hello,
I’ve recently had blood test including TSH and T4.
On two occasions my TSH has been within normal range, but T4 has been low at 10.6 and 10.3 (ref range 12-22) Main symptoms are heavy periods and I’ve also noticed that I bruise quite easily.
has anyone had any similar experience of this?
welcome to the forum
Heavy periods likely to lead to anaemia
Low vitamin levels, especially low iron and/or ferritin can lower TSH
Request GP do FULL thyroid and vitamin testing including full iron panel test for anaemia including ferritin
cks.nice.org.uk/topics/anae...
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.
It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
If taking any iron supplements stop 5-7 days before testing
Medichecks iron panel test
medichecks.com/products/iro...
Low vitamin levels can be result of low thyroid levels
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once for autoimmune thyroid disease
Very important to test vitamin D, folate, ferritin and B12
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)
NHS only tests TG antibodies if TPO are high
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
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)
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...
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
thank you, I’ve already had a full blood count and was told I wasn’t anaemic but I’ll look into the other tests you have mentioned below.
Just being in-range doesn't automatically make it 'normal'. The ranges are too wide. What were the actual numbers? What time of day was the blood draw?
If you’re referring to TSH, it was 2.49 and blood draw was taken at around 12pm
Sorry yes, the tsh.
Well, over 2 is not 'normal', it suggests your thyroid is struggling. And at around 12 pm it would have been at its lowest. It would have been higher before 9 am.
That said, I doubt it would have been high enough to correspond to your under-range FT4s, so you may be looking at a pituitary problem here.
So would probably have been at least over 3 at 8am…..possibly higher
Please add results for iron, ferritin etc
HB 157 ug/l, Ferritin - 44 ug/l, Folate - 5.6 ug/l
HB 157 ug/l, Ferritin - 44 ug/l, Folate - 5.6 ug/l
Can you add ranges on these
Full iron panel test here
Medichecks iron panel test
medichecks.com/products/iro...
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
If taking any iron supplements stop 5-7 days before testing
No vitamin D result?
no B12 result?
Folate looks low
Hello,
Thanks for your reply, I have added the results below with ranges. Apologies as i didn't think to add some of the results before
Vit D = 83 nmol/L (range 62-102)
HB 157 ug/l (range 125-270)
Ferritin 44 ug/l (range 30 - 400)
TSAT 22% (range 15 - 50)
B12 136 pmol/l (range 40 - 210)
Folate 5.6 ug/l (range 3 - 25)
So folate is rather low
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 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...
Post discussing start B12 injections
Ferritin 44 ug/l (range 30 - 400)
cks.nice.org.uk/topics/anae...
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.
It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
If taking any iron supplements stop 5-7 days before testing
Medichecks iron panel test
medichecks.com/products/iro...
Look at increasing iron rich foods in diet
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
List of iron rich foods
Links about iron and ferritin
irondisorders.org/too-littl...
davidg170.sg-host.com/wp-co...
Great in-depth article on low ferritin
oatext.com/iron-deficiency-...
Aim to improve ferritin to at least over 70
Then retest thyroid levels in 3-4 months
Thank you. Could folate / ferritin cause low T4?
Important to maintain good vitamin levels for good thyroid function
Then retest thyroid
See if thyroid levels have improved
Ok, thank you.
GG I am with you. Ranges on the lab don't work for me having had TT. I need higher FT4 at 1.4-1.5 which lowers my TSH to near zero. But everyone has a different set point that makes them feel their very best. Thank you GG for bringing it to the forefront that not necessarily the ranges are the be all.
As Greygoose has suggested this seems like central/secondary hypothyroidism.
In primary hypothyroidism when FT4 gets low the TSH usually rises. In your case your FT4 has dropped below the range but your TSH is, you say, normal. That suggests a problem with the pituitary which should be sending a message to the TSH to rise but for some reason the message isn’t being sent or message not getting through
GP probably hasn’t heard of this so you’ll need to be diagnosed by an endo. Unfortunately a lot of them don’t know about it either!
It’s better to get diagnosed before starting Levothyroxine (same treatment as for primary hypothyroidism). Diagnosis is harder after hormone replacement has started - but if you get more test results with below range FT4 Levothyroxine may be needed and GP can prescribe that, so long as they look at FT4 not TSH only.
Thank you all for your replies.
I did have some other blood tests taken, but these were from a few months back, wonder if it's worth checking again.. and whether these could be causing the issue. TSAT & Ferritin were 'normal' but in the lower side of 'normal'
HB - 157 g/l
Ferritin - 44 ug/l
TSAT - 22%
Folate - 5.6 ug/l
Although these were within 'normal' range, the ferritin and TSAT
normal TSH and T3 but Low T4
Mega low TSH normal T4 & T3
Normal TSH but low T4
low TSH normal t3 and t4
High tsh normal t4
