Are my numbers bad enough for symptoms?

[thunderthyroid]

Hi, I'm 46 year old male. I have yearly thyroid tests because I'm 'borderline'. I feel like I have a lot of symptoms: low libido, sensitivity to cold, weight gain, depression, brain fog, increasing aches and pains. I'm a bit overweight but not hugely so and regularly run and lift weights. My last bloods in September '24 were: TSH - 5.94 mu/L (range:0.35-4.94); free T4 11.7 pmol/L (range 9.0 - 19.1). So my TSH is above the range and my T4 scraping the bottom but still within range. Are my symptoms just 'aging' or could I be exhibiting hypothyroidism? I feel like I'm 67, not 47.

[Agitator23]

Maybe your T4 is too low for you. Your natural healthy T4 level may be much higher than that. TSH at that level is shouting for more T4. It's at least likely your symptoms are due to hypothyroidism. Took me years of struggling to get a diagnosis. I finally was diagnosed hypothyroid with T4 and TSH within range. (My biog explains).

[thunderthyroid in reply to Agitator23]

That's what I'm going to say to doctor: if they can't exclude possibility my thyroid numbers are causing my symptoms, then how can they exclude any offer of treatment?

[Agitator23 in reply to thunderthyroid]

One of my previous posts has a graph that might be useful to illustrate your point...

[tattybogle in reply to Agitator23]

this graph perhaps ?,

thundthyroid ~ it shows it's extremely unlikely that TSH persistently around 5 is 'healthy' in anyone of any age ~ useful visual aid when discussing with GP : healthunlocked.com/thyroidu... tsh-levels-in-healthy-people-with-no-known-thyroid-disease

(this post may be useful if you do get prescribed levo : healthunlocked.com/thyroidu.... list-of-references-recommending-gps-keep-tsh-lower-in-range )

it's definitely possible to have significant symptoms without dreadful bloods ~ age 37 i was very cold and slow physically and mentally , often monosylabic ~ to the level i'd had to move to an easier to manage lifestyle / job / give up social life etc/ much worse in winter ....with TSH /TT4 that didn't look too bad :

TSH 5.7 then 6.8 [0.36-4.1] and my Total T4 was still within range 94 then 91 [65 -155]

i'd had worsening symptoms for 4yrs but no one thought to look at thyroid as i hadn't gained much weight , just a puffy/ lumpy looking face . I was prescribed levo on those results , ( this was back in 2003 , before the current 'TSH 10' guidelines )

I think the main reason they gave it despite TSH / TT4 not looking too bad was my TPOab were extremely high ( 2499 then >3000 [0-50] and also the trend of TSH going higher , and TT4 going lower over a couple of months,

i never totally got my previous energy/ stamina back even on levo , but it improved how was doing by about 75% .

[thunderthyroid in reply to tattybogle]

Thanks for your reply. I'm getting a 404 error message from the link to the useful visual aid.

[tattybogle in reply to thunderthyroid]

fixed it now . hopefully

[tattybogle in reply to tattybogle]

p.s as well as helvella's point about closer to 9 than 10 am making a small difference to TSH..... not having breakfast before testing is also worth considering ,,, in some people , but not all , eating breakfast before testing was shown to lower TSH by up to 30%,,, so probably worth having all future TSH tests as 'fasting' , just in case . (details of that study are in relies to link i gave above )

[Agitator23 in reply to thunderthyroid]

This is the graph I mentioned.

Graph

[helvella Administrator]

My own results were not that different at the point I was diagnosed. (Though long enough ago that the idea TSH must be at least 10 had not taken root like it has now.)

Numerous issues improved very obviously (to me) as my dose increased and time on levothyroxine increased.

The point about repeating tests (at whatever interval) shouldn't be to provide a reason to refuse treatment. Far more, it should be to ensure that a transient period of modestly disturbed test results don't automatically get treated with levothyroxine. Sometimes short periods of relatively low thyroid levels do resolve without treatment. But we see relatively few here!

From your long history, they are actually just refusing to treat you because of numbers alone. Happily ignoring symptoms and the context - of repeated tests over years.

Scraping the bottom and having symptoms is far from acceptable.

Do you get your blood draws done early in the morning? TSH tends to be highest early - preferably before 09:00. Which can help with getting results which convince.

It would be good to be sure of several other factors. Like vitamin B12, vitamin B9 (folate), vitamin D, iron levels, lipids (cholesterol, etc.), full blood count. Unfortunately, too many of us do not get these done by our GPs - and if you can manage it, a private test might be helpful to find out where you are.

[thunderthyroid in reply to helvella]

I've been away from this site a while, but I've reread some of my old posts from 8 years ago and I was suffering the same symptoms with similar bloods, tho' my TSH was just about in range and now it isn't. The docs just prescribe Viagra, tho' I tell them about my whole suite of symptoms. I'm pretty sure it's not just 'aging' as I remember distinctly a very precipitous drop in libido at age of about 35, then other symptoms creeping in. The physical sensation was like that of a neon hotel light flickering on and off over that year, something inside struggling to work; 1 month I felt 'normal', the next I felt like I was 'off', like I feel now, like an old man. By the time I was 37, I was in this new reality of a body I didn't recognise. It wasn't a gradual decline at all.

And it doesn't improve, whether I lose weight or exercise more. At 1st I thought it might be SAD as there was marginal improvement come summer, but even that's disappeared. My memory's a lot worse; I keep fit (but don't over do it), yet still struggle with fatigue and aching; my eyes have gone down the toilet; I put on weight incredibly easy, tho' I cut more and more from my diet; my depression and low mood is overpowering, despite the fact my life is ostensibly much better (with a wife and child).

I'm going to doctors tomorrow and gonna hammer them. Or maybe beg. What's the risk of a low trial dose of levo? They're happy to give out the blue pill like Smarties, but never want to get to root of problem.

I get my bloods done by about 10am as I've got to cycle to the phlebotomy place.

[helvella Administrator in reply to thunderthyroid]

The risk of levothyroxine is extremely low.

The biggest issue seems to be getting them to accept your reports, your symptoms, and deciding to offer it.

Maybe words like "trial", "low dose" or similar confetti words would help?

And make sure you have spent some time reviewing and revising your symptom list. Be prepared to go through it step by step with explanations and examples, or whatever you think right. Just doing that should help in preparation.

By 10:00, TSH could have dropped enough to make a difference to interpretation. It's not going toto go from 20 to 5.94, but it very much could drop from 7.1 to 5.94 - and, although we can see that difference is quite small, 7.1 LOOKS to be a much higher result!

[SlowDragon Ambassador]

Suggest you get FULL thyroid and vitamin testing as next step

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

Also both TPO and TG thyroid antibodies tested at least once for utoimmune thyroid disease (hashimoto’s)

Very important to test vitamin D, folate, ferritin and B12 once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

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)

What vitamin supplements are you taking …..if any?

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...

Suggest you also get testosterone level tested

[thunderthyroid in reply to SlowDragon]

Thanks everso for your comprehensive answer. I had my testosterone checked last year and it was midrange, not too bad for my age (18.6 nmol/L out of range 8.6-29.0). My free testosterone was okay too. I thought it might be low-T, but my T results are not consistently underwhelming, unlike my thyroid, which has been high TSH and low T4 for a decade. Besides, it would make more sense to me to go the thyroid route 1st, given the side effects and cost are less severe.

Just vitamin D, C and Zinc really. And cod liver oil, garlic tabs - the usual over-the-counter suspects. I've experimented with all kinds of herbal supplements before e.g. pine pollen, l-citruline, tongkat - all of it snake oil in my experience.

I've purchased a Medickecks full thyroid package and will take your advice about a 9am appointment on a Monday or Tuesday.

When I talk to other men my age (47) about how they feel physically, the only 1s who can empathise are those with an illness e.g. diabetes, morbid obesity, arthritis, something. Well I haven't got any of these, so why do I feel so knackered, depressed and impotent half the time? There must be an answer.

[SlowDragon Ambassador in reply to thunderthyroid]

Come back with new post once you get results

[Doris11]

I had problems for 6 months before I was diagnosed! I looked it up on google!

Night sweats, feeling cold, hair loss, burning feet, brain fog! Fatigue…. Weight gain! . I had low B12 to and low folate so it might be worth getting that checked too.

My results were similar to yours and luckily my GP prescribed thyroxine for me!