Thyroid results question

[Stathiss]

26M 65kg Hi, i take 100mg sertraline everyday. 2nd of May Tsh was 5.76 μIU/mL, 18th of May anti-tg was 2.00 iu/ml and anti-tpo 3.00, 4th of july tsh was 3.79 μIU/mL, ft3 was 2.89 pg/mL, ft4 was 0.91 ng/dLl. Do i have hypo-hyper thyroid or something else thyroid-related? I didn't go to the last appointment because the weather was unbearably hot, that's why i am asking.

[greygoose]

Hi Stathiss, welcome to the forum.

Could you put the ranges for those results, please? Results without ranges are meaningless because they vary frm lab to lab.

But, with a TSH over 5, you are hypo, not hyper.

What time of day were the blood draws for these tests? Were they all done at the same time of day?

[Stathiss in reply to greygoose]

Before i send the ranges, i want to ask if this endocrinologist(on a medical site) gave me correct advice. I am gonna visit my pathologist either way. I am just asking because my appointment is in 3 weeks almost. Here is the conversation.

Conversation

[SlowDragon Ambassador in reply to Stathiss]

With TSH over 5 you are HYPO …..not hyper

Please add ranges on antibodies, Ft4 and Ft3 results

ALWAYS test thyroid early morning

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12

Low vitamin levels very common when hypo

Are you in U.K. ?

[Stathiss in reply to SlowDragon]

I am in Greece, anti tg reference value < 4.11 iu/ml anti tpo <5.61 iu/ml , tsh 0.35-4.94 μiu/ml ft3 1.58-3.91 pg/ml, ft4 0.70-1.48 ng/dl, my vitamin d 25oh was 15.9 reference value was 30-40 ng/mL, i am taking 2000 iu vitamin d for 2 months, then i stop for 3 months and then i take again so it should have been improved, folate was 6.6 reference value is 3.1-20.5 ng/ml, tsh was tested with mU/l values. b12 was 313, reference is 187-883 pg/mL. all the tests were done without eating. 9 am in the morning except thyroid tests, they were done 11am, the other one/two 12 pm something like that. i think i had taken sertraline first(if that matters). i forgot to say that the tests as i said in my first post were done in different dates. you can check them above

[SlowDragon Ambassador in reply to Stathiss]

May 2024

tsh 5.76 range 0.35-4.94 μiu/ml

July tests

TSH 3.79 range 0.35-4.94 μiu/ml

ft3 2.89 range 1.58-3.91 pg/ml,

ft4 0.91 range 0.70-1.48 ng/dl,

anti tg reference value 2.00 range < 4.11 iu/ml

anti tpo 3.00 range <5.61 iu/ml ,

vitamin d 25oh was 15.9 reference value was 30-40 ng/mL,

folate was 6.6 reference value is 3.1-20.5 ng/ml,

b12 was 313, reference is 187-883 pg/mL.

July test shows low Ft4

Free T4 (fT4) .91 pmol/L (.70 - 1.48) 

Ft4 only 26.9% through range

Negative antibodies

No ferritin result. Get FULL iron panel including ferritin tested

Low vitamin levels could be because of low thyroid or low Ft4 could be because of low vitamin levels

Retest vitamin D

Likely to need to supplement vitamin D continuously to maintain at least around 40ng/ml

Are you vegetarian or vegan?

Have you been tested for coeliac disease

B12 and folate low

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...

In-depth article on different forms of B12

perniciousanemia.org/b12/fo...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

perniciousanemia.org/b12/le...

And why aiming to keep B12 over 500 recommended

perniciousanemia.org/b12/le...

Great reply by @humanbean on B12 here

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...

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) and continue separate B12 as last test result serum B12 was below 500 or active B12 (private test) under 70:

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

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

Come back with new post once you get iron panel results

Retest thyroid early morning in 2-4 months after improving all four vitamins to OPTIMAL levels

[greygoose in reply to Stathiss]

No, he is 100% wrong. You are not any sort of hyper with a TSH over 5 and you definitely do not need an anti-thyroid drug - in, fact, that's the last thing you need! The man is a charlatan!

[Tina_Maria in reply to Stathiss]

I think it is clear that this General Practitioner you consulted knows nothing about thyroid conditions. I wish people like that would stay away from patients and certainly not take any money for advice!

A TSH of 5.76 is indicative of HYPOthyroidism, as is a low fT4 of 0.91. Your fT3 was at the top of the range, but this can happen in hypothyroidism, when you have a so-called hyper swing. Basically, your thyroid is giving a last effort to get your thyroid hormones higher, but eventually you fT4 and fT3 will keep falling. You should keep monitoring TSH, T4 and T3 and eventually you might need to go on replacement therapy.

Prednisolone is quite a powerful steroid and usually only given in severe or painful cases of thyroiditis, but you have not mentioned anywhere if you are in pain and neither has that practitioner examined you to judge, if that is necessary. I would consult another GP, if prednisolone is really medically warranted. I would be very suspicious, especially if you would have to pay for the medication on top of the consultation (as this guy may have an incentive to prescribe meds to get more money out of you). Sorry if this sounds very cynical, but it is always better to be cautious.

Setraline can cause hypothyroidism in some patients, so it may be possible that this could be the cause of your TSH rising and your thyroid hormones to fall. The best way forward is really to monitor your thyroid levels and see how the situation develops (and if you may need thyroid medication or not).

[Stathiss in reply to greygoose]

I ate so i posted the ranges to the other person below(in case it doesn't notify you if someone else replies to another person in this post).

[greygoose in reply to Stathiss]

No, it doesn't notify me if you reply to someone else.

OK, so you had your blood draws at the time when your TSH would have been at its lowest, so if you had done it before 9am, the results would have been higher - impossible to tell how much higher, though. But you are definitely hypo.

Your antibodies are negative, but that doesn't automatically rule out autoimmune thyroiditis - aka Hashi's - because antibodies fluctuate all the time. So, they should be repeated a couple of times.