What is this frequent tiredness without much physical output about?

[Ohlife2020]

A bit of background information:

I'm 47. Stopped working 5 years ago since my maternity leave. I'm not as active as I used to be (I have never been, but even just the usual movements in an office kept me in good shape back then). In between the early childcare years and up to late last year, I've been busy mentally, but my physical output was just about some housework and nursery runs twice a day often involved a bit running.. From around 5pm, I'm often on my feet non-stop (cooking and all the evening routines) for 3-4hours until kids go to bed.

Low mood: I was fine until last autumn. Since last autumn, I experienced very low mood (had been a while but got really bad in December) and just lack of motivation to do anything, which didn't help me to keep physically active.

I then had problem with my knees and put me off to even try any lengthy walk for a few months.

Fatigue and coldness: I just feel constantly tired and cold. When the living room was kept above 18C-19C, I have to wear a thermal legging under my trousers and a pure wool jumper underneath a fleece hoodie to keep myself sane, just indoors.

Lips crack in the corner: This was a mystery which I first had in mid summer last year. It just would't go away. Tried various products but in vane. It really hurt when I ate and drank or anytime when I opened my mouth. It mysteriously went away. It came back last month and I read online B12 deficiency could cause it. Got tablets dissolving into water for b12 supplment and had it twice before the crack quietly disappeared.

I had a blood test last summer with a result of :

Serum ferrintin 25/ug/l (normal range 14 to 148)
Serum folate: 7.7ug/l (normal range 2.9 to 50)
Serum B12 746ug/l (normal range 160 to 925)
An overly high TSH level - 7.49mU/l (normal range 0.30 to 4.20)

What I can't get is: Can long-term low physical activity cause all the above, or even just simply the constant fatigue and coldness I experienced?

The borderline iron level is not clinically low to trigger GP to do anything. Do I have to get top-up by myself all the time?

Underactive Thyroid indicator may not be severe enough to promote the GP to act. I'm doing another blood test this month, but not sure where it would go.

Just fed up to be so tired all the time. I don't like physical exercise, but if it can help, I will make the effort. But then, is lack of physical exercise the culprit of all these issues? What's wrong with me in general???

Your ferritin is still pretty low, although classed as ‘normal’. Most women need to be above 50 to feel well, it needs to be over 70 for health hair growth.
this works well for bumping up levels.
https://www.amazon.co.uk/Vitality-Bioresearch-Iron-Bisglycinate/dp/B08SKKL9TS/ref=sr_1_3?crid=1HGHRJF63ZRHQ&dib=eyJ2IjoiMSJ9.LbTeCIwpMUQe4pW8QX9FSccSfX0I3WuelthMVm7RFdrnSmu4qCq1NqMM3MApOuoWDi_VDpYUMB0S2_gjaxlN097_FveiJ1c6TwGP6_0hYUsU3eMiK0YcIyXn19xj7_1xjXrDbLUy7an37Q3Dv74fcXe3VlyDjdmr20Mfnw7pYeiTub5oOngjfIyIptmbS1L6_ojMa9TGBVI9B3xXXspPZJ-VCUpEKGCT28UB7jkjE0ghes6TTug4S7-Wk3mm_ekkeHoLe-hle1sY9ZVsauOj4Xu2pukMSBWyKrjcl49EYjk.Fi1IDVyoXfTWWdzB_voX7Nj-pAJQ_hfjDzuiRbXkgaw&dib_tag=se&keywords=iron+bisglycinate&qid=1708961721&rdc=1&sprefix=Iron+bis%2Caps%2C123&sr=8-3-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9hdGY&psc=1

What about Vitamin D, has that ever been checked? That can cause fatigue and pain.

I can’t (well, I can) believe the GP won’t treat your thyroid, you’d feel mikes better if it was but it does seem usual to retest to see if things go into ‘normal’ range. Low iron, Vit D and B12 do seem to be common in people suffering hypothyroidism though.

I hope things improve for you soon

You are of the right age to be perimenopause which gives lots of lovely symptoms, including joint pain. But so can low Vitamin D.

Serum ferrintin 25/ug/l (normal range 14 to 148)
Serum folate: 7.7ug/l (normal range 2.9 to 50)
Those are on the low side and are definitely not anywhere near the middle. Someone better than me can confirm but I thought you needed to be nearer 60 for hair growth and you are 25. I would supplement if your GP won't help.

It very much sounds as if the problem is related to an underactive thyroid. An underactive thyroid is known as the great mimic as it can have so many symptoms that can be part of other conditions. It has nothing to do with lack of exercise - the underactive thyroid will make it more difficult for you to exercise - but the other symptoms you describe are absolutely typical of this condition. You are also a classic age for developing it. It doesn’t help that the UK has the highest reference range for normal in Europe, so there are a lot of people who could feel a lot better than they do. I have been treated for an underactive thyroid for twenty years but in the last few months I have noticed the old symptoms creeping back so I am going to try and get a doctor’s appointment and, hopefully, tweak my medication. As it is, I am like you with constant fatigue, feeling cold and, for me, far too many migraines. I am generally feeling as though I am not A1, which, I think, could describe you, too. I hope you have some answers and feel better soon.

Sounds like thyroid to me.

My DD had these issues.

Are you overweight? I found losing even 5 kilos made a huge difference to my energy and tiredness levels.
Are you eating a good diet? Not too much sugar or carbs?
Agree you are at the age where you can get hormonal fluctuations.

How often are you outside in natural daylight?

Thanks to so many of you replied!

All sounds like what I feared: thyroid led issues...
I felt massive guilt because I'm not doing regular exercise. But it feels there are so many small things wrong with me, it's hard to believe just due to short of exercise.

I'm not overweight. I probably have very fast metabolism and never gain much weight despite I eat more than DH or my male colleagues.

Vitamin D is something I just started looking into. But never been tested.

If it's under active thyroid and the GP keeps using wait and see strategies, what can I do to make better?

@BristolBorn@AutumnFroglets It's a shame if the level of my iron levels is enough to cause alarm, yet the GP actively chose to minimise the potential implications and decide not to address it. I didn't realise the supposed level is so much higher for a healthy body to function!

The new blood test form I just received indicates : TFT and BCF. Does the BCF give results for the iron levels? Or I shall request an additional test, if you know?

Thanks 🙏

Sounds like thyroid, vit d and anaemia issues.
Get a second opinion and/or consider appt privately with an endocrinologist if not satisfied.
Symptoms should be considered not purely numbers.

BCF? I’m not sure what that is.

Is it FBC? Full blood count -no, ferritin is a separate test ( although things within it can be low if your ferritin or b12 is very low such as the measurement for MVC / MVH.

Full blood count (FBC)
This is a test to check the types and numbers of cells in your blood, including red blood cells, white blood cells and platelets. This can help give an indication of your general health, as well as provide important clues about certain health problems you may have.

@BristolBorn , it's printed as BCF. I suppose it's the same as FBC.

I feel wanting to cry honestly. I'm so tired this morning, after 7 hours sleep. So after DCs left for school, I went back to bed for another two hours sleep. But still feel so lethargic and can barely function!

How can I plan go back to work if my daily state is like this? 😭

Bone crushing fatigue and low mood / no motivation was my main peri symptom. Within a week of starting HRT it had all vanished.

It sounds as though you had dcs a bit on the older side so I can imagine that’s v tiring . I’m v late 30’s and kids older . I feel tired a lot but thats because of working and juggling 3 dcs. I worked less before so had more time to exercise and felt way better .
I would definitely look into taking iron supplements and echo a previous poster on going out more in daylight if you don’t already . I don’t actually think 7 hours is enough sleep, I was chronically sleep deprived for literally 6years between all my dcs and despite everyone saying we need less sleep when older I actually need more tbh . I would try and get 8/9 hours .

Definitely your thyroid (I suspected this from your title, your symptoms basically confirmed it and then I saw your tsh level 👀).

You should have further tests with a level like that. T4 and antibodies.

If GP still refuses to treat it, how much (realistically) could it cost if I seek private treatment? Will be very costly, I'd imagine.

I don't have medical insurance.

I had all these symptoms. I was convinced I had thyroid problems. I had peri-menopause, with anaemia and low Vitamin D. In your position I'd get some Better You Vitamin D spray and some Feroglobin iron capsules. Start taking them daily. Maybe with a vitamin B complex tablet too as that improves low mood. See if you feel at all better. If these are the issue, you should improve within a week, if not sooner.

@Ohlife2020 just keep on at your GP and just keep on asking to be referred for whatever. Be insistent.

No idea about private treatment but I am very surprised your T4 wasn’t tested by your GP already. Where I am, in the south west, if your TSH is over 4.2 your T4 and antibodies are automatically tested.

Also, the Nice guidelines say the following regarding a TSH in your range

If your TSH is between 4.2 - 10 BUT your T4 is normal, then it is considered sub-clinical hypothyroidism and you are just retested regularly (if gf your TSH goes over 10 at any point OR your T4 dips below 12, you are treated).

If your TSH is between 4.2-10 and you have antibodies, symptoms or other high risk factors e.g family history of cardiovascular disease, then the GP should offer a trial of treatment.

Basically, with a TSH as high as yours you should either be having further tests to determine whether you need treatment now or monitoring. You should not just be left.

Sorry, I forgot to mention that medichecks does a thyroid panel check that has t4 and antibodies. I think it was about £80 when I got it a few years ago .

perimenopause!!!!!!!!

I agree ferritin is still at low level so could be this. My GP is the same and stopped iron when it reached 30 I think, now I’m symptomatic again 3 months later. I actually went to see her to say I was still feeling fatigued and she insisted it was because I wasn’t getting enough sleep. But it wasn’t that kind of tired I meant. So I stopped the iron as suggested now I’ve had two almost pass out occasions with dizzyness and lots of dizzy moments so need to go back for more bloods. My DD 15 has problems with low ferritin, she has a transfusion after her first period (poor kid) and since then 3yrs ago she’s suffered initially low HB but now low ferritin and is still symptomatic when it’s 20 odd. I agree it should be much higher but docs don’t seem to pick up on it.

Ask for a second opinion, also try tpauk uk there are sample letters on there to take to gp. Wait and see strategies… wait for what? Useless GP. They rarely have the knowledge about thyroid issues. The rest of the world would treat you at that tsh level and well below. I guess the UK tries to save money by not treating

Thyroid definitely. Any autoimmune disease in family? I would also ask for coeliac blood test due to lack of weight gain despite what you are eating.

I also agree with PPs, thyroid. With a TSH at that level (TSH isn't a thyroid hormone, it's a pituitary one, which signals the thyroid to produce more T4 and T3) the lab should also be testing T4 and T3. The low ferritin, B12 and folate go alongside thyroid disorder (I have Graves' Disease - overactive thyroid). I take a vitamin B complex and the Better You vitamin D and K2 spray, but nothing will make you feel better if your thyroid hormones levels are not correct. It's an absolute travesty the way some GPs treat (or don't) thyroid problems in this country.

Read the NICE guidelines and quote them to your GP. Is there a different GP at the surgery you could see. It's one of those situations where you really need to advocate for yourself,.

I have awful symptoms if my TSH goes above 2.5! You definitely need to be treated! Hope your GP listens!