Please can you offer any advice on my 16-year old daughter’s test results? She’s been suffering with increasing fatigue, apathy and depression since October last year, to the point she is now missing school and her mock GCSEs. I’ve been with her to the GP 3 times and 3-4 phone consults but she was only offered an online mental health resource as local services are too busy. I took matters into my own hands (having just started treatment myself for hypothyroidism and doing it privately/self with help from the forum!) and ran the advanced thyroid test from Medichecks (knowing the GP won’t check thyroid properly or any vitamins). Here are her results (8am fasted):
Ferritin 47 ug/L (Range: 30 - 207)
Active Vitamin B12 39.7 pmol/L (Range: > 37.5)
Folate X - sample error (from finger prick)
Vitamin D 88nmol/L (50-250)
Thyroid Hormones:
TSH 4.670 mIU/L (Range: 0.27 - 4.2)
T3 5.4 pmol/L (Range: 3.1 - 6.8)
T4 13.4 pmol/L (Range: 12 - 22)
Antibodies 23.2 kIU/L (Range: 0 - 115)
TPO 32.9 kIU/L (Range: 0 - 34)
Clearly her thyroid appears to be struggling but also her vitamins aren’t looking good either. Also why would her T4 be so low in range but T3 middle? I’ve been back to the GP and insisted they run a full panel- FBC , folate, liver, kidney, b12, vit d I asked for thyroid but in checking the form at home it only says TSH 😡, but I’m not expecting them to even treat her as her TSH isn’t over 5.
My thoughts are to get her vitamins up asap (I posted in the b12 forum as I’m pretty concerned about that low active level), and then to retest thyroid in a month or so. Thoughts? I’d like to investigate why the b12 is so low and hoping the full blood panel will shed a light and see what’s going on with her folate and iron status too.
Other things to note she’s not a vegetarian but is gluten intolerant - we picked it up on a home York test when she was around 10 years old and suffering with stomach issues which the NHS labelled as ‘anxiety’ because all tests were normal 🙄. She mostly avoids gluten (we have all the GF alternatives, but she does sneak in treats here and there and can reach for the bread sometimes!). Should I push for a coeliac test given almost out of range TPO?
Many thanks 🙏
Written by
GussyG
To view profiles and participate in discussions please or .
the higher TSH causes the T3 to stay relatively ok despite low fT4
because higher TSH level increases the ratio of T3:T4 that the thyroid produces. making a bit more T3 than usual.
higher TSH also has a small effect of upregulating the deiodinases to make conversion of T4 to T3 more efficient . so you get more T3 out of the same amount of T4
it's presumably a kind of safety net to protect T3 levels ,,, when T4 goes low , the system does it's best to make sure there is enough T3 available to keep the essentials working.... (it doesn't keep this up forever , ultimately the fT3 level starts to fall as well ,,, but that takes a long time) ,
in early thyroid failure , first the T4 falls a little , and the TSH goes up . TSH moves a lot in relation to small fT4 changes , so the raised TSH is usually the first thing that goes out of range . so in early thyroid failure , you get result like your daughters ... raised TSH / T4 lowish but still in range / T3 looks ok.
show GP the over range TSH , get it on her records now , they will probably need to do their own test, unlikely to accept private results, so make sure the GP blood test appt is early am , without eating breakfast. teas coffee etc . just water . that gives highest TSH.
they will need to retest to make sure it's not a one off , expect to be told she needs a retest in 3 months, you can try pushing them to shorten this a bit to maybe 6-8 wks , since it's affecting her so badly and school etc.
they can't prescribe levo yet , but once they have 2 over-range TSH's plus symptoms of hypo, they 'can consider it '
When discussing whether or not to start treatment for subclinical hypothyroidism, take into account features that might suggest underlying thyroid disease, such as symptoms of hypothyroidism, previous radioactive iodine treatment or thyroid surgery, or raised levels of thyroid autoantibodies.
Adults
1.5.3
Consider levothyroxine for adults with subclinical hypothyroidism who have a TSH of 10 mlU/litre or higher on 2 separate occasions 3 months apart. Follow the recommendations in section 1.4 on follow-up and monitoring of hypothyroidism.
1.5.4
Consider a 6-month trial of levothyroxine for adults under 65 with subclinical hypothyroidism who have:
a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions 3 months apart, and
symptoms of hypothyroidism.
If symptoms do not improve after starting levothyroxine, re-measure TSH and if the level remains raised, adjust the dose. If symptoms persist when serum TSH is within the reference range, consider stopping levothyroxine and follow the recommendations on monitoring untreated subclinical hypothyroidism and monitoring after stopping treatment.
Children and young people aged 2 years and over
1.5.5
Consider levothyroxine for children aged 2 years and over and young people with subclinical hypothyroidism who have:
a TSH level of 20 mlU/litre or higher, or
a TSH level between 10 and 20 mlU/litre on 2 separate occasions 3 months apart, or
a TSH level between 5 and 10 mlU/litre on 2 separate occasions 3 months apart, and
thyroid dysgenesis (an underdeveloped thyroid gland), or
signs or symptoms of thyroid dysfunction.
During levothyroxine treatment, follow the recommendations in section 1.4 on follow-up and monitoring.
Thank you Tatty for more great knowledge sharing! That’s fascinating about the T4/T3 regulation.
I don’t really want her to start any thyroid replacement at this stage and if the uk guidelines are TSH over 5 on two separate occasions and she’s under that already, then it’s going to be a battle. Let’s see what the second reading says… I’m really hoping once I get her vits into a good range her thyroid might make some improvements, let’s see 🤞
i think you're right actually .... last thing she needs is doctors suggesting it's all in her head, she needs to feel supported and validated , and the "oh but your TSH is only marginally over range dear" conversation is unlikely to help .
so as long as you're keeping a close eye on it,,,, that's ok for now . my reply last night was mainly meaning to make sure to get her TSH on record officially as it might be useful later on .It's possible GP test may not quite be over range as labs/tests will always differ a little bit , and its only marginally over on your test
also .. the fact that her antibodies are (just) within range means GP's would be extremely reluctant to even consider levo without seeing much stronger evidence of persistently higher TSH.
the in range antibodies gives you both some hope that it's not autoimmune hypo starting ....yes , it is technically possible to have autoimmune damage without finding positive TPO / TG antibodies, but the vast majority do have them ..so i agree , fix the other stuff first , and just observe thyroid for now .
oh...i just remembered .. when my D was at secondary school , the school had access to some free counselling services for pupils in need of it , so it might be worth asking xxx
I have often been grateful for getting sick (actually, grateful for finding the forum…) as I been able to guide my own daughter (now 18) through fatigue and symptoms for the past couple years. You can see some advice I got in a couple posts I’ve written asking for help with her.
Our daughters sound different.
I am still not 100% sure if my daughter needs thyroid treatment. Some days I think not some days I think it’s inevitable.
But I will just call out a point about vitamins:
So for the past year or so, while I’ve gotten her blood tested every couple months, while her thyroid numbers were ambiguous , I used the time to optimize the essential vitamins/minerals: iron/ferritin, b12, folate and d3. Because without those at optimal, even a healthy thyroid won’t be able to function.
My daughter takes three arrows under my supervision… d3/k, magnesium, Thorne b complex and b12 spray for a boost if a blood test shows she needs it.
Surprisingly and confusingly in the past year her numbers have stabilized. For a while her TSH kept creeping up. A month ago I was shocked to see it at 1. There’s a lot more to the story, but basically - tackle her vitamins with purpose! No need to delay, do it while you wait and advocate through the system.
No matter the outcome (Levo or not), she needs these to be good in any scenario.
Second - get her a full iron panel + a complete CBC (FBC) so you can start addressing what might be low iron.
* Iron
* Total iron-binding capacity (TIBC)
* Transferrin saturation %
* Ferritin
* High Sensitivity CRP (CRP-hs)
FBC for hemoglobin, hematocrit, MCV, MCH, MCHC, and RDW, etc.
As you know iron in excess is toxic and you need all measures tested together (and regularly when supplementing) to be able to draw any good conclusion and action plan.
In the USA doctors do a CBC i.e. Complete Blood Count.
In the UK doctors do a FBC i.e. Full Blood Count.
They are largely the same as far as I'm aware, despite the difference in name, but I wouldn't be surprised if there are occasionally some minor differences between them. Even labs within the UK don't always do FBCs that are identical to each other, but they are usually very close.
Hello, watch Mikayla Peterson or her dad Jordan Peterson on Joe Rogan. Animal based diet is nutritious for our brains and relieves depression, anxiety, and helps thyroid do what it's supposed to do. If you go this route change over slowly for gut to keep up and not have diarrhea. I started with breakfast bacon and eggs couple weeks, then changed lunch to burgers or steak and butter few weeks and then made more at lunch to have left overs for dinner. I read Paul Sauldino's and Shawn Baker's books on carnivore before starting because it sounded too wild to me going against everything we have been told. But I ate what I thought was healthy prior--lean protein, salads, little fruit, nuts, avocados for healthy fat, olive oil etc. I have never felt better and I"m 56 had hashi's and low thyroid, hair falling out, ringing in the ears (will begin again when I have sugar) . I do take NP Thyroid (dessicated pig thyroid) 30mg and baked egg shells grinded for calcium (Ken Barry recipe). I know sounds crazy. Read about it I did not believe either. Good luck on your daughter's journey!
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
High T4 - Test Results
Updated Results 
Daughter’s results causing confusion - Hashimoto’s AND Graves??
Test results advice
My latest test results, still not well
