What should I be asking my GP regarding thyroid test?

[alitom123]

Last week I had a thyroid blood test and I was told that in November '12 my TSH was 0.08 and the latest reading is 0.19 Despite the November low reading no changes were made. This time I have been asked to see the GP. I will see her on Thursday. I am so confused with the thyroid function. What do you think I should ask the GP when I see her and what should I insist on? I am on 125mg Levothyroxine and have been now for a number of years. Do you think I should be asking for an adrenal test? Could there be a malfunction there? What about Free T3 and Free T4 tests - are these included in the standard thyroid blood test? I would be very grateful if you could give me some pointers as I hate to think I'm being fobbed off by GPs. I have for a little while now been taking seaweed (kelp and bladderwrack) and I'm wondering whether that might have contributed to the latest result.

[Moggie]

You don't say how you are feeling - have you still got symptoms.

No you will not automatically get a FT4 and definitely not a FT3 test. The FT3 test is getting harder and harder to get done but you might be lucky seeing as your TSH levels will be classed as low according to the doctors.

If you do still have symptoms then you will need to ask your GP to test your B12, Iron, Ferritin, and VitD - low iron, B12 or VitD mimic thyroid symptoms and being low in iron can also effect your adrenals.

Don't know about the kelp and have never even heard of bladderwrack so cant help you there.

Moggie x

[alitom123 in reply to Moggie]

Thanks Moggie and Greygoose for your replies. I am feeling more or less the same as I've felt since I've been on this dosage of Levothyroxine - tired and find it very difficult to get motivated - which isn't how I used to be. I've also got a weight problem. I eat quite healthily on the whole and can't eat large quantities of food nowadays but I find it difficult to lose any weight.

I shall certainly ask for the FT4 and FT3 blood tests and see what happens.

Thank you both very much for your help. I feel better equipped now to speak to the GP.

[greygoose]

Alitom, why are you taking the seaweed? Have you tested deficient for iodine? If not, taking extra iodine could cause more problems than it solves. The thyroid does need iodine to make thyroid hormone, but too much is as bad as too little.

Why do you think there's a malfunciton? The fact that your TSH has risen could just mean that you need an increase in dose - although I know that no doctor would ever think that! But it's impossible to know what is going on without testing the frees (FT4 and FT3). You could ask your doctor about the possiblity of getting an FT4 test, but as Moggie says, there's not much chance of getting an FT3 without seeing an endo. Stupid, I know, but that's the way it is. But difficult to see if there is an adrenal or conversion problem with just the TSH.

As Moggie says, you don't say how you feel. Do you feel ok on your present dose? If so, whatever you do, don't accept a decrease in your dose due to your low TSH. That would be totally unreasonable and unwarranted. Once you are taking thyroid hormone replacement, the TSH becomes irrelevant because the thyroid/pituitary link is broken and the TSH no-longer reliably reflects thyroid status. And having a low TSH - or even a suppressed TSH - is of no consequence.

Hope that helps, Grey

[JennyC2 in reply to greygoose]

My medication was reduced. My TSH was low (0.137 in a range of 0.300 - 5.000) but my Free T4 was high (25.3 in a range of 11.0 - 23.0). Does the high T4 stand alone as a need for decrease?

Thanks

[greygoose in reply to JennyC2]

Well, I'm not medically qualified, but I would say no. I would say you need an FT3 to set the dose. Because T4 is inactive, it doesn't do anything. It is a storage hormone waiting to be converted into T3. Having a high T4 does not make you hyper anymore than a low TSH on its own. You need the FT3, and the very fact that it isn't tested for the most part means that a lot of people are not correctly treated.

Now, if you test the FT3 and it is also high, the next step should be, in an ideal world, to ask the patient how s/he feels. If s/he feels fine, then fine. Some people need a high FT3. I do myself.

However, if the FT3 is high but the patient doesn't feel good, then there could be an adrenal problem. That should be looked into.

But the FT3 might be low. If you have a high FT4 and a low FT3, that means there's a conversion problem. Again, could be adrenals. Or low selenium.

The ideal is to have the FT3 slightly higher in its range than the FT4 is in its. If you see what I mean.

But, as I said, that would be in an ideal world, and this isn't an ideal world, and your average GP can no more treat thyroid than fly to the moon. Sigh.

Hugs, Grey

[JennyC2 in reply to greygoose]

Thanks , that's really helpful. I've never asked for a T3 test so I am going to try.

Fingers crossed.

Jenny

[Moggie in reply to JennyC2]

Definitely get your iron checked (along with the others I have already mentioned) - if this is low then the T4 you are taking will not be able to convert into the T3 your body really needs, which could explain the high FT4 result.

Moggie x

[Heloise]

ali, I've been posting this webpage because it shows the relationship among the three tests which helps determine where the problem may lie. I don't know if you have enough testing to find your problem but it shows the necessary balance of your hormones.

drrind.com/therapies/thyroi...

[alitom123 in reply to Heloise]

Hi Heloise. Thanks for this, It's very useful and set out so clearly. I shall print off a copy and take it along to my appointment with the GP tomorrow. I feel I'm getting better equipped all the time, thanks to you people.

Alitom