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'm not sure that there is guidance tiokiko, but remind the GP of how awful you feel and how deficient your iron stores are and ask if you could have a infusion/injection to get you started and supplement thereafter.

GPs usually prescribe ferrous sulphate, which I think is very hard for the body to absorb and can give you black poo & constipation. You may want to investigate your own supplements and I have found that ferrous gluconate or chelated iron bisglycinate, are less hard on the guts and maybe better absorbed. Vitamin C can aid absorption of iron too, so if you don't take any at the moment, that could be worth supplementing too. Tea and dairy can inhibit absorption, so I try and keep consumption of those a few hours away from ingestion of the iron supplement.

I'm not medically qualified, so I'm just sharing my experience - it is not advice or instructions.

Sure, understand - that all makes sense. Just called GP and the receptionist said the ferritin level is satisfactory so no further action is required... feeling a bit baffled by it all.

I am the opposite of a hypochondriac- generally really well and healthy but feel so shocking at the moment.

GP might call back later but in the meantime I will look at other supplements.

So I think your TSH is off. Your symptoms are classic of low thyroid levels (TSH is inversly proportional to T4 and 3}. You could be meant to be running a much lower TSH. The reference ranges are so wide, you could easily be way off wher you normally would be and still look like you are withon normal ranges. For example, my TSH need to be below 0.5 for me to feel normal. If it gets any higher I get symptoms exactly like yours.

If all your other bloodwork comes back normal, I would ask the GP if you could trial a small amount of thyroxine supplementation to see if it helps your symptoms. You should be able to tell within a few weeks although standard practice is to wait 6 weeks.

You may well have to push hard for this, most doctors are awful at treating thyroid issues as they dont see the symptoms of low thyroid as a problem.

One quick question, are you noticing any difficulty, or change in swallowing recently. If you look in the mirror at your neck and swallow, does it look normal?

SeaToSki, I agree with what you are saying, but there is no way in a million years that a GP in the UK will agree to trial thyroxine when the TSH is 1.3. Asking for that would be like whistling in the wind. I would recommend Thyroid UK and TPAUK for further information/advice regarding thyroid issues .

I'm struggling to understand how to below range ferritin can be deemed 'satisfactory' with no further action required. The ferritin range is already too wide. No one will feel on top of their game with iron stores around the bottom of the range - let alone below them. What is the point of having a range, if you ignore it when results fall outside of it?

Our health system depresses me sometimes.

Was it this over 40s health check you had OP? I had this recently (I am on thyroxine already for Hashimoto's) and it showed up low folate levels, I've been prescribed supplements. The symptoms look similar to thyroid.

You do have to be careful not to become obsessed with the idea that it's a thyroid problem if it isn't. It's tricky to pinpoint what makes so many women in their 40s feel so unwell. There are just so many factors, diet and lifestyle, hormones etc I regularly hear people say they are sure they must have a thyroid problem because they associate it with tiredness but there's a lot more to it than that.

Thanks @SeaToSki - agree but also agree with Margo that they won’t prescribe atvthis stage.

@MargoLovebutter totally agree. I genuinely don’t see any way that level could be satisfactory given the range.

I’ve told her how terrible I feel, this is not my normal state and it’s really starting to be a problem. Not sure how much longer I can function if I keep feeling like this.

I might get a proper care full Thyroid test done - thinking Thriva for speed. That will give me full info Free T3 and might give a better picture.

But ferritin obv needs to be addressed and infusion sounds sensible. I can’t wait months for tablets to work. Also remember ages ago I took them and had stomach problems (cramps, sickness, diarrhoea) and really don’t want that now on top of everything else.

My iron stores were about that level and I felt shocking, wanted to sleep on the pavement! They gave me ferrous fumarate which helped a lot. I would get an iron supplement, take it with orange juice and make sure you're avoiding drinking tea with meals or the iron supplement

@SaturndayNight no not an over 40s check, just a GP appointment because I feel incredibly unwell.

I’m not obsessed with it being a thyroid problem but given my symptoms and significant family history of hypothyroidism it seems like a sensible thing to rule out.

Given the fairly basic NHS tests and apparent lack of understanding, I don’t think it’s unreasonable to investigate further. If it’s not a thyroid problem that’s great, we rule it out and look elsewhere but I’m not willing to continue feeling this bad at a relatively young age.

@SaturndayNight also hormone levels are good. I thought it could be perimenopause but hormone levels are all good and cycle regular (until last month) 28 days on the dot. I’m confident that’s been ruled out as that would be an obvious one to check.

I've used Medichecks and Blue Horizon for private blood tests and they've both been fine and relatively inexpensive too.

If you can face it, liver is a great way of boosting lots of vitamins & minerals. You don't need to eat loads (in fact you shouldn't) but a serving once a week is very helpful. There are ways to cook it that make it palatable, or you could have liver pate - lots around at the moment for Christmas.

I would get supplementing the iron asap, don't wait for GP.

Hi OP

google sub-clinical hypothyroid, and also look at the reference ranges used in other countries. It is quite interesting. I used Medicheck for blood tests, cheap and fast but my problem was I couldn't get enough blood out easily with the fingerprick so that was the hardest bit!

GP called earlier and will prescribe iron tablets. She doesn’t think ferritin is an issue as Hb was fine. Not sure why they bothered testing ferritin separately in that case.

She’s also sure all thyroid function is fine so has ruled that out. I feel so tired and confused by it all now, not sure what to do next but guess I have to take the iron and see how I am in a few weeks. Wish I could convince her how unwell I feel.

A week into taking the iron supplement and I'm still feeling as bad as ever, but I've had a bad cold and I know it will take a while to feel any different so am not too despondent!

I'd already ordered the Medichecks thyroid check you mentioned @MargoLoveButter so thought I might as well do it. Results broadly the same as GP test (apart from Free T4 which has increased from 13 to 15.9), Free T3 is 4.5 which is within range too.

B12 is 360 which again is within range but I've read elsewhere is better to be over 500 so I should maybe supplement there too.

You'll get different figures on a different test because they are using different equipment, simple as that. Again it would be useful to have the ranges for FT4 and FT3 but, assuming they are something like 12-22 and 3-7, and looking at where in the range you fall, your FT4 and FT3 are both far too low.

Your B12 is also way too low. It needs to be at least 500, as you have read, but the Pernicious Anaemia Society would say it needs to be double that. The range where I live is 191-663. I take a daily sub lingual supplement and keep my level round about 900.

Unmedicated, with a TSH around 1 and FT4 and FT3 in the bottom 40% of the range, or thereabouts, I would definitely be asking about secondary hypothyroidism, doing my homework and asking for a referral to an endocrinologist.

The NHS kept me ill for ten years in exactly this situation, by looking only at the TSH. I wouldn't want that to happen to you.

tiokiko, as timeistight says, it would be really helpful to have all the results from Medichecks with the ranges, as these can differ from lab to lab.

Ranges are: FT4 (12-22) and FT3 (3.1-6.8)

So, looks like:

FT4 15.9 (12-22)
FT3 4.5 (3.1-6.8)

I've put these through my calculator and both figures are just less than 40% into the range, which is too low.

Good results for those ranges would be 20 and 6 respectively.