Urgent response please - can these 'normal' results still lead to thyroid problems?

Urgent - sorry but answer needed for 3.30 Doctor's appointment!!

Husband is suffering from depression, anxiety etc and GPs first thought was thyroid but blood test was inconclusive and so he was sent to Endocrinology Dept. who said his thyroid is normal. The hospital letter gives two results only - TSH 2.48 and FT4 is 12.8.

Question - could he still have 'thyroid problems' with these results?

22 Replies

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  • Ideally, we need the accompanying reference ranges for these results. But, assuming typical reference ranges, it looks as if the FT4 is near the bottom of the range (i.e. too low) and this could indicate hypothyroidism. However, as TSH is not near the typical top of range, the idea of a thyroid problem is going to be dismissed.

    This does not mean that your husband is not suffering symptoms of hypothyroidism though. Symptoms typically start to manifest long before blood results tell the full story. Unfortunately treatment is unlikely to be offered until blood results are outside the ranges.

    A 'retest in x months' might be the best you'll be offered for now. And other medications may well be prescribed in an effort to deal with the various symptoms individually.

  • Thanks for your speedy reply. I noted that some experts say that 3.0 should be the top range for TSH (and not the 4.5 usually given) which would put him almost at the top. How accepted is this new lower figure (any refereed citations I can quote)?

    I have no FT3 result (maybe test not done?) might this make the results seem more 'normal'?

    I am not trying to have my husband have hypothyroidism but the GP pounced on the symptoms immediately and I have looked too and he seems to have most of them!

    Where do you think we should go with this? We see GP this afternoon, what should we be asking for?

  • The top of the range for TSH depends on the lab that did the test. If your lab has a top of range at 3.0, you will be more fortunate than most here! An FT3 result will be unlikely to help. TSH is the one that counts, with the FT4 result acting as a 'backup'.

    In theory, a GP could offer a 'trial' of levothyroxine if he feels it's warranted. But few will do this with the test numbers you've quoted. Especially if an endo has already dismissed the idea. No harm in asking though.

  • I suppose it will depend on how convinced the GP was in his original diagnosis.

    Re the FT3 being important, I was reading that from the Thyroid UK site 'Thyroid Blood Tests' which says:

    If you are not converting from R4 to T3 or if your cells are not taking up the T3 normally, your T4 levels and your TSH levels will still show as normal

    Do I take it that you don't think this is relevant here?

  • It's not that I don't think that FT3 is relevant. It is that your GP and endo are unlikely to :(

    Also, the 'converting' from T4 to T3 is more likely to be relevant to those already taking thyroid medication.

    Getting an FT3 test done via the usual NHS route is extremely difficult. If you feel the need to follow up on this and can afford to fund your own testing, you could consider doing so (details are on the Thyroid UK site). However, it is still unlikely to be taken into account by the majority of NHS doctors.

  • Thanks so much for all your help.

    This has been going on for 6 months and all we have so far is anti-depressants, diazepam, tamazepam etc and nothing alleviates the utter exhaustion (anyone would be depressed with that for 6 months!). We have to eliminate the physical causes of the symptoms before we keep going on with the depression meds. We will certainly have a thorough talk about the thyroid results before we dismiss this as a cause - here's hoping for a fruitful appointment (whatever that brings)

    Again thanks

  • At the very least, repeat testing should be done frequently. If there can be a steady ongoing rise in the TSH result (ideally with an accompanying decrease in FT4), this will highlight the issue and make it harder to dismiss.

    And for future info, TSH is at it's highest in the early morning, so that is the best time to get the blood drawn. Time of day can make quite a difference to the TSH test result, to the extent that a 'borderline' TSH test result from an afternoon blood draw might be a clear cut 'over' the range at an 8am blood draw.

  • Have they checked thyroid antibodies ?

  • No idea, what is that?

  • That's a good question loulabel. However, it's usual to only do the antibody test once thyroid dysfunction has actually been diagnosed. And even if a doctor does decide to go ahead and test for antibodies pre-diagnosis, a positive test will probably not change the current diagnosis, because (apparently) some people can have positive antibody tests but never actually become hypothyroid at all. A typical comment is something along the lines of 'this is indicative of a possible thyroid problem at some point in the future'.

  • Just another thought, my husband suffers with low testosterone and it has the same symptoms as thyroid (his thyroid test is similar to your husbands too). He managed to get an endo to agree to trial testosterone shots and the difference is night and day. They put him on anti depressants for a year which made him tired and he needed to change to another one, still tired but bearable. Then we got his testosterone tested again (had been low but not magically 10 low!) and he finally went over the line. Needless to say the anti depressants were not what he needed and hasn't since starting the shots.

  • Well long (amazingly) chat with GP. The hospital did not do a further thyroid test and the results I quoted were the GPs results done in early Dec. quoted back to us! So GP is doing the tests again and the antibody test too! I think GP still wants to rule out thyroid as it fits the symptoms so well.

    Poppy03 - what did you mean by the 'magic 10 low'?

    Husband's testosterone was 10.3 but we were told that, although on the low side, it was nothing to worry about. Thyroid trouble can affect testosterone production too can't it? How do you know which to blame - thyroid or testosterone? Sounds a bit chicken and egg to me.

  • Testosterone tests seems to work similar to thyroid tests. Instead of TSH you have FSH which had always been high for my husband and over the range but not over 10. My husband has documented testicular damage along with a undescended and therefore dead testicle but still this was not counted as a problem even with his results. It is as misunderstood as thyroid conditions. Also with womens hormones and going through the menopause at least HRT is offered with men it seems that you get the 'well what do you expect you are getting older' talk. Once we managed to get him to the good endo I had for my thyroid he immediately agreed he was a candidate for the hormone treatment and agreed to treat him.

    I do agree, however, that thyroid could be a cause of low testosterone. Basically it is worth getting checked out via a simple test (call and ask them to add it to the list of bloods to be taken) and then you will at least have a guideline of any changes.

    Have you had his iron/ferritin, vit D, B12 etc all tested. Low Vit D and iron can cause very similar symptoms of fatigue and brain fog.

  • Sorry, also my husband is being retested for thyroid as I am not totally convinced that he doesn't have a problem with it. We will continue to keep an eye on it just in case. He has other auto immune conditions (god help our little girl with her genes!!)

  • Hi Poppy - my husband's FSH is 9.8 (didn't know what that was testing) but the hosp letter continues saying his testosterone is normal at 10.3 but on the low side.

    We can only deal with one thing a a time so I will deal with thyroid (re-doing blood test tomorrow) and take it from there but I will question the testosterone again if the thyroid results are normal.

    I am sure your little girl will be fine!

  • So his FSH is up high which does indicate that there could be a problem with his testosterone. My husbands is on the low side but hadn't fallen off the scale. Luckily the endo saw sense and it really has made a difference.

    We have FSH too which is follicle stimulating hormone, as ours gets higher it indicates we are close to menopause. With men it is how hard the body is working to produce the testosterone. It may well be something you will need to follow up.

  • Stick with it... trials should be available for those who are under 12 nmol/L do more research, the info is out there

    !

    SHBG is very significant too and needs testing, also LH.

    With an FSH as high as that, his pituitary is shouting for more testosterone to be produced! ;-)

  • Picton I do have lots of results but not the ranges so I can't interpret, just the lab saying they are normal:

    FSH 9.8

    LH 2.9

    Prolactin 271

    Testosterone 10.3 (normal but low)

    Male 61 years

    Do you have the ranges so that I can see where his results fall?

  • The ranges will vary for every different lab, but in general terms, 12 is the cut off for testosterone to eb prescribed, he is below that (for a trial!)... the FSH and LH are relevant to what sort of hypogonadism it is...(primary or secondary) SHBG might be high, making it even worse, so you need to know that too.

    Look on Google for "UK Guidelines Androgens" for copy of the official BSSH standards, and make sure your GP knows you expect toe get that standard of treatment!

    Prolactin being a bit high is not unusual and causes some problems too, but they probably wont treat it!

    Treatment is in the dark ages in the UK, and it's very basic even when you do get treated, but don't take no for an answer!

  • Sounds very much like my situation then. It was hard enough to get testosterone, and had to see a private consultant for that even though my levels were rock bottom! (I am a chronic pain sufferer, Opiates wreck endocrine function) I got absolutely nowhere with my thyroid issues and have had to resort to self treating (and Adrenals too)

    Self treating is not for everyone though, and all about doing lots of your own research.

  • hi. yes. yes. yes. i have been the same. doctors keep telling you thyroid blood test normal. the t.s.h test is no good. 12 years on, i am still not right. n.d.thyroid is best. google stop the thyroid madness.

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