TSH & Ferritin

[yewotc23]

Hi, all... I read the following online:

Low ferritin levels, which indicate iron deficiency, can indirectly influence thyroid-stimulating hormone (TSH) levels, potentially leading to elevated TSH and a picture of hypothyroidism, even if the thyroid itself is functioning normally

Does that mean if I've always had low ferritin, I may actually not have hypothyroidism?

My TSH was always in range, then one random blood test it had gone over range to

Serum TSH: 11.9 [0.27 - 4.2]

Serum free T4: 12 [12.0 - 22.0]

GP started me on Levo straight away and my next Serum TSH came back as

Serum TSH: 5.1 [0.27 - 4.2]

I then found out I had low ferritin, but not idea how long that had been low for

So no idea if I am actually hypo or if low ferritin made my TSH increase and paints picture or hypo as no idea how long ferritin had been low

[greygoose]

I always thought it was the other way round, that low ferritin lowered the TSH. But even if it actually raises it, it's highly unlikely that it would raise it that much! Plus your TSH corresponded well with your very low FT4. Pretty certain you were very hypo at that point, given that a euthyroid TSH is around 1.

Plus, if your high TSH had been due to low ferritin and not to being hypo, taking levo would not have brought it down like that. I don't think there's any doubt that you're hypo.

[yewotc23 in reply to greygoose]

Thanks greygoose

Interesting things are my thyroid last year was 3.58, but that was an afternoon test as was all they could offer me

But this week's thyroid check, TSH came back as 1.5 - that was done early morning with last levo about 22 hours before and only water to drink 12 hours beforehand.

Also had full blood count with MCV, MCH and Haemotrocit all lower than before I took ferrous fumarate last year. But red blood cells & Haemoglobin were both higher. Due ferritin check again next month so whether that is low will be interesting

So you think I am definitely hypo?

[greygoose in reply to yewotc23]

nteresting things are my thyroid last year was 3.58, but that was an afternoon test as was all they could offer me But this week's thyroid check, TSH came back as 1.5 - that was done early morning

Well, not really interesting. You'd hardly expect it to be the same a year later when you've been taking levo.

But that reading is TSH. TSH is not your thyroid. It is a pituitary hormone and when you're taking levo, it tells you very little about your thyroid.

But, yes, I really do think you're hypo.

[yewotc23 in reply to greygoose]

Thanks greygoose the other thing is, i' due to have my Ferritin retested next month. If that comes back low again and I have to take iron tablets again, would that send me hyper?

It's so confusing as no idea if low iron decreaeases TSH or raises it. So whether iron tablets would raise TSH or lower it further from the TSH 1.5 l got this week?

[greygoose in reply to yewotc23]

Absolutely not, no.

The definition of 'hyper' (over-active thyroid) is: extremely high FT4 and FT3, and therefore low TSH.

Hyper does not just mean low TSH.

Besides, as you are hypo - as proved by your very low FT4 - your thyroid cannot suddenly regenerate and start over-producing hormone, whether your ferritin rises or not. It's a physical impossibility.

It's not confusing really. The TSH just follows the level of your thyroid hormones: low thyroid hormones, high TSH. High thyroid hormones, low TSH. If the TSH is high it's because it is telling the thyroid to make more thyroid hormone. And that's about all it does. On its own, it cannot make you hyper. And ferritin levels might have a slight effect on it but not that much.

[SlowDragon Administrator]

Have you ever had thyroid antibodies tested

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

Getting thyroid levels optimal should improve poor kidney function

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

The GFR is reversibly reduced (by about 40%) in more than 55% of adults with hypothyroidism[40] due to several reasons.

[yewotc23 in reply to SlowDragon]

Hi SlowDragon - never had TPO or antibodies tested as couldn't afford to get them done privately. Would mine be subclinical rather than primary as subclinical is high TSH, normal FT4 - and my FT4 was technically normal but very bottom number in range?

Do you think it's likely I am actually hypo or just low ferritin causing high TSH?

If my Ferritin comes back low again next month, and I get put on iron to bring it back up again. I wonder if I'd then have to stop levothyroxine - test this week came back as TSH 1.5, that was with last levo about 22 hours before and only water to drink 12 hours before

Is it likely taking iron tablets would send me hyperthyroid with latest TSH being 1.5?

[SlowDragon Administrator in reply to yewotc23]

never had TPO or antibodies tested as couldn't afford to get them done privately.

GP should have tested TPO antibodies at diagnosis

Check your blood test results from then

If not been tested request they are

If TPO were tested and negative…..then you would need to test Thyroglobulin antibodies privately

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[SlowDragon Administrator in reply to yewotc23]

test this week came back as TSH 1.5,

What were Ft4 and Ft3 results

Improving vitamin levels improves conversion rate

Eg with low vitamin levels Ft4 might be 80% through range but Ft3 only 30% through range

With vitamin levels optimised Ft4 reduces as Ft3 improves

Your aiming for both Ft4 and Ft3 at similar % through range

[yewotc23 in reply to SlowDragon]

SlowDragon GP didn't test FT4 or FT3 this time. When my TSH first came back at 11.9, they tested FT4. But since then, they've only tested TSH

[yewotc23]

Hey SlowDragon , yeah the only things checked when my TSH came back at 11.9 was TSH & FT4

Not sure if they would agree to testing TPO antibodies or what reason to give then?

Is there anything anywhere that says that they should check them?

[SlowDragon Administrator in reply to yewotc23]

80-90% of primary hypothyroidism is autoimmune

nhs.uk/conditions/underacti...

gps.northcentrallondon.icb....

Do you have relatives with autoimmune diseases or other autoimmune diseases yourself

If autoimmune

A) they should test for coeliac disease

B) be especially vigilant for other autoimmune diseases such as Pernicious Anaemia

c) keep close eye on vitamin levels

It’s important for you as the patient to know if it’s autoimmune because there’s lots you can do to help yourself reduce symptoms

[yewotc23 in reply to SlowDragon]

My mum has diabetes, ulcerative colitis and in hospital last year she found out she has an overactive thyroid. They said its Graves disease. The total opposite to what I got with my high TSH

[SlowDragon Administrator in reply to yewotc23]

Type 1 diabetes? - autoimmune

Graves’ disease - autoimmune

So yes ……on this basis ask GP to test

[yewotc23 in reply to SlowDragon]

Yeah SlowDragon she is type 1 diabetes. Whether it makes any difference, she started with it when she was pregnant with my brother

Do you think GP would agree to test?

[SlowDragon Administrator in reply to yewotc23]

Yes they should do

[yewotc23 in reply to SlowDragon]

SlowDragon Would this sound okay as a message to the doctors?

Hi,

I am wondering if it would be possible to get my TPO antibodies tested on a blood test as they were not tested when first diagnosed with hypothyroidism

TPO antibodies will show if my hypothyroidism is autoimmune

My mum has 2 autoimmune diseases - type 1 diabetes and Graves disease so would like my TPO antibodies tested on this basis

If you can think of a better way to reword it would be fab

[SlowDragon Administrator in reply to yewotc23]

how about this….

I understand that autoimmune diseases often have genetic link. My mother has type 1 diabetes and Graves’ disease, it’s therefore possible my hypothyroidism is also autoimmune.

Please could you arrange to test for thyroid peroxidase antibodies and thyroglobulin antibodies for autoimmune hypothyroid disease as I don’t think I have had these tested yet.

[yewotc23 in reply to SlowDragon]

Thank you SlowDragon - I've sent that as a message to our surgery so will see what they say. With anxiety I worry they will say no but fingers crossed they will agree to test them

[yewotc23 in reply to SlowDragon]

SlowDragon - looks like they won't test them. This was the response I got in response to testing antibodies:

"As you are already diagnosed and treated, a blood test would not add anything to your management"

How true is that? Would knowing antibodies add anything to management?

[SlowDragon Administrator in reply to yewotc23]

It would to you

But not to them

They are supposed to test for autoimmunity at diagnosis……increasingly they don’t

Many many U.K. patients forced to test privately

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Blue horizon results

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