyroid disease (hashimoto’s)
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
GP's are obsessed with TSH, its literally all they care about. Your TSH is a little lower than average but then again who is average? It could just be your normal. In true hyperthyroidism we'd expect to see your FT4 result much much higher, often over range.
And FT3 which isnt shown/ tested is usually very high as well. Even if you get referred there's every chance an Endo will decline the referral.
The endo has accepted the referral and suggest subclinical hyper. I been getting a few symptoms and they said this could be the course.
SlowDragonAdministrator
You will need to test antibodies privately along with Ft3
NHS won’t test TG antibodies if TPO are normal
Suggest you test vitamin levels too before starting B12 or B complex. You might find Active B12 may be low
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
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
Thanks there a lot here,i will have a read through
SlowDragonAdministrator
come back with new post once you get retested
Possibly looking at central HYPOthyroidism
Low TSH and low(ish) Ft4 and low vitamin levels
Central hypothyroidism
bestpractice.bmj.com/topics...
ncbi.nlm.nih.gov/pmc/articl...
endocrinologyadvisor.com/ho...
academic.oup.com/jcem/artic...
Hyper??? With a TSH almost in the normal range????? You'd be more likely to see a TSH around 0.03. I wonder why GP thinks that without over range FT4 and FT3. I am hypo (secondary) and I have never had a TSH over 0.6 even with under range Frees. Perhaps, like me, you have a pituitary problem.
. He said sub hyper. I dont kmow much about it,but all confuing. My tsh 39 is the lowest it ever been.
You results appear to indicate subclinical hypothyroidism. To decide if you need treatment or not, I assume your thyroid will be scanned for any abnormalities.
I have been given 5 mg carnimazole but not taken them yet
it seems a bit hasty to prescribe antithyroid drugs without first knowing if T3 is high.
Has GP had advice from endo ?
Yes he was told to perscribe them
I really wouldn't take those with your results. Your free T4 is already too low. Most Gps and endos (who generally specialise in diabetes and dabble in thyroid) have never heard of central hypothyroid, which is more likely what you have with those results, but I'd get a full thyroid test with FT3 as well before taking anything - you could make yourself really ill. What symptoms do you have?
Headaches,heart beating faster while doing things,shaking,muscle weakness and blurry eyes. Do you think i should go private ? Who domyou recommened ?
I have also had a scan to
ultrasound ? or some other type of scan ?
what did it show ?
Ultrasound of neck and it come back fine
Mmm ...... so no nodules seen ?
if it was me i would get my own fT3 test done BEFORE taking an antithyroid drug so at least you know what your fT3 level is ~ even if Gp / endo can't be bothered to try and find out.
Carbimazole will lower your fT4/ fT3 levels , but your fT4 is nowhere near high it's always been under 50%, so they are just assuming your T3 is too high for you without even bothering to test it.
yes your symptoms (especially the shaking) 'could be' mild hyper , and if so a low dose carbimzole may help by stopping your thyroid making quite so much T4/T3 ... but if you lower T4/ T3 levels when they are not too high , it will not help at all, and you could end up with not enough T4/ T3 and consequently get symptoms of hypo.
"Monitor My Health" do a cheap TSH + fT4 + fT3 test (it's a private service run by an NHS hospital lab in exeter) , for around £30, ThyroidUK webpage has a 10% discount code.
Thanks i will have alook. There was no nodules seen.
Agree with tattybogle get your in ft3 result before deciding to take medication particularly as your thyroid seems normal.
Done in jan
Ultrascan
You're getting labs done at the wrong time of day. Your doctor should know this.
Proper testing time is 8am, fasting. It's imperative you get it done at 8am. No meds prior to 8am, and no vitamins or supplements taken for at least 3-5 days prior.
You are wise to hold off on taking that drug, Carbimazole. You need a full panel of thyroid labs.
You can order your own labs w/o a doctor. I'm not in the UK but I've seen many people on this board order their own labs. Many can instruct you on how to obtain it. Get it done quickly, as two years is an awfully. long stretch, no need to waste anymore time. And remember, 8am! Go to a reputable lab, and don't have them drawn in the doctor's office.
That is a good point Tinal25 , TSH has a circadian rhythm , so it is naturally higher around the middle of the night /very early morning ..... falling to it's lowest point every day around 1-3pm .. then gradually rising again , so you also need to bear this in mind.
When your TSH has been tested around midday and 4pm it will have been very close to it's lowest for that day .
the difference between highest / lowest each day may not be much in some people , but even so, if you have been tested around 8/9 am ish on those days instead of midday / 4pm ... your TSH could very well have been within range ... and GP would have sent you on your way with TSH results marked 'normal'.
The NHS fail to take 'time of day' into account for TSH tests (which is a bit idiotic of them )
I think many GP's are flat-out unaware of this detail, but it's of the utmost importance.
Results
I had this done a while back to
tattybogle some more results. No trabs.
Tinal25 are you taking any medicines or supplements? Some can interfere with thyroid itself as well as blood tests.
off to work , will look later x
N medicines and supplements
helvellaAdministratorThyroid UK
Aside from everything else, TSH varies through the day and afternoon is at its lowest.
Can you get the next blood draw earlier? Like the first test in the morning at 08:30?
See the graphs in my blog post:
helvella - Scheduling Blood Draws
Factors to consider when choosing time for blood draws. Includes links to several documents/webpages and previous HealthUnlocked posts.
Last updated 31/07/2024
In order for people to help, you may need to start a new post or edit your current with results all in one place. On the forum we tend to share results in date order like this:
TSH - Number followed by range
FT4 - Number followed by range
FT3 - Number followed by range
Then any antibodies.
TPO - Number followed by range
TGA - Number followed by range
TRAb - Number followed by range
Any other antibodies/blood tests
It’s also important to note the time of day for the tests (especially if the tests were had many hours after awaking), any supplements or medications you are taking, whether pregnant or not, or any other health condition (physical and/or mental) you or your family may have (thyroid and autoimmune issues run in families).
As you already have done, you can then mention any results of other investigations such as the scan.
From what you have shared so far (it’s difficult for me as the information isn’t all in one place) I can only reiterate what I have shared previously which is you need your most up to date FT3 result. With your scan and other blood test results, it seems very premature to start anti thyroid drugs. You mentioned that your referral for endo has been accepted, I assume this will be the same endo that advised your GP to start anti thyroid drugs in which case don’t hesitate to ask for a second opinion. It is your right. I suspect some other thing is going on that is affecting your TSH or as others have mentioned that it is your normal.
Please bear in mind I am not a medical expert.
I hope that helps.
Edit: tidied typos.
HSD-Nice post! I agree that it’s hard to grasp the big picture here with all the info scattered.
But I think we can all sense the doctor didn’t have enough info to make the assessment/prescription that was done.
Tinal25
If you can put all your blood test results in one place in date order, that would help us all.
We can then clearly recommend what tests we think you’re missing- and what your next blood test should include. These tests need to be done all together in the sane (edit:SAME) blood draw and under particular conditions to be most useful.
This post is a little too back-and-forth even for us seasoned forum members : )
If you can organize the info in order I’m sure we can crack the code!
But I think we can all sense the doctor didn’t have enough info to make the assessment/prescription that was done.
Yes. Scary isn’t it?!
HSD - yes this one is kinda next level… with the caveat that maybe there is something the dr knows that isn’t being shared here that would make this make sense, but … if not… what the heck! Yikes.
You did make me chuckle at “sane” blood test.
It’d be interesting to know if the Doctor knows something we don’t so far. I doubt it mind.
Sane indeed!!!!!
I mean… Negative for trabs too! I mean it could be subclinical hyperthyroidism (given the poster’s reported symptoms somewhere in the thread) with a ft3 that’s outside of the range, but it is a scarily premature decision.
Exactly 💯
I have to seem the endo this week with these results.
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