I have the following symptoms, most of which have been explored individually to no avail...
Irrational anxiety with no cause.
Chronic fatigue
Slow heart rate (bradycardic on ECG)
Irregular and heavy periods (being investigated with gynaecologist)
Spontaneous weight gain
Elevated cholesterol wiyh no diet change
Dry skin on legs mostly
Pain and tingling in left wrists and fingers.
Only recently, after years of trying antidepressants for my anxiety I finally asked if there could be a physical medical issue as there is no reason for my anxiety...and my GP mentioned testing my thyroid...which would shine a light on the other issues too...
However, my bloods seem in range...except for the cholesterol which is a newly discovered issue.
Please help, I have attached the results of the bloods.
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Anxiousannix
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Your FT4 is much, much too low at only about 5% through the range. Should be more like 50%. Unfortunately, doctors only look at the TSH and your TSH 'looks' fine, but it's not reflecting your low FT4. What time of day was the blood draw for this test?
Also, the picture is incomplete. To really see what is going on you also need FT3, TPO antibodies and Tg antibodies tested. But the NHS don't like testing those! Most people get them done privately. And if your cholesterol is high, it more than likely means that your FT3 is also too low.
So, no, you're not going mad, you are hypo. But your doctor is relying on an unreliable test and mis-reading your results - what there are of them!
Thank you so much for your response. I had the test at 7.30am, which I believe was the best time to have bloods taken.
I will book in to the GP ASAP and at least attempt to get these tests. They won't increase my anxiety medication until we've discussed the results in person so maybe they are on board!
Your T4 is very low in range and I suspect that your T3 will be low as well. Anxiety / depression is a symptom of low thyroid hormones, if your thyroid hormones and especially if your T3 (active thyroid hormone) is low, your body cannot produce sufficient amounts of serotonin and noradrenaline, which can have implications for depression and anxiety. This will correct itself once you are on medication to replace the thyroid hormones that are missing.
As others have suggested, you should do a full thyroid function test with measuring TSH, T4 and T3 as well as measuring TPO and TG antibodies to see, if there is an immune reaction going on (in 90% of cases, 10% of under-active thyroid disorders present without antibodies).
7.30 was a good time, yes. Your TSH should have been not far off it's highest at that time. So, that means that rather than a thyroid problem, you have a pituitary problem.
TSH is a pituitary hormone, not a thyroid hormone. As thyroid hormone levels drop, the pituitary is supposed to increase it's output of TSH to tell the thyroid to make more thyroid hormone. Your pituitary is not doing that. And the thyroid cannot make hormone without the stimulation of the TSH. Which is why your FT4 is so low.
We call this 'Central Hypo', but the majority of doctors have never even heard of it, let alone be able to recognise it when they see it. So, you're probably going to have difficulty convincing your doctor that there is a problem.
I would recommend that you research Central Hypo - the info is all out there! - so that you know what you're talking about when you speak to your doctor, because the odds are that he won't know anything about it. It just isn't taught in med school.
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before ALL BLOOD TESTS , as biotin can falsely affect test results
In days 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 if last test result serum B12 was below 500 or active B12 (private test) under 70
No, they are not OK. Your B12 is dangerously low, risking permanent neurological damage. And you're probably iron deficient with that low ferritin.
Your GP is unlikely to understand about the B12, but tell him you want testing for Pernicious Anemia. You also need a full iron panel to see why your ferritin is so low.
It's really not surprising that you have so many symptoms and feel so bad. As well as low thyroid hormones, the low nutrients will also be causing many symptoms, like fatigue, dry skin and the pain and tingling in your fingers and wrists. Even if you can't get your GP on board with the thyroid - you will need to see an endo - you need urgent action on your nutrients. Vit D and folate are probably equally 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
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 2 per day and/or may need separate methyl folate couple times a week
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 3-5 days before ALL BLOOD TESTS , as biotin can falsely affect test results
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 if last test result serum B12 was below 500 or active B12 (private test) under 70
You will likely need to take at least vitamin B complex daily and indefinitely
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 3-5 days before testing
Eating iron rich foods like liver or liver pate once a week. Increase the amount of red meat you eat, other foods include pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thank you so much for all your advise. So if I go to my doctor and request these tests. Then follow the supplements guidance here...will I still need medication?
It's all so confusing for me, especially after being told there's nothing wrong for so long.
Yes, you will still need thyroid hormone replacement because although it's essential to have optimal nutrient levels for many reasons, they won't be able to repair whatever the problem is with your pituitary. As a general rule, glands are not curable, not the thyroid, not the pituitary, not the adrenals... Once they go wrong, they stay wrong.
But don't think of thyroid hormone replacement - which is what you need - as 'medication'. It's not drugs, it doesn't cure anything. It's just replacing the hormones that your glands can no-longer make enough of.
I can imagine your confusion but your GP just hasn't had the education to recognise what the problem is. Three things doctors do not learn in med school: how to recognise and treat thyroid problem, the importance of nutrients, and how to interpret blood test results. I know that sounds crazy, but that's the way it is. And that's why we're all here.
That's because generally speaking GPs don't have a clue when it comes to all things thyroid!! I suffered for years due to their ignorance+the NHS' insistence on testing+often dosing Levo just from TSH! Is it any wonder we suffer at their hands?!
Also, I am not vegan or vegetarian. I eat a lot of iron rich foods, I think. I'm so lost with this all. Tomorrow I will read through all this again and make a plan !
Even with the most perfect diet imaginable, hypos will still suffer from nutritional deficiencies. This is because without adequate thyroid hormone - T3 - the stomach cannot secrete enough stomach acid to effectively digest your food and absorb the nutrients. And, even living in Australia, a hypo can be vit D deficient. And you will more than likely have high cholesterol. Not because of your diet or lifestyle but because of your low T3.
T3 is the active thyroid hormone and it is needed by every single cell in your body to function correctly. If the T3 level is low, all sorts of things can go wrong. But none of it is your fault. And certainly nothing to do with your diet.
Thank you so much for all your input. The doctors surgery have called to ask it I still want to come in and discuss my results, or am I happy with them and to just alter my diet to control my cholesterol.
I've made an appointment for next week, but this nonchalance makes me think they're going to reassure me that the results are all OK.
I am reading up on everything, but could somebody explain, in words I can repeat to the doctor, why I need further investigation when the results claim I am I'm range.
High cholesterol levels are a classical sign of hypothyroidism and especially low T3. I have included a publication showing that thyroid treatment improves the lipid profile of people with hypothyroidism.
In the UK, there is also the advise that the underlying cause for the high cholesterol should be addressed first before offering medications such as statins:
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
I am sure that there is a similar guidance in Australia regarding statins in hypothyroidism.
Sorry only just saw your reply. The only thing I can think of they could prescribe in the short-term is something for the anxiety. I have been prescribed propanolol (beta adrenergic blocker) in the past, which helped me quite a bit at the beginning of my thyroid journey, as I also had really bad anxiety.
Your anxiety could well be related to your low T4 and your T3 may equally be low, as you need sufficient thyroid hormones to produce serotonin and noradrenaline. Your low B12 is also contributing to your anxiety, as the low levels can affect brain function and neurotransmitter production. Can you get a good Vitamin B complex, have a look if you can get hold of Thorne B complex or Igennus B complex and start taking them as soon as you can to build up your levels.
It is also quite unusual that your TSH is still so low, considering your T4 is low as well, as normally when T4 and T3 are low, the TSH should get high (and would then stimulate the secretion of T4 and T3 from your thyroid). But in your case this does not seem to happen. Could you perhaps be referred to an endocrinologist, as it seems that maybe your pituitary feedback is not as it should be? greygoose has also mentioned central hypothyroidism; yes it is rare, but probably not as rare as HCPs make it out to be, because if you don't look you won't find!
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