Help Interpreting Thyroid Bloods

[StarTravels]

Hello

I've been having problems with constipation and tiredness for some time. My B12 and Vitamin D were low but in the normal range, so I've been taking supplements. The doctor checked my TSH and it was 2.1.

I decided to have a private blood test of my thyroid and the results are as follows:

TSH 1.4
Free T4 11 (range 12-22)
Free T3 3.8 (range 3.1-6.8)

Does anyone know what this means? I seem to have low Free T4 and although the Free T3 is within range, it is at the lower end. Is this indicating a problem with the pituitary gland (tumor?!)

I only ask star as the BMA book lists both sertraline and birth control pills as requiring extra thyroxine (though in the context of already being on thyroxine)

I found I needed more on sertaline and was first diagnosed with thyroid disease when on oral contraceptives. I came off them and did not need the thyroxine for a while, before deteriorating again as the antibody process must have started. (Memory hazy as 19 years ago!)

Alwayscheerful I used blue horizon. Their prices are online. Go to www.privatebloodtests.co.uk. The Thyroid UK website has links to other testing companies too. Mine was £132 for TSH, FT4, FT3 and antibodies.

Hi Clarella, no, I'm not on any birth control, just sertraline.

So HairyLittleCarrot was your reading just down to hypothyroidism and not due to a pituitary problem? Did you hate to wait till your TSH rose before they would treat you or could they do this on the basis of the FT4 alone?

I haven't been diagnosed with anything yet!
FT4 always fairly low normal, around 13 ish
My Tsh is now over 3 so if it continues to slowly rise I may end up being diagnosed with hypothyroidism by, say, 2020...

That's how I was. My TSH rose from 1.6 to 4.2 over six years, but FT4 and FT3 were always low in range. Symptoms often run ahead of blood work Abd I was very unwell for all of those years and more.

Treatment, first with thyroxine and then with NDT, has changed my life.

Oddly enough, MrsTweedie, I find your post both encouraging and depressing at the same time!

Do you have Hashimotos?

I can see where I am headed and have some hope that treatment will be forthcoming eventually. It could still be a couple of years away yet.

In the meantime, I am trying to pursue other problems that can be treated...deficient in vitamin D: started supplements. Deficient in B12 - beginning the process of trying to get my GP to read the bloody B12 guidelines.

Trying to fix the fixable whilst waiting for the other shoe to drop.

So will it not normally be possible to get thyroxine until the TSH rises even if the FT4 is low?

Unfortunately not, unless it was clear that there were antibodies (there are 3 sorts possible) which are actively attacking the thyroid. And so would slowly degrade anyway.

Tsh is released from the pituitary to tell the thyroid to make more thyroxine, the pro hormone which is converted to t3, the hormone that actually has effect on your metabolism. T3 has a short half life, so there can be small changes daily. But Tsh is a good barometer of how the whole system is working - unless there's a rare issue at source eg pituitary or hypothalamus (which tells pituitary to make Tsh!)

Because it would be hoped that a slightly low t4 and a slightly upped Tsh is indication of the thermostat feed back responding and hopefully sorting it's self out, just like a spike in insulin in a healthy person (though not great for body, evidence it's working)

But then if Tsh slowly over months or years continued to rise it would show that the thyroid itself isn't responding. As the pituitary keeps desperately trying to produce more to keep things going. So around 4.5 -10 is the grey area where usually people get tested for antibodies to see if there's any autoimmunity.

It's worth it, to keep going to GP and asking for help, 'just in case' if you are experiencing symptoms. But it's worth remembering other things can cause similar symptoms too.

The low t4 is a little odd, which is why I question the sertaline. If on sertaline it can mean you need a little more thyroxine, if you take it. I have no idea what it means to someone not on thyroxine. It DOES mention something about thyroids in the sertaline patient leaflet though, I don't have mine any more.

www.medicines.org.uk/emcmobile/PIL.23062.latest.pdf

Annoyingly vague but page 7 - "low thyroid hormones"

But this should be weighed up and discussed with GP and after other investigations.

It just seems bizarre to me that if my thyroid hormones are low I won't be medicated unless the TSH rises. I'm feeling so unwell, I had hoped I would be able to get some treatment with these blood results.

You should get treated. Your blood results indicate probable secondary hypothyroidism.

You need to be treated based on your FT4 and FT3 results, regardless of your TSH and your GP should follow the NICE guidelines and refer you to an endocrinologist.

(I wouldn't recommend my endocrinologist)

Google Jostel TSHI. Andreas Jostel came up with a mathematical formula to predict the likelihood of secondary hypothyroidism based on the relationship between TSH and FT4.

I am no longer as convinced that I have secondary hypothyroidism since my TSH has risen. But you should try to convince your doctor for further testing.

So...

I went and saw my GP and had more blood tests. I haven't seen a print out yet, but I did speak to the GP on the phone. She said that my FT4 did come back as low and out of range at 11 but that she spoke to the people at the Labs who told her that 95% of people have a normal that's not within the reference range and that it's probably just my normal?!

Do you think that's likely? She has sent a message to an endo to find out whether they want to see me or not, so it sounds like it's down to the endo to decide whether I need further investigation.

She did do other tests (including antibodies which isn't back yet) and cortisol and testosterone which again I'm told are normal but I don't have the print outs. I'm going to request them today.

Really, I was just wondering what your opinion was of what the Lab said and whether it's likely an endo will want to see me and if not, what I should do now?

95% of people have a normal that's not within the reference range and that it's probably just my normal

erm... 95% people are IN the reference range, I think she means!

See what your antibodies come back as and then take stock.

Thanks Hairy. I know you're right. I will wait... although, I'm starting to wonder whether my GP didn't actually request the antibody test. When I picked up my results this afternoon, no one said any results were outstanding, and to me it looks like weird stuff has been tested:

I've been tested for:

Calcium
PTH
Prolactin
Serum LH
Serum FSH
Testosterone
SHBG

No cortisol either, which I was told was being tested so I had to get there early for the blood to be drawn.

And although she told me over the phone my FT4 was 11 matching my private test, this isn't included on the print out of my results. Could the Lab have refused to send the results, but gave them to her on the phone?!

Are these the normal things you would test for to rule out secondary hypothyroidism?

I think I'm going to try a private Endo. I'm not patient enough for all this!

That looks as if they are looking at menopause as a possibility...

Follow up on the cortisol and missing results, they may still be outstanding as not all results are ready at the same time.

I'm 32 and had a baby 8 months ago! I sure hope menopause isn't a possibility!!!! I will call them tomorrow about the missing results.

sorry, didn't mean to freak you out!
My periods went wonky whilst I was winding up breastfeeding and after a couple of years of faffing it was decided I had gone through menopause. (So I suspect this may be more about me being alerted to those sorts of hormone tests, and not necessarily an indication about your results!)

Haven't got any advice for you I'm afraid OP
but can empathise and really hope your GP is more receptive than mine is.

My TSH is slowly on the increase (2.64 a couple of years ago, 3.76 now) but I'm very, very unwell and have now been diagnosed with CFS although I'm starting to believe some of my symptoms could be treated. The thought of having to wait years for my TSH to increase to the point where my GP will treat me makes me want to give up now. The thought of being left with these symptoms is really affecting my mental health.

Mrstweedie was kind enough to point me in the direction of the thyroid uk forum (on health unlocked) which has lots of knowledgable members willing to help. There is even a section for people struggling to get diagnosed. They were very helpful to me with the only stumbling block being my GP.

Also have your iron, b12, vit D and folate checked. I have come back as either very low or deficient in all of these. Also now struggling to get my GP to check if my low B12 is pernicious anemia!

Tiptops - my story is pretty similar to yours, TSH on the rise, B12 of 188 but GP unwilling to act. I actually sorted out some private blood tests today because I decided to take matters into my own hands.

Sorry to hear that Tiptops. It sounds like there are lots of us all in this same unfortunate boat.

Have you had your FT4/FT3 checked?

Hairy I don't blame you at all. I can't believe symptoms can be ignored no matter how unwell you feel, until your blood tests show a magic number. I think in some countries it's now recognised that people feel unwell when TSH is over 2.5.

Star my T4 has remained at 12 since the first test a couple of years ago. T3 not tested although I'm also considering going down the same route as Hairy and having some private blood tests.

Not had any FT tests done yet. Do you think you'll go ahead with the private endo? Makes me cross that the NHS is failing us to the point that we have to go elsewhere for answers but totally understand you wanting to move forward with it.

Yes. I've just now emailed a private endo's secretary to see when I can see him. I got a list of recommended private and NSH endos from the people on the forum MrsTweedie recommended.

I don't mind paying if it means I will get some help. I'm just worried that if I see a private consultant and I do finally get some medication, that I will have to pay for it privately for the rest of my days. I'm not sure if the NHS will prescribe it if a private consultant says it's necessary?

I got my bloods done privately too. I used Blue Horizon. They do some finger prick tests too. I think it's important you get the Free Ts done from what I've read, as T4 doesn't give you a true indication of the amount of thyroid available for your body to actually use for FT3 (I think!)... still new to all this!

I'm not sure if the NHS will prescribe it if a private consultant says it's necessary?

My GP seems to be happy to give me free private prescriptions on the NHS - not sure if that's NHS policy or just him.