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???

I feel great when my TSH is close to zero - I’d be on my knees at 7+ !

Ferritin might be in range but it’s not ‘optimal’ nhs and their guidelines drive me nuts they never say what is optimal for better health 🫤

A dr once told me that your thyroid controls your zest for life and if it’s out of whack you’ll feel it.

That’s why your so cold, so miserable I know 😞

I don’t understand your dr’s reluctance to prescribe thyroxine it really doesn’t get better on its own!

I would go see another GP.

You're hypothyroid, your TSH is way, way too high. You need to get a full thyroid panel done, unlikely you'll get that on the NHS, but you can buy fingerprick blood tests from companies like Medichecks or Blue Horizon (and several others) that will check your TSH, FT4, FT3 and antibodies. Very important to get a test kit that includes the antibodies, as you may have developed autoimmunity.

Sadly low ferritin, folate, B12 and Vit D often accompany hypothyroidism. Combined, all that will make you feel ghastly. Your ferritin isn't 'borderline' low (only according to the daft range they use) it's way too low, because it should be around 90. Hypothyroidism will make all your bodily processes slow down. Hence you feel cold, probably your heart rate has decreased, maybe you have constipation, etc.

Do you have any family members with thyroid disease or other types of autoimmune disease?

I was diagnosed as subclinical with a TSH of 4.95, and a family history of thyroid disease, also had high antibodies. You need thyroid hormone replacement to be started asap.

Thanks, everyone, for every kind comments.

I went back to my NHS app and dug a bit more. They did test T4 which was within the range. Now I remember that's why they didn't take action.

The strange thing is, the app listed the test results across a few years. Apparently, I have a history for issues with my thyroid AND my GP always chose to do anything about it (I was even aware!)

TSH
Date Result
19 July 2023 7.49 mU/L
29 March 2016 4.24 mu/L
13 February 2013 6.47 mu/L

T4
Date Result
19 July 2023 15.2 pmol/L
29 March 2016 10.9 pmol/L
13 February 2013 11.3 pmol/L

I now remember the exact words that female doctor said to me were "give it some time and retest in 6 months. Sometimes they (the thyroid data) would return to normal themselves"...

I went to see the GP while I had quite a few problems. Spotting between periods, heavy bleeding during period. Knee problems. And all the symptoms mentioned in my original post. I felt there were too many things to deal with, so I didn't press on the abnormal thyroid data. My various follow-up scans showed I have thickened uterine lining. Just had the mirena ring implant two weeks ago. (Last night I started panicking about how the mirena ring would affect my hormones!)

My situation is, I am requesting for additional blood test form on top of the one I have in my hand for BCF and TFT. Shall I start taking iron and vitamins D supplements rigidly or not? That would certainly alter my otherwise blood test results and mask the problem? Or shall I wait until the blood test done before doing anything?

Thanks. I think I will order a full thyroid panel test as you suggested. It's too painful to make attempt to go through with the GP - usually an hour just in the queue on phone then they wouldn't give you an appointment any earlier than a month and a half after!

Oops, I meant

AND my GP always chose to NOT do anything about it (I was NOT even aware!)

All of the above plus your oestrogen is probably plummeting as well, and you have small DCs. I went back on the combined pill aged 46/47 after being on progesterone only for years- all the blood results being well into normal ranges - and I feel like a new woman since. I didn't feel tired as such (mine was vaginal/vulval symptoms which gave me cause for concern) but I have far more energy now and have been able to do loads more exercise and I can take this for another year or so until I'm 50, then I will probably switch to HRT.

@shearwater2 , do you mean having the combined pills on top of with the coil implanted? I didn't know you can have both!

I'm in tear right now.

Had a shower to get my hair washed and now I'm soooo exhausted.

DH carries on and can't be bothered to know how much this constant tiredness reduces me into nothing. And I don't feel want to whine about it again after I made so clear yesterday it's not normal and I felt so tired after two hours sleep in the middle morning! I don't want sympathy, but it hurts so much that he seems just imagine I can get over anything all by myself (quietly).

I never fell ill enough to be in bed since the two childbirths I went through. Only this winter, I had a bad cold and shamelessly lied in bed and did nothing for two days - that was like holiday!

Do men just think women are born to be so strong and get on with their own health issues?

I'd consider finding a new GP if they won't take your Thyroid seriously.

No, I switched from progesterone only pill back to combined pill, no coil, but I believe you can combine taking oestrogen with the Mirena coil.

I'm considering now. Just came to realise how stupid I have been all these years. The blood test data clearly said there's issue all along! The problem is that before the new format for test results on screen with the clear range shown, I was never aware!

But nearly all GP surgery are going downhill. Not sure switching to someone else would make any difference!

And keep complaining.
Make a diary of your symptoms, when you need to sleep. How many naps a day you have,what you can and can't do, how you feel.
Does your GP have online access? If so send in reports regularily.
Basically be a squeaky wheel.
It is not your place to diagnose, it is theirs. You need to keep telling them about your symptoms, and don't let them park you with :depression or ME etc. they need to keep looking, and start by treating your Thyroid.
And if you are taking supplements ask if these could be masking other deficiencies.

Some doctors seem reluctant to treat but others are far better.
Eg I was told by a hospital doctor that I needed regular vitamin B12 as my body couldn't absorb it but one Doctor tried to persuade me to self medicate with supplements. My present surgery are fine about it and have even talked about shortening the period a little of my symptoms warrant it.
As to your husband it can be hard to understand these hidden health problems, but do lay it out to him in black and white rather than sheltering him or feeling guilty

Let us know when you get any results for tests back, OP. Many of us here have jumped through the hypothyroidism hoops - or rather, fell through them due to lack of energy! It really is awful just how fatigued one can get, not normal tiredness at all. Then the lack of refreshing sleep.

Sorry your DH doesn't understand, I have to say that's not uncommon, either. Be sure that if it was him, he'd be demanding something be done!

Re doing blood tests for other things like Vit D - don't supplement until you have the test results, so you have a baseline.

@CrunchyCarrot , thank you for the reminder about not supplementing for now. I'm waiting for additional test form before going to the hospital to get it done.

And the sleep! My sleep quality has plumbed so badly. Every morning I ask myself what's the reason!

@MollyButton tha thanks. Will note down the symptoms and keep putting in front of them. They do have online access. I just left another note after yesterday's request for additional tests.

Same for me.

I couldn't believe how much more energy and the will to do things I had when I started on HRT.

Can I ask what shall I do now? Shall I insist in being medicated?

Blood test result came back:

TSH level:
Date Result
6 March 2024 5.84 mU/L
19 July 2023 7.49 mU/L
29 March 2016 4.24 mu/L
13 February 2013 6.47 mu/L

T4 level:
Date Result
6 March 2024 13.6 pmol/L
19 July 2023 15.2 pmol/L
29 March 2016 10.9 pmol/L
13 February 2013 11.3 pmol/L

So it looks like TSH dropped slightly but still beyond the normal upper ceiling of 4.2. but a lot less than treatment threshold of above 10.

T4 is still within normal range, but edging near the lower limit of 11.9.

And over 10 years, TSH has been always above 4.2, whilst T4 was under 11.9 twice out of four tests.

The problem is, I feel I just can't cope anymore. Everyday lately, I feel exhausted from the moment when I wake up. A bit of chore would make me pant and have hard time to catch breath (not sure if it's. my lung or my heart).

I was so tired yesterday morning and simply wanted the go back to bed after DCs left for school. But I thought some physical exercise might help wake up my energy. So I went to the gym. It did feel good at the moment, even though I just did moderate amount of workout, low intensity. But once came back home, the tiredness and coldness gradually consumed me. By 6pm, I was so cold and tired (wearing two layers of trousers and a 100% woolly jumper and fleece on top).

I'm so fed up. I asked for blood test for iron level and it seems not included after all...

B12 was alright last time (6 months ago) though.

What shall I do? I have an appointment next week? I fear they wouldn't treat me as I haven't reached the standard threshold, only "subclinical". 😭

By the way, I've got IUD implanted last month. And my period this month has been going strong - the 10th day, still at medium level with no sign to stop soon.

Go to tpauk uk they have a sample letter there for gps. Post a thread there and they will advise

Also ask for thyroid antibodies test, it may be Hashimoto's which can cycle between under and overactive.

I thought Hashimoto only applies to over active thyroid... Why didn't they test me previously? 😨

Thank you.

At this stage, I've really lost any trust to my GP surgery. I will post there.

Are you having your TFT bloods taken early morning OP?
Did you know that TSH follows a circadian rhythm over 24 hours? So TSH is highest early hours of the morning and drops to its lowest levels mid afternoon. Therefore to capture the truest picture of what your TSH actually is, you have to have your blood taken as early in the morning as your local phlebotomy team have appointments for.

The funny thing is...I just found out exactly the same information 30 minutes ago! I was wondering if my hormones/thyroid whatever fluctuate during the day, as I magically feel much better every evening after 8pm. Almost all tiredness is gone.

I didn't figure out that part, but stumbled across exactly what you mentioned!

No, my last data was based on 2:30pm blood test results. That might explain the slightly lower TSH value than July last year (I did it in early-ish morning!).

But GP wouldn't consider this, would they? I found it based on a piece of research paper. Not widely recognised I suppose?

I can try to push for some more test, like antibody and full blood test before next appointment

But unlikely they'd have results before then. (5 days for blood tests results through).

Can GP prescribe medication for hypothyroid or they'd have to refer to specialist?

And I also gradually came to realisation so many small or big health issues I had in recent years all clicked together and they are all inter-related!

Hypothyroid has a link to polypoid endometrium too!

I had two scans while they gave feedback saying they couldn't be see. And at the third time it's straightaway removed during hysteroscopy procedure and was sent for biopsy! They didn't say anything about it. I was only focused on the implantation of IUD!

Do they ever still inform patients about any procedure results at all? I only saw this in my NHS App. But no result was filled in for biopsy which was sent for nearly a month ago!

My DD was referred to specialist as the medication needs to be stabilised at the level that gives stable tsh for the patient which apparently is a consultant job.

Once stabilised she moved to gp.