Low FT4, normal TSH and low FT4:FT3 ratio - what does this mean? Secondary hypothyroidism? Or something else?

[marymouse]

Hello there

I'd really appreciate your help. My husband has been poorly for some time with joint pain, fatigue, sore throat, irritability, palpitations, and many more symptoms from the list on the Thyroid UK website. We have been monitoring his basal temp for some time and it is consistently low. We asked his GP if he would do a full thyroid work up. He refused because when my husband last had a TSH done, 5 months ago, it was normal, as was the one before. He said he might repeat that in a few months.

Because my husband is so frustrated at being ill and feeling so appalling all the time, and because he runs his own business and is terrified he won't be able to work if this continues, we paid to have thyroid tests done by Genova Diagnostics.

We now have the results but are a bit confused as they are not what we expected, but they do show some low levels. I'll detail them below:

TT4 - 80.1 (58 - 154)

TSH - 1.45 (0.4 - 4.0)

FT4 - 11.7 (10 - 22) Low

FT3 - 5.94 (2.8 - 6.5)

FT4:FT3 Ratio - 2.0 (2.0 - 4.5) Low

RT3 - not done

TG < 20.0 (0 - 40)

TPO < 10.0 (0 - 35)

Having poked about online it looks possible that these results could be classed as secondary hypothyroidism, but I'm really not sure.

Any help, opinions or advice would be gratefully received.

Many thanks.

[nostoneunturned]

While I am definitely not a doctor everything I have read confirms your understanding that this could be secondary hypothyroidism and if so your husband must be referred to an endocrinologist.

Did you come across these two papers below on thyroid function test interpretation when on the internet? The first link is to a paper by Colin Dayan, currently working (I think) in Bristol:

ncbi.nlm.nih.gov/pubmed/115...

and in this one there is some more information:

auburn.edu/~deruija/endo_th...

This link will show you that you have choice, and exactly how to exercise it, in the matter of what endocrinologist you see:

chooseandbook.nhs.uk

Sorry if you knew all this already but thought it might help.

[helvella Administrator Thyroid UK in reply to nostoneunturned]

Agreed.

Have a look here:

thyroidmanager.org/algorith...

Other possibilities are the effect of some drugs/medicines and non-thyroidal illness.

Colin Dayan - Bristol& Cardiff:

medicine.cf.ac.uk/person/pr...

(If you search for him, don't confuse with "Colin Dayan also known as Joan Dayan" ...??????)

Rod

[shaws Administrator]

If you can afford it, a private consultation may be worthwhile. If so email [e-mail] for the name of a sympathetic doctor.

GP's do not appear to take into account clinical symptoms and rely only on the TSH result.

[Hashi_since_age9-1988]

yes his T4 levels are pretty low. I imagine he would benefit from taking thyroxine.

[marymouse]

Thank you for all your help. My husband went back to the GP this morning. H'ed done a lot of tests - CRP, GGT, LFT, Vit D metabolism, ESR and a full blood count. All of these came back normal except for the vit D which isn't in yet.

Ade then asked for a Vit B12 as his symptoms are similar and it seemed worth ruling that out. The doc said he couldn't do that too, having done all the others. Ade then didn't tell him about the thyroid results, I think cos he thought he wouldn't approve that we'd done it privately.

Ade now wants me to find him a private specialist and I was going to try Dr Skinner as he's closest to us, we're in Kidderminster, but it seems he only takes GP referrals according to the Thyroid UK list and our GP practice don't like to refer to him. Just wondering if anyone has recommendations for any other doctors in the Midlands?

Also I'm new to this and am not sure I understand the difference between a thyroid doctor and an endocrinologist - except that they cover all hormone disorders?

From Dr Myhill's website last week (before it went down) I got the name Dr Jens Rohrbeck in Bristol who is an Ecological practitioner and I'm wondering if he would be a good person to see as he does treat thyroid disorders. Anyone have any experience of him or any advice generally?

Many thanks.

[lainer in reply to marymouse]

Hello

I have just stumbled across your post and after 20 months of searching for someone with similar thyroid blood results and symptoms i have finally found someone! FT4 10.4, FT3 4.2, RATIO 2.5, TSH 1.7. I took these to my docs who was happy to try me on 50mg of Levothyroxine which gave no improvement.

I am very sorry to hear of your husbands poor state and can very much understand what he is going through. I have pretty much exact same blood results and the following symptoms; extreme fatigue and weakness, poor memory, poor ability to carry out simple calculations at work, poor concentration, short tempered etc etc.

I have tried many things to get rid of these symptoms and this week drove to London to see Dr Barry Durrant Peatfield. I have learned over the last 18 months not to build my hopes up too much but he has diagnosed me as being hypothyroid by listening to my symptoms and carrying out a clinical examination as well as looking at blood results. He is not registered on the GMC anymore so he cant prescribe medicines directly but he did tell me to order Armour desicated thyroid from Internationalpharmacy.com.

He resigned from the GMC many years ago due to his dissagreement with the use of synthetic thyroid replacment and its ineffectiveness compared to natural throid replacement.

I ordered the Armour yesterday which should arrive in a week or so hopefully. I will let you know how i get on with it. Fingers crossed again!

I hope this is of use to you and your husband. And if you have any other avenues of exploration i would certainly appreciate the heads up!

All the best.

Laine (male 39 yrs)