Is this subclinical hyperthyroidism?

[16yearsofpainsofar]

I recently had a blood test which showed that my TSH was 0.27mU/L (0.35.5.5) and T4 was 11.3pmol (10-20). I'm waiting to hear back from my doctor, but does this show that there's potentially an issue with my thyroid? This is all new to me so I would appreciate some help, thank you.

[SlowDragon Administrator]

Not enough testing to be useful

If anything low Ft4 suggests hypothyroid

are you male or female

Approx age

Are you in U.K.

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

[16yearsofpainsofar in reply to SlowDragon]

Thanks SlowDragon! I am a woman and 27, UK. Folate, b12 and vitamin D are fine but ferritin is low. I didn't eat anything before my blood test and only drank water. I'll check out those links.

[SlowDragon Administrator in reply to 16yearsofpainsofar]

Please add actual vitamin results and ranges

Low ferritin will make you feel exhausted

TSH is highest early morning and lowest in afternoon

[greygoose]

Hi 16yearsofpainsofar, welcome to the forum.

It doesn't show any sort of hyperthyroidism. But we don't really have enough information about you to know what it shows.

The TSH is low, yes, but on the other hand, the bottom of the range is too high. And if you were hyper it would be much lower than that.

Your FT4 is very low, but that doesn't mean much without an FT3 result. But, if you were hyper it would be way, way above the top of the range.

And we need to know the time of the blood draw, and whether you have any sort of thyroid diagnosis, and if you're taking anything for it. Interpreting thyroid blood test results is not as simple as it might seem.

[16yearsofpainsofar in reply to greygoose]

Thanks greygoose. Dr was actually checking something else but included tsh and T4 in the blood test. T3 wasn't tested. No thyroid diagnosis so no meds. Blood test was in the afternoon but I hadn't eaten anything and only drank water. I just want to know what is wrong with me 😔

[greygoose in reply to 16yearsofpainsofar]

Well of course you do - don't we all!

So, a TSH tested in the afternoon is going to be low. It's best to test it before 9 am, when it's at its highest.

Given your very low FT4, I think it would be a good idea to get full thyroid testing privately:

TSH

FT4

FT3

TPO antibodies

Tg antibodies

vit D

vit B12

folate

ferritin

to get the full picture. You really can't tell very much from just a TSH and an FT4. And have the blood draw before 9 am. That will give you a better idea of what is going on.

[16yearsofpainsofar in reply to greygoose]

That's good to know about the time of day! I think I will look into private testing so I get the full picture!

[greygoose in reply to 16yearsofpainsofar]

Details of private testing companies here:

thyroiduk.org/testing/priva...

[SlowDragon Administrator]

looking at your other posts you have psoriasis and possibly endometriosis

Both are autoimmune and having one autoimmune disease makes others more likely……especially autoimmune thyroid disease also called Hashimoto’s

Hashimoto’s frequently starts after hormonal changes, eg pregnancy or menopause

[16yearsofpainsofar in reply to SlowDragon]

Yes I'm no stranger to autoimmune diseases, unfortunately! I gave birth almost a year ago so that might've affected my thyroid?

[SlowDragon Administrator in reply to 16yearsofpainsofar]

Yes many of us with Hashimoto’s get diagnosed after pregnancy

[16yearsofpainsofar in reply to SlowDragon]

That's very interesting. I'm definitely bringing this up when I speak to my Dr! I looked at the symptoms of Hashimoto's and I have many of these. I am underweight and don't gain weight so this doesn't align with Hashimoto's or maybe weight doesn't matter?

[SlowDragon Administrator in reply to 16yearsofpainsofar]

Medics tend to assume you can only be hypothyroid if you’re overweight

But significant minority of Hashimoto’s patients struggle to maintain weight, especially if also develop gluten intolerance (very common)

U.K. medics generally only call hashimoto’s autoimmune hypothyroid (and they almost always ignore the autoimmune aspect of disease)

Hashimoto’s frequently starts with transient hyperthyroid type results and symptoms before becoming increasingly hypothyroid

[16yearsofpainsofar in reply to SlowDragon]

I can't tolerate gluten!! Stopped eating it in my teens as it made me swell up and I was in so much pain. That's why I didn't think I could have Hashimoto's because I'm underweight!

[SlowDragon Administrator in reply to 16yearsofpainsofar]

So it’s looking more and more likely that you do have Hashimoto’s ……or coeliac

Were you tested for coeliac before you cut gluten out?

No point testing now as you are already gluten free

[16yearsofpainsofar in reply to SlowDragon]

No I stopped eating it before I could have the test. This was 10 years ago so I don't fancy eating gluten again to have the test done. I wish the Dr had told me this back then.

[SlowDragon Administrator in reply to 16yearsofpainsofar]

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

[SlowDragon Administrator]

Low ferritin

Heavy or prolonged or frequent periods will lead to low iron and ferritin ask for full iron panel testing for Anaemia

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

Stop iron supplements 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40. 30 to 180

Females 40 ≤ age < 50. 30 to 207

Females 50 ≤ age < 60. 30 to 264l

Females Age ≥ 60. 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

[Angel_of_the_North]

Looks more like central hypothyroidism - where the hypothalamus or pituitary doesn't respond to low thyroid hormones by making TSH rise. Most GPs haven't a clue about central hypo (or anything except TSH). What time of day was test done? Have you ever had a head injury or whiplash? Have you had a problem with excess bleeding in childbirth?

[16yearsofpainsofar in reply to Angel_of_the_North]

Interesting! Never heard of central hypo. It was done in the afternoon (a couple of weeks ago) but I hadn't eaten anything beforehand. The GP is going to redo the test in the morning soon. I don't think I've ever had a head injury or whiplash. I tore during childbirth and since giving birth (nearly a year ago) I've been bleeding almost everyday. My periods have always been extremely heavy but now I'm bleeding all the time (heavy periods and heavy spotting between periods).

[SlowDragon Administrator in reply to 16yearsofpainsofar]

You need to see gynaecologist for this.

Has GP referred you

[SlowDragon Administrator in reply to Angel_of_the_North]

Possibly…..but with absolutely dire ferritin- below 10 …..TSH is often low

Thyroid needs OPTIMAL vitamin levels