Thyroid function checked out in blood test...what now?

[AnthonyMs]

I've had a blood test for thyroid function.

I'm mid-20s male, have anxiety/depression, have no sex drive and always feel tired.

My results were are follows

TSH - 3.92

FT4 - 16.8

can anyone shed some light on it please?????

[shaws Administrator]

I am sorry you aren't feeling too good. Do you happen to have the ranges of your blood tests as labs differ throughout the country as it would make it easier for people to comment. Ranges are the figures in brackets.

[Hashi_since_age9-1988]

your FT4 doesnt look too bad but your TSH is a bit high. Best if its below 2. Ask for an antibody test. Might also be worth checking fT3.

[AnthonyMs in reply to Hashi_since_age9-1988]

So you believe my TSH is higher than normal..do you know what this could indicate? My FT4 seems normal though? I'm wondering if this could indicate a problem with the thyroid gland or the brain?

[Hashi_since_age9-1988 in reply to AnthonyMs]

Early stages/mild hypothyroidism? Thyroid is managing to produce enough T4 but only if it is being overstimulated by highish levels of TSH? Perhaps your T4 is ok but T3 or TT4 low leading to the raised TSH? Its hard to interpret blood results when they only show part of the picture. Doctors like to skimp on tests to save money. Best to get everything checked to get a fuller picture and shed some light on what is going on. Do you feel hypothyroid? eg Dry skin, constipated, cold.

[AnthonyMs]

Here are the results again with the ranges, sorry.

THYROID STIMULATING HORMONE 3.92 mIU/L (0.27 - 4.2)

FREE THYROXINE 16.8 pmol/l (12.0 - 22.0)

[AnthonyMs]

I have a long-term neurological condition and lived with depression for many years. I've always wondered if my hormones are out of balance and if that could be influencing my depression?

The results fall into the normal ranges the lab follows, but surely there is 'optimal normal' and then there's 'suspicious normal'? So long as the results fall into the normal ranges, as per the laboratory guidelines, doctors don't feel the need to comment/take action. I'd like all my hormones to be checked out, but I doubt that my GP will allow that.

[greygoose in reply to AnthonyMs]

Hi Anthony, yes, of course there is 'normal' and there is 'optimal' but not on the NHS. lol

Sorry.

Doctors don't make these distinctions. In range is in range! And that's all there is to it! They say.

But your TSH - although in range - is high when you realise that a person with absolutley no thyroid problems has a TSH of 0.8. But once again, you don't get that on the NHS.

Your FT4 is too low, it's not even mid-range. I would think you are hypo, judging by these limited results. Anxiety/depression, having no sex drive and always feeling tired are hypo symptoms. And if your thyroid hormones are out of quilter, then a lot of your other hormones will be too. And a lot of them can influence depression.

Have you had your B12, iron, Vitamin D, etc tested? They could be causing problems too, if they're low. And what would be absolutley brilliant would be an FT3 and antibody tests. But... not on the NHS!

Hugs, Grey

[AnthonyMs in reply to greygoose]

Hi,

I'm suprised by what you're saying! So I possibly have a hypothyroid problem, can you explain why you think my FT4 is low, it was considered mid-range by the lab? I can't believe that the lab would say it's normal then. I did these tests privately, my GP has never suggested I do these tests, for all the years I've been depressed (10 years). Of course there could be many other things factoring into my depression, but the thyroid issue certainly needs investigating. My iron level seems way too low? But again, the private doctor didn't comment, only commenting on the ones outside the lab's range of normalcy.

I think I should check my Ferritin level, as I believe that can determine whether the cause of anemia is iron-deficiency. Thanks for the heads-up on B12 and Vitamin D, I might as well check these too.

If I was also to have an FT3 and antibodies test, what would the result tell me? Isn't TSH and FT4 enough to check for thyroid problems?

Please excuse my ignorance on these matters.

[greygoose in reply to AnthonyMs]

Hi Anthony, we all start out ignorant. Nobody is born knowing all the answers. Even after 13 years hard slog I'm far from knowing all the answers!

I would say you definately have a thyroid problem - unless by some miracle your FT3 is at the top of its range.

Well, actually your FT4 is just under mid-range, mid-range being 17 here. But most people need it higher than that to feel well. But your TSH is too high. Sod the ranges, they are just rediculous. A 'normal' person, with absolutely no thyroid problems would have a TSH of 0.8. So yours is high. In the US you would get treated once it hit 3.0 (in theory). And, you have several important symptoms of hypo. If you read the list you'd probably find more.

So, what would the FT3 do? It would show just how much active hormone your body has to function with. T4 is just a storage hormone, it doesn't do anything except wait to be converted into T3. But some people have difficulty converting, for various reasons, and an FT3 would show you that. It is true if you are converting terrifically well, that FT4 might be ok, but we don't know if you are because we haven't got an FT3.

The antibodies would show whether or not your hypo is due to and autoimmune disease, Hashimoto's disease. Now, in England that wouldn't seem to make much difference, but in other parts of the world they would keep your TSH suppressed if you have Hashimoto's. But the thing is, if it's Hashi's, you know it's just going to get worse and worse until your thyroid is destroyed, so it would be best to start treatment now. Of course, these are just my opinions - and the short version at that - and I know that millions of doctors would disagree! But, we live in hope...

So, the long and the short of it is, no, TSH and FT4 are not sufficient to determine thyroid status. In other countries the other tests would be done automatically, but in the UK...

Hugs, Grey

[CarolineAnne]

Hi there

Did you have any other tests done? It would be a good idea to have iron, vitamin b12, vitamin d and thyroid antibodies tested. Even though your ft4 is not dragging the floor some people need it higher to feel well. Your tsh is definately too high. Should be around 1.

Things such as low iron, low vitamin b12 and low vitamin d can result in symptoms of depression, anxiety, panic attacks and even feeling suicidal so get these checked out and possibly read up on them online as it is surprising to people that 'little vitamins' can make us feel so bad.

Try to get free t3 and thyroid antibodies tested as they will give a clearer picture. Another thing always have your bloodtest as early as you can as your tsh will be higher then.

I am sorry that you have suffered from depression from a young age but there will be a cause and you can find it. I applaud you for searching for your answer ( my son of 23 is burying his head in the sand and will not let me help him!)

Keep asking questions, this is a great site!

Good luck

Carolineanne x

[AnthonyMs in reply to CarolineAnne]

Thanks for your reply and support. It really helps, I'm beginning to piece together everything now. Reading the comments from other users gave me the inclination that my TSH was too high..whatever that means I don't know.

I had my Iron levels, TIBC and Transferrin Saturation (all iron related) checked too. The results were:

Iron - 12.5 umol/L (10.6 - 28.3)

TIBC - 54 umol/L (41 - 77)

Transferrin Saturation 23% (20 - 55)

I also had a number of other things checked out, however vitamin levels weren't checked.

I think I should show these results to my GP and hope he takes it seriously.

[Heloise in reply to AnthonyMs]

Anthony, you've had good information. I'll just add if no one has mentioned that the adrenal glands support your thyroid. Sometimes they may be stressed. Do you get enough sleep? Are you often having a flight or fight response which comes with some work or lifestyles which would cause high cortisol? Sometimes an iodine deficiency will deny the thyroid enough to function. Vitamin D is supremely important for just about everything and often deficient for any of us who don't get enough sun. (also considered a hormone)

I hope you can improve any of this and avoid the necessity of lifelong medication for hypothyroid.

[editfmrt]

Hi Anthony

Carolineanne has read my mind - in addition to the comments about thyroid (which can most certainly cause depression) I was going to suggest you consider getting tested for B12 deficiency and the other tests she suggested.

The serum B12 is not so good as the Active B12 which is not so freely available but can give a guideline if you are towards the lower end of the range. There is as much ignorance about B12 and the levels as there is with thyroid tests so if you do get tested please post the results with ranges for comments.

B12 deficiency or the autoimmune form called Pernicious Anaemia often goes hand in hand with thyroid conditions and the symptoms can mimic both too. It can also cause neurological damage.

Here are a couple of links which may prompt you to investigate further:

ncbi.nlm.nih.gov/pubmed/186...

This second link explores psychiatric manifestations - not for one moment suggesting you have all of these but it shows how badly someone can be affected by a B12 deficiency. The annoying thing about this one is they mention the serum test and 'normal' levels which many posters on here will tell you are far from normal! so please don't rely on that information!

ncbi.nlm.nih.gov/pubmed/150...

It is great you have found this site at such a young age so you can learn and make sure you do not end up down the path of dreadful ill health for decades like some people who have had missed or misdiagnosis and/or poor treatment.

Wishing you well...

[Hidden]

Is this a one off level for TSH, or has it been this high repeatedly?

I say that because a one off could be Euthyroid Sick Syndrome (ie. a symptom of some other condition, you seem to have others!) and not *necessarily* thyroid related directly.

If it is a regular thing, then join the club... it's my problem too, and I have had to resort to self treatment

Certainly you need more testing either way.

You mention low libido, so have you had sex hormones checked too... Testosterone, Oestradiol E2, SHBG, LH & FSH at the very least (you can calculate free Testosterone from Test & SHBG) - just because you are young, does not mean they are OK... I have Hypogonadism myself, so know the effects of the problem go FAR beyond just libido! If you are taking antidepressants of course this could be the cause of much of that problem too. (tell me about it!!!)

Do you take opiate pain killers for your Neurological condition? (are the side effects of other drugs possibly linked too?)

Have you had cortisol level checked?

Vit D, and B12 yes, worth checking as someone mentioned..

You have Neuro issues.. so Magnesium is something that immediately comes to mind to me too, and it's something that's very common to be low on, but not something Doctors seem to think of.

Good luck

[AnthonyMs]

I'll go ahead and post the entire blood test results. If anyone has some insight that possibly support/don't support some of the arguments made and/or suggest other health problems including, whether qualified or not, I'd really appreciate it.

HAEMATOLOGY

HAEMOGLOBIN 14.6 g/dL 13.0 - 17.0

HCT 0.433 0.37 - 0.50

RED CELL COUNT 4.78 x10^12/L 4.40 - 5.80

MCV 90.6 fL 80 - 99

MCH 30.5 pg 26.0 - 33.5

MCHC 33.7 g/dL 30 - 35

RDW 12.9 11.5 - 15.0

PLATELET COUNT 227 x10^9/L 150 - 400

MPV 11.3 fL 7 - 13

WHITE CELL COUNT 5.60 x10^9/L 3.0 - 10.0

Neutrophils 2.98 x10^9/L 2.0 - 7.5

Lymphocytes 2.03 x10^9/L 1.2 - 3.65

Monocytes 0.39 x10^9/L 0.2 - 1.0

Eosinophils 0.17 x10^9/L 0.0 - 0.4

Basophils 0.02 x10^9/L 0.0 - 0.1

BIOCHEMISTRY

SODIUM 143 mmol/L 135 - 145

POTASSIUM 4.2 mmol/L 3.5 - 5.1

CHLORIDE 99 mmol/L 98 - 107

BICARBONATE 24 mmol/l 22 - 29

UREA 5.6 mmol/L 1.7 - 8.3

CREATININE 90 umol/L 66 - 112

BILIRUBIN 7 umol/L 0 - 20

ALKALINE PHOSPHATASE 63 IU/L 40 - 129

ASPARTATE TRANSFERASE 22 IU/L 0 - 37

ALANINE TRANSFERASE 17 IU/L 10 - 50

LDH 173 IU/L 135 - 225

CK 123 IU/L 38 - 204

GAMMA GT 18 IU/L 10 - 71

TOTAL PROTEIN 82 g/L 63 - 83

ALBUMIN *55 g/L 34 - 50

GLOBULIN 27 g/L 19 - 35

CALCIUM 2.52 mmol/L 2.15 - 2.55

Corrected Calcium 2.32 mmol/L 2.15 - 2.55

PHOSPHATE 0.97 mmol/L 0.87 - 1.45

URIC ACID 372 umol/L 266 - 474

RANDOM BLOOD GLUCOSE (FL) 4.4 mmol/L 3.5 - 7.9

TRIGLYCERIDES 1.3 mmol/L < 2.3

CHOLESTEROL *5.4 mmol/L Optimum <5.0

HDL CHOLESTEROL 1.4 mmol/L 0.9 - 1.5

HDL % of total 26 % 20 and over

LDL CHOLESTEROL *3.4 mmol/L Up to 3.0

IRON 12.5 umol/L 10.6 - 28.3

T.I.B.C 54 umol/L 41 - 77

TRANSFERRIN SATURATION 23 % 20 - 55

ENDOCRINOLOGY

THYROID STIMULATING HORMONE 3.92 mIU/L 0.27 - 4.2

FREE THYROXINE 16.8 pmol/l 12.0 - 22.0

[AnthonyMs]

I asked a doctor whether I have a thyroid problem based on my TSH and FT4 results, here's what they said.

"I would need to know the free T3, reverse T3 and the TPO and TG antibodies to see if you are producing antibodies to your thyroid. The new level per the American Academy of Endocrinology lowered the upper normal for TSH to 3.5."

So armed with this information, I'll ask some serious questions to my GP.

[AnthonyMs]

Well I showed the results to my GP and apparently he doesn't think there's a problem. He seemed to suggest that in order to pursue this any further my TSH would need to be much higher in the case of hypothyroidism, so any potential further testing wouldn't be justified on the NHS. I questioned him about whether this could be a case of Hashimotos and he seemed to acknowledge the possibility, but that was all. He also acknowledged I have high cholesterol and the link between cholesterol and thyroid problems. I don't understand why my GP doesn't feel the need to investigate any further, all the scientific literature suggests that TSH and FT4 tests aren't enough for diagnosing so why should I have pay for another expensive private blood test?

Disgruntled.