Help interpreting blood results

[Alba68]

Hi,

Following on from a slightly high tsh of 8.2 when I had a general blood check done a month ago, I’ve had another set done with following results:

TSH 8.58 (0.4 - 4)

Free T4 14.9 (11.90 - 21.60)

TPO 298 (<34)

TSH RECEPTOR ANTIBODY 0.85 (<1.75)

If I’m interpreting these results correctly, then

- T4 is within normal range so no evidence of hypothyroidism yet

- TSH receptor normal so no evidence of graves

- TPO too high so evidence of Hashimotos unfortunately

- TSH slightly high

I’m a bit confused as to why my TSH is high when it seems I don’t have hypothyroidism. Is there any explanation for this? I would expect this to mean I don’t need any treatment (yet) and I don’t have any symptoms. Does this interpretation seem correct and can anyone explain why the TSH is above normal?

I also expect that, given indication of hashimotos, I should have bloods done in the future to check for hypothyroidism? In the absence of symptoms what would be the recommended frequency - annually?

TIA

[GlowCoach Administrator]

The net result of your blood test is that you have whats known as sub clinical hypothyroidism. This is determined by above range TSH but within range FT4.

I see that you are in France and I dont know the details about what is required to begin treatment in France but in the UK, if you have 1 TSH result above 10 or 2x TSH results above range its usual to begin treatment at that point.

Suggest retesting every 3 months but really I would recommend beginning treatment now as its unlikely to improve.

Leaving it a long time to start treatment can mean very low vitamin levels, as we get low stomach acid and therefore poor absorption of vitamins. These cause symptoms on top of the low thyroid hormone symptoms and can mean it is harder to begin Levo when you do.

Suggest you get key vitamins checked - ferritin, folate, B12 & D3. Start a new post when you have the results for members suggestions.

You say you have no symptoms but perhaps there are irritating things happening that you may not associate with being hypo?

Many with autoimmune thyroid disease aka Hashimoto's benefit from a gluten free diet. A smaller percentage of those also need to remove dairy from their diet to feel well. These are intolerances and will not show up on any blood test.

Do you do tests as per the protocol recommended here?

Recommended blood test protocol: Test at 9am (or as close as possible) & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process).

Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day.

[Alba68 in reply to GlowCoach]

Thanks for the advice.

Out of interest, what does Biotin do to the results? Does it result in a too high or too low TSH/TPO/T4?

When I say I don’t have symptoms, I mean I don’t have obvious abnormal symptoms. For example I’m a man in my fifties so thinning hair kind of comes with the territory unfortunately (which is irritating 😉).

One additional factor is that I had Lymes disease this summer but spotted it early and had antibiotic course to clear it.

I did read that subclinical hypo can sometimes resolve itself so (barring symptoms) I think my plan might be to get retested in say 3-6 months and take it from there.

[GlowCoach Administrator in reply to Alba68]

I couldnt be specific about how biotin affects results I'm afraid. The studies done on it used large amounts of biotin.

In the mean time before beginning treatment I would get the vitamin tests run, then you can be ahead of the game once you do start Levo.

'In range' results arent good enough, they need to be good - well over 50-70% of range depending on the test.

Hair thinning can also be due to low iron or ferritin which is common with hypo. Even with the best diet we just dont absorb the vitamins well at all.

[greygoose]

No, I'm afraid you haven't interpreted them correctly:

TSH: given that a euthyroid (i.e. no thyroid problems) is around 1, yours is not 'slightly high', it's pretty hypo!

FT4: 14.9 pmol/l (Range 11.9 - 21.6) 30.93%

Your FT4 may be in-range but it's very low. Euthyroid would be around 50%. Yours is hypo.

And there's no FT3 but pretty certain that that is even lower which is causing your TSH to rise.

The TPOab are saying Hashi's, yes. And given your TSH level, it's been active for quite some time already. Your thyroid has already been considerably damaged. And, yes, you do have hypothyroidism, I'm afraid.

So, with low FT4, high TSH and high antibodies, you should be put on levo straight away. It isn't going to get any better and will undoubtedly get a lot worse. I really don't think you should wait.

[tattybogle]

Small changes in fT4 level lead to relatively bigger changes in TSH level. That is how the regulating system works , tiny changes in thyroid hormone level lead to bigger changes in TSH level.

So when thyroid is starting to fail due to autoimmune damage , the relatively small drop in ft4 levels won't stand out on a blood test because the fT4 levels will tend to still be 'in range' albeit 'a little bit lower in range than is normal for that individual' ... but the relatively larger rise in TSH level flags it up.....this is why they tend to rely on TSH rather than fT4 as a useful early warning light' for developing hypothyroidism.

individuals will notice symptoms from the lower fT4 levels at different points .. some will struggle to function even though their fT4 levels still appear ok , some won't notice any symptoms until much later when TSH is much higher and fT4 is below range. But once TSH is over range the risks for all sort of issues go up even though fT4 is still within range (cardiovascular / bones/ raised cholesterol to name just a few) , this is why in NHS thyroid hormone replacement is recommended once TSH is over 10 , even in patients with no obvious symptoms .

Some individuals will worsen extremely quickly and become overtly hypo within weeks ( 'overt' meaning fT4 is also below range) ..... other individuals will take many years, even decades to worsen to that extent .. and others may never become overtly hypo.

in the absence of symptoms monitoring annually is 'ok',,, but with TSH already at 8 i would be looking at 3 or 6 monthly if it was me .

The longer you leave the body without quite enough thyroid hormone , the more damage is done to various bits of the body , and they are not all obvious ..eg tendons ligaments , all sorts ....and so the longer it takes to repair once you do get enough.

The body is pretty clever in trying to minimise this damage initially .. when the TSH rises , one of it's effects is to cause the thyroid to make a higher ratio of T3 to T4 than it usually does .. it also improves the efficiency of conversion from T4 to T3 in cells within the rest of the body . T3 is the active hormone (T4 is more or less a storage / transport form of T3) .... this seems to be a 'safety net' to compensate for temporary sub optimal levels of T4 , to make sure the organs have enough essential T3 to keep you alive , but this safety net only lasts for so long ... if / when the thyroid becomes so damaged that it can't maintain T3 production either , fT3 level will fall too .

[Alba68 in reply to tattybogle]

Thank you for the advice.

I’ll obviously see what my dr advises but as a minimum will ask to get bloods done again in a few months, as you suggest.

I’ve since read a bit about subclinical (mayo, nice advisories etc) and they suggest that a (small) percentage of people who are subclinical do actually resolve with no intervention. I’m reluctant to go on medication unless it’s necessary but understand that my results are indicating there is a problem. The only symptom I have is high cholesterol and that may/may not be related to the hashimotos as have a family history of high cholesterol. Unfortunately this is the first blood screen I’ve had so I can’t be sure how long any of these issues have been present.

[tattybogle in reply to Alba68]

yes they do say that 'some resolve without intervention'.... but

(certainly in the case of those who DO have symptoms when 'subclinical')

unless we could ask the individuals involved we don't know if 'resolved' means:

"yeah! it was just a blip in TSH from some other cause , it got better by itself i'm now feeling ok, and have been for several years "

or

"my TSH was 5. 8 at first test (possibly taken early morning when TSH is highest) , and then marginally within range at next test (taken mid afternoon ~TSH is lowest) so i was dismissed as resolved , but i'm still cold , mentally slow ,and constipated and now GP will not even offer a trial of levo because my TSH is 4.99 "

( when in fact the vast majority of healthy people have a TSH of consistently around 1 or 2 ... not nearly 5 .... see this graph : healthunlocked.com/thyroidu... tsh-levels-in-healthy-people-with-no-known-thyroid-disease )

So we have to be a bit careful and look at the research that NICE etc base these ideas on... statistics can be misleading if you don't know the details of where they got the data . and how long the follow up was.

the examples above would both have TSH results on file , which would be included in research data saying it resolved..... yes , one appears resolved ...but the other one is clearly not .

and we know from experience on here that the second example is extremely common... ~obviously we tend not to hear from the first sort, so who knows how common that really is ?

Hopefully you continue to feel ok for a long time and don't need to 'go there' ,,, but forewarned is forearmed... it 's good you now know to keep an eye on it ,, and if you do start to feel hypo , you know what it is and can deal with it promptly.

[Alba68 in reply to tattybogle]

Ha - yes, ex-statistician here so I know how easily they can be misused/misunderstood. I also wondered about the cohort who ‘recovered’. e.g. they may be younger/healthier so their body can resolve the problem better and being in my fifties that may be less possible - we shall see.

Thanks again

[tattybogle in reply to Alba68]

yup ... "lies ... damn lies ..and statistics"

endocrinologists also seem very fond of telling hyper patients that "there is a small chance of becoming hypo after having Radio Active Iodine ablation to control overactive thyroid but most people won't" ....... this 'fact' seems to be based on statistics of how many are on levo by 6 mths after the procedure ....however,,, if you look at how many of them are on levo after 5 yrs it will be most of them. (because RAI is a slow burn)