Thyroid problem? "Normal" TSH - Help please.

[TMM1]

I've been feeling unwell for approximately 3.5 years. I suspect I may be hyperthyroid, however, have had numerous blood tests and everything has come back normal in terms of TSH, which was 2.4.

Main symptoms are as follows - this is not exhaustive:

Sleep problems - insomnia/unable to get back to sleep after waking.

Extreme Fatigue/tiredness

weakness

Stomach problems/pain - pale bowel movements.

Loss of sex drive.

Anxiety/feeling on edge/anger.

Eye floaters.

Unable to concentrate.

Redness/ mottled appearance on palms of hands.

Ringing in ear.

Racing heart (occasionally).

Mouth ulcers.

I should say that I'm male and 30 years old. I'm not sure what to do as my GP is basically saying they can't find anything wrong with me and are saying that it is basically IBS/anxiety. I know this is not correct, but I'm not sure what direction to go in. Based on reading and excluding certain things, I feel it is most likely a thyroid problem.

I would be extremely grateful to have any opinions as to whether it is possible to have a normal TSH but still be hyperthyroid, and what further tests I should also ask from my GP. Feeling miserable at the moment and just want to be well again.

I should also point out the following:

Vit D was very low (10 I think) but went back up after taking supplements.

Folic acid was low, but again went back up after supplements.

My Cholesterol was high, which I gather doesn't quite fit with hyper.

Celiac has been ruled out.

Any thoughts and experiences would be appreciated.

[helvella]

May I check that you had a vitamin B12 test before supplementing with folic acid?

That is vital. Otherwise the folic acid can hide some symptoms of low vitamin B12. Trouble is, other symptoms, including irreversible nerve damage, can continue and not be identified until too late.

Then I have to ask why you suggest HYPERthyroidism? A lot of what you write suggests HYPOthyroidism. Including the slightly elevated TSH. (That is, in range but towards the upper end.)

Though less common in males, have you been tested for iron/ferritin levels?

As a hypothyroid male I certainly found it difficult to get back to sleep once I woke up. I sleep much better now.

Rod

[TMM1 in reply to helvella]

Thanks for the response. Yes, B12 was within normal range. Iron/Ferritin was normal too.

I was thinking HYPER based on comparing symptoms to HYPO, heart palpitations, feeling on edge etc.

[helvella in reply to TMM1]

Palpitations can occur in hypo or hyper. Some people seem to get them either way, some when hyper, some when hypo.

Glad you were tested. But normal range is not an adequate result for B12. It is recognised that many people with apparently "normal" serum B12 are, nonetheless, still effectively low in B12. A more recent test (not widely available) called Active B12 is supposed to be somewhat better. Do you have the numeric result?

Anxiety is common in hypothyroidism.

I don't suppose you have had a Free T4 test?

Did you notice on the main Thyroid UK site these symptom lists:

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

Oh! - and to answer your specific question, it is perfectly possible to have a low, "normal" or high TSH result and yet be hypo, hyper or have entirely acceptable thyroid hormone levels. There are many possible reasons including a pituitary problem.

Rod

[TMM1 in reply to helvella]

Thanks for that.

Just went to get the print out of my blood test results...

Firstly, the TSH was 2.2 - I got that wrong.

B12 was 266 (210-910 value). Thought this was on the low side at the time, however, my GP didn't mention it. I decided myself to take a B12 supplement and this went up after a further test, but I don't have the values to hand.

Thanks for the links to the symptoms. Yes, there are a lot of things on the HYPO list I can identify with, perhaps I need to reconsider my thinking on this...

No, I haven't had a free T4. My GP basically said that if the TSH was within range, then that was that and ruled out a thyroid problem.

[helvella in reply to TMM1]

I would be very much happier to see B12 up above 500.

Your GP is plain wrong. High or low TSH suggests a problem (somewhere), but "normal" TSH absolutely does not exclude there being a problem.

[TMM1 in reply to helvella]

Yes, I have no doubt he is wrong, but how do I put this to him? I am currently writing a letter to my GP before I have an appointment in May. I am trying to make it clear that something must be done as I cannot carry on the way I am.

[helvella in reply to TMM1]

Have a look here:

acb.org.uk/docs/TFTguidelin...

Specifically 2.2.1

These are the guidelines with which many here (including me!) have lots of disagreements - but they do have some truths in them. And many medics seem to believe the guidelines to be official.

If laboratories are unable to identify those specimens that specifically require

the measurement of both serum TSH and FT4 then it would be prudent to

measure serum TSH and FT4 on all specimens rather than embark on a first-

line serum TSH strategy

Any help?

Rod

[TMM1 in reply to helvella]

Yes, very helpful. Thank you. I will have a read of this.

[TMM1 in reply to helvella]

Hi,

Another thing I was going to mention, I had a fasting blood test 5 months ago and my cholesterol was very high. I thought this was odd as my diet is pretty good and I'm not overweight (in fact very very thin). Do HYPO people often have raised cholesterol? The one bad thing was that I was a smoker, although I have now quit for just over 2 months.

My GP also mentioned that my glucose level was slightly raised after the fasting blood test, although nothing to suggest diabetes. Is this something also experience by HYPO people?

Sorry for all the questions.

[Jackie in reply to TMM1]

Hi Just seen the extra question. high cholesterol common with under treated ( or not) thyroid disease. Most thyroid disease is autoimmune. If so you are quite likely to have Diabetes, 2 tests best, Glucose and Hb 1 Ac, I have severe Di and am underweight. Similar symptoms to start with,

Jackie

[TMM1 in reply to Jackie]

Thanks for this. Diabetes was ruled out for me, although there is a family history.

The other thing I find odd is pale bowel movements, I keep mentioning this to my GP and to a GI Doc but no-one seems concerned. I have an appointment with my GP soon, however, before I go I will be writing a letter detailing everything.

It's all so frustrating. I feel so unwell that I can barely do anything, however, all my GP is interested in doing is looking at blood test results instead of listening to how I feel.

[Jackie in reply to TMM1]

Hi That is significant, so make sure you tell the GP, and he listens!!It may be liver, gall bladder or pancreas. However, do not panic, likely not much without other symptoms. At least not blood! I bleed heavily every day!You need LFT`s, liver function, often to do with bile, a Faecal elastase test, specific bowl test for panceatic enzymes ( simple treatment replacement enzymes)and Gall bladder on an ultra sound.It is probably the Biliirubin, nothing to bad, may be grit from Gall bladder, the most likely.it is not very serious but you do need to speak to GPIf you need a referral make sure it is a Hepatologist,liver man, large teaching hospital, their field not really Gastro, who are not much use anyway!I saw and see gastros for 40 years, the so called top ones, which is were I base my info!!I had Hepatitis 9 months, yellow ,seeing gastro weekly, very ill, it took the new cardio 5 mins to diagnose without even knowing my symptoms, Autoimmune.Of course, then he did the tests.

best wishes,

Jackie

[Jackie]

Hi Make sure for a proper picture to have tSH, T4 and Free T3, with ranges( all vary). then there are the other tests which are important too.Always keep the results for comparison etc.You can pay for tests if you wish.thyroiduk.org.uk/tuk/te all done by you and results on line. With Blue horizon ( or main site) I pay £ 61 for this including the discount ( TUK 10).

Best wishes,

Jackie

[TMM1 in reply to Jackie]

Thanks for your response.

Do you know if it is possible for these tests to be carried out on the NHS?

[Jackie in reply to TMM1]

Hi They should be try first, a lot of NHS authorities no longer do FT3 as it is all about costs, My endo and I consider essential. When I started treatment for Hashimoto ,only my FT3 was low, TSH always been below range, yet HYpo. FT3 always tested up to about 2 yeas ago,T4 easier. If GP cannot do it, it is the Labs, some will do the others and FT3 if you ask to pay, usually about £10.

Best wishes,

Jackie