Help interpreting latest results please

[CallMeSunny]

January 2024 July 2024 Nov 2024

TSH. 0.27-4.20. 1.59 1.59 3.5

T4. 12.00-22.0. 15.2 15.2 15.1

T3. 3.1-6.8. 3.5. 3.4. 4.5

All ranges the same. All tested privately.

78 years old, female. Diagnosed inflammatory arthritis 2019 (poor response to treatments, DMARDs and biologics).

Symptoms; Unable to regulate body temperature, usually 35.3-36.3, extremities always cold

Fatigue, hair loss, weight gain, anaemia, weakness, diminished sweating, constipation (poor motility), abdominal distension, post nasal drip, dry eyes, brittle nails.

Severe retrolisthesis, causing back, loin, groin, leg pain from trapped nerve at T12-L1 level.

Unfortunately no further intervention is possible (already had instrumented fusion L2-5, vertebrae above are too fragile for further pinning etc), consequently I keep pain at acceptable (mostly)

level with transdermal Bunorphrine patches, Pregabalin and Paracetamol plus a sensible Mediterranean diet. Exercising is difficult as I am now bent double . Thankfully my mental

health is ok. DVT in left leg post partum, DVT right leg post spine surgery. Does anyone think I have an issue with my thyroid levels please?

[greygoose]

Hi CallMeSunny, welcome to the forum.

I see in one of your other posts that you believe you have Central Hypo. Well, I think you might be right.

FT4: 15.1 pmol/l (Range 12 - 22) 31.00%

FT3: 4.5 pmol/l (Range 3.1 - 6.8) 37.84%

As you can see above, your Frees are very low. They should be around mid-range. And whilst a TSH of over 3 is technically hypo (although no doctor would ever admit that!) one would expect it to be higher with such low Frees.

This suggests that your pituitary, or you hypothalamus, is a bit sluggish. So, what you need are the other pituitary hormones tested to see if they are also low.

The problem is, getting a GP to take it seriously. For the most part, they only look at the TSH, and if it is anywhere within the range, they refuse to believe there's a problem. Convincing them to refer you to an endo can be hard. But only an endo can order the necessary tests.

Were all these tests done at the same time of day? What time was that? It rather looks as if the last one was done earlier than the other two. If so, you can't compare them. TSH is highest before 9 am. It then drops rapidly to its lowest point around midday. Then it starts to climb again. So, we always recommend having the blood draw before 9 am and fasting.

[CallMeSunny in reply to greygoose]

Thank you for your kind reply, GreyGoose. Testing as per protocol with vits B/Biotin stopped 6 days beforehand. Latest results as below:

Vitamin D ..75-200 //90. B12 ..37.5-150 / /150…Serum Folate.. 8.83-60.8//11.5

Ferritin 13-150//122 ….RBC, WBC, Neutrophils, Lymphocytes all low….

MCH, Mean Cell HB, ALT all above normal.

[greygoose in reply to CallMeSunny]

OK, so there is definitely a problem with the TSH, it does not correspond to the levels of the Frees. So, you need to see an endo that knows about Central Hypo. And they are rather thin on the ground! But, they do exist because we have quite a few people on here who have been diagnosed with CH - it's really not as rare as doctors insist!

So, what I would suggest is that you write a new post asking for recommendations for an endo well-up in Central Hypo, replies by PM only. Because we're not allowed to mention individual doctors on the open forum.

[CallMeSunny in reply to greygoose]

Could you please explain why the TSH doesn’t correspond to the level of the frees….do you mean the ratios? How is Central Hypo treated?

[SlowDragon Administrator in reply to CallMeSunny]

TSH should rise as Ft4 and Ft3 drop

TSH is message from pituitary asking thyroid to make more hormones

The higher the TSH the more insistent the message from pituitary

Next step

Improve low folate

Retest thyroid including BOTH thyroid antibodies

Your age is against you getting thyroid considered as an issue

Central hypothyroidism

bestpractice.bmj.com/topics...

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

endocrinologyadvisor.com/ho...

academic.oup.com/jcem/artic...

ec.bioscientifica.com/view/...

academic.oup.com/jcem/artic...

[SlowDragon Administrator]

What vitamin supplements are you taking

When were vitamin D, folate, ferritin and B12 last tested

I would get full thyroid including BOTH TPO and TG thyroid antibodies and vitamin testing

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...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

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 if taking

[CallMeSunny in reply to SlowDragon]

Thank you for your reply SlowDragon..and helpful information. I haven’t been diagnosed as yet, therefore am not taking levothyroxine. Regarding vitamin results etc, please see my reply to GreyGoose.

[SlowDragon Administrator in reply to CallMeSunny]

Folate.. 8.83-60.8//11.5

This is low

what vitamin supplements are you taking

Vitamin D, B12 and ferritin are good

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...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

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 and may need separate methyl folate couple times a week

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)

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[Judithdalston]

I saw a NHS endo.the other week ( I’ve been hypothyroid for 20+ years but GP getting consistently upset about suppressed TSH)…but he started the 45 min.appointment telling me about the hypothalamus, pituitary and thyroid axis where each gland communicates with each other to try to get thyroid hormones produced, and thus there was plenty of stages that could, be, to be scientific, ‘off’….age and other ailments seemed to send them more so! Unfortunately there has been growing ‘research’ suggesting older women naturally get a higher TSH level and do not need thyroid hormone supplements ( can you hear the cry of many forum members ‘Rubbish’?), so I hope you get a PM recommending someone who can help you.

[CallMeSunny in reply to Judithdalston]

I’m almost used to being placed on The Old Age Tip: I just don’t want to believe it! Thanks for your reply

[CallMeSunny]

So helpful…many thanks, I’m really grateful.

All test results taken on same date 27-11-2024. I’ll order the vitamin B complex tablets and take them after breakfast as you suggest.

At present I take half the recommended dose of following: Calcium Citrate + D3, Magnesium Citrate, Biotin + Zinc + Selenium, also B12 Complex 5000 sublingual spray (recommended dose) and D3000 sublingual spray (recommended dose).

I had TPO <9 [<34] & antiThyroglobulin Abs 12 [<115] taken January 2024.

My testosterone level was flagged up as below normal. 0.09 [1.101-1.42], which I’m curious about!

[Bearo]

low testosterone can be linked with pituitary problems. this isn’t the only cause, but it’s another indicator of central hypothyroidism.

[CallMeSunny in reply to Bearo]

Thanks Bearo…..I had a feeling it might be!