Help interpreting thyroid blood results

[tiokiko]

I've been feeling terrible for ages (incredibly tired, cold, hair thinning/loss, 'slow' thinking etc etc).

GP arranged blood tests for lots inc VitD, blood count etc inc thyroid - there is some history in my family (grandmother, aunt, great-aunt).

All results are apparently fine but that doesn't explain why I feel so terrible. I think you can have 'fine' levels but still have a problem - is that right?

My results were:
TSH = 1.3
Free T4 = 13

Should they have also looked at T3 or is that not important if TSH and FT4 are OK?

Would really appreciate any thoughts/advice as having a repeat sample taken on Fri morning (start of cycle).

I would have a look at this website as the information on it is good.

www.thyroiduk.org/index.html

Sorry to hear you're not feeling well.

It's much easier to interpret your results if you can give us the reference ranges as well as the result itself. The ranges differ from place to place because of the different equipment used in labs and in interpretation it's not just the figure we look at, but where you fall within the reference range.

Having said all that, your results as posted do not rule out a thyroid condition, but your GP am6 not know that. Sad but true.

Thanks. Ref rants as follows:

TSH 0.2-4.5mU / L

Free T4 9-21 pmol/ L

Any recommendations?

Completely normal, no need to check T3.

That’s good to know, but I thought you needed to look at T3 too? Or have I misunderstood.

If it’s not thyroid, what else could it be? I really do feel so terrible. They’ve checked hormone levels too in case of peri-menopause (I’m 45) but all ok there. I’m totally shattered and just feel like I’m in a fog. This isn’t a normal way to feel and it’s really getting me down now.

The nhs rarely test T3.

Iron? I would guess the GP checked that.

Your T4 is low in the range and yet your TSH is still low. That could possibly indicate that your pituitary is not signalling properly to the thyroid gland to produce more T4 (secondary hypothyroidism).

I think it would be well worth getting your T3 tested, as this is the active part of the hormone that your cells actually use - but you'll probably have trouble persuading your GP to do this & even if your GP agrees, the lab may well not do it, which is an extra-ordinary state of affairs! You could get it done privately - which is less expensive and difficult than you'd think.

You should also ask to have thyroid antibodies tested to rule out autoimmune thyroiditis (aka Hashimoto's disease).

Vitamin & mineral tests would be worth doing to, to include: B12, folate, Vit D & ferritin.

The treatment of people with thyroid issues in this country is pretty dire IMO, so you may need to get proactive yourself. Thyroid UK and TPAUK are helpful websites to find more information.

Thanks @Margot that's what I was getting at. FT4 is less than half way up the reference range, so FT3 will be correspondingly low, thus explaining your symptoms. This looks like secondary hypothyroidism to me, but again your GP may never have heard of it.

I would suggest you do some reading and then go back to the GP and ask for a referral to an endocrinologist in accordance with the current guidelines.

Huge thanks Margot and Time - that’s what I was trying to remember/ explain.

I think I’ll wait to get results of Fridays hormone levels (assuming all will be fine as was fine in first sample) then will go back to GP.

She is generally pretty reasonable and helpful but it sounds like I might need to be persistent. I have to get this sorted as I feel increasingly unwell.

VitD was definitely ok, at the upper end of the range. Iron fine, not sure what other minerals they tested but nothing else flagged as an issue. Kidney/liver function good, cholesterol and blood sugar etc all good so nothing else of concern.

Really appreciate your help, will do some more reading and follow up with GP when I get the next results next week.

Double check the ferritin (iron stores) tiokiko, as the range is huge and for optimal levels, you want to be at least half way through the range.

Stick with it and try and get the GP to delve a bit deeper with your thyroid testing. Be prepared for it not to happen though & consider private testing.

Thanks Margo - will take your advice. Seeing GP next Friday so will see what she says.

Re ferritin - I looked again at my results and this wasn’t tested... nurse said haemoglobin is fine so no need to test ferritin - is this right? I’m feeling worse than ever today, so fed up.

You could still have low ferritin with a normal haemoglobin. Although related, they are two different things. Ferritin tests your iron stores, where haemoglobin is the iron-containing protein in the blood that carries iron and oxygen to cells. It would be worth checking where in the range your haemoglobin was. If you still have periods, it could also be worth asking to check your MCV (Mean Corpuscle Volume) as if you have low iron stores and you lose iron through your periods every month, you can end up with Microcytic anemia, also called Microcytosis.

Have you had B12 tested? Again if not, you should try and get that done.

Thanks Margo that makes sense re ferritin.

Mean Cell Volume is 87 (range 77-98fl) which seems ok?

Don’t think they’ve done B12.

Yes, that MCV is well within the range. Get B12 done - but only if you are not supplementing at the moment (and haven't been).

No not supplementing - I did last year but stopped as I felt absolutely no difference having taken various supplements for about 6 months.

So T3, thyroid antibodies, B12 - and ferritin even though MCV is OK?

Really appreciate your input, I will obv read up on all of this and discuss with GP but it's so helpful to have a steer.

@MargoLovebutter thanks for your help - saw GP today, she's taken more bloods and will look at various things inc ferritin, B12 and others.

She has requested T3 but as you predicted says the lab may not do it... will cross that bridget when we come to it but I guess it's another step closer to feeling better. I have felt absolutely dreadful for the past fortnight, really struggling to get through the day. Hopefully next set of results will show something.

Bridge, not bridget!!

Thyroid blood test results come through v quickly, usually within 24 hours and the lab does hold on to the sample for a while after that. If you can find out whether the results are back and whether the FT3 was done soon enough, your GP can call the lab and give them the clinical justification for doing FT3. Just writing it on the form is often not enough. Timing is critical though.

Please feel free to come back with the next set of results.

Fingers crossed for the T3 tiokiko. Let me know how you get on when the results come in - ask for a print out of them.

@timeistight GP said these results would take longer so not likely to be available before Thursday?

@MargoLovebutter yes will def get printout, I have the others so will add to the set!

Thanks both.

@MargoLovebutter just got a printout of the latest results and they did do T3.

Total T3 is 1.6 (range is 0.9-2.4 nmol/L

So that’s normal.... but I feel absolutely terrible. Worse every day I think.

Ferritin is 9 (range 15-200 ug/L) so low - could that be making me feel this bad, including weight gain?

tiokiko, yes the extremely low ferritin could well be making you feel awful. You have virtually no iron reserves. With a level that low, your GP should be arranging for you to have iron infusions or injections - do not be fobbed off with just supplements.

Did they check your B12?

What is your diet like?

Thanks @MargoLovebutter - my diet is pretty good to be honest. Red meat, fish, lots of pulses, dairy etc. Slow carb but not low carb. Not much sugar.

I’ll see if I can get an appointment ASAP. Are there are guidelines I can reference to back up my case re iron transfusions / injections?