Help with thyroid results please!

[Eyelashesoffire]

Here are my thyroid results
May
Serum TSH level (XaELV) 2.26 miu/L [0.27 - 4.2]
Serum free T4 level (XaERr) 11.3 pmol/L [11.9 - 21.6] - Below low reference limit

July
Serum TSH level (XaELV) 2.79 miu/L [0.27 - 4.2]
Serum free T4 level (XaERr) 11.4 pmol/L [11.9 - 21.6] - Below low reference limit

Can anyone help me to interpret these please?

Just a bit of background - I went to the GP reporting fatigue. The initial bloods came back low for T4, so they repeated the bloods in July. They messaged me to say T4 has gone up so they'll just retest in 6 months.

I've had a closer look on the NHS app and found the details. I'm really shocked to see my T4 has only gone up 0.1 pmol/L! This doesn't seem significant to me.

I still feel exhausted, my hair is falling out! I don't feel cold but I'm very heat intolerant generally. I have heart palpitations most days.

Can anyone advise what to say (if anything) to my GP? @gentlesheep thanks for suggesting I post.

Have you also had your B12 checked? Deficiency can cause fatigue and palpitations. Eta: and hair loss!

B12 has come back normal. If be surprised if it's not a very healthy normal, I eat a lot of Marmite!

Heart palpitations need to be addressed. Ask for a 24 hour tape.

Ask for thyroid antibody test for hashimotos. All your symptoms sound similar to what I had before I was diagnosed. Your thyroid might be coping but it could be the start of hashimotos. Pay privately if they won’t do it. A small dose of Levothyroxine sorted all my symptoms straight away.

Forgot to say I've put on a lot of weight in the last few months

There is a lot of information regarding hashimotos and how to manage it with lifestyle and diet changes. I had high TSH but for a couple of years before I was diagnosed I had all the symptoms you have.

Are your iron levels ok?

I think with the NICE guidelines they can treat - symptomatic and T4
my GP started my on levo, my TSH was higher but the trigger seemed to be my T4

They say iron is ok, I don't have the details on the app. Though in my experience they'll say ferritin is ok but when you get the print out it's 11.2, which is just at the very lowest end of normal.

Hey @Eyelashesoffire glad you posted!

Right so yes you do have a problem there. So there are 3 thyroid labs that should be checked but it's rare to see all 3 being done. They are TSH (thyroid stimulating hormone, produced by the pituitary), FT4 (free thyroxine, the storage form of thyroid hormone) and FT3 (the active form of thyroid hormone - FT4 must be converted into FT3 by your body). Now for most people when their thyroid starts slowing down and producing less FT4, their pituitary leaps into action and pushes the thyroid to produce more, and consequently you'll see TSH rising as it attempts to get the thyroid going.

In your case, although your FT4 is very low, your TSH hasn't really responded by increasing and going over the top of the reference range. This can happen and it's unfortunate for you as doctors place a lot of importance on TSH pretty much to the exclusion of any of the other labs. Your FT4 should be about 3/4 of the way through its reference range. We don't know what your FT3 is doing (it must be similarly very low because of your low FT4) because it hasn't been tested. It really needs to be, along with 2 important antibodies - TPO and TG. These will rise (or at least one of them will) if you have autoimmunity that is causing your thyroid to be attacked and destroyed over time.

Along with this will nearly always be low ferritin, low Vit D, low B12 and low folate. Is there anyone in your family with an autoimmune disease, even if not thyroid disease? It can be hereditary.

Basically you need the extra tests to be certain but your thyroid is struggling at this point and you have the classic symptoms. You may have what's called central hypothyroidism which simply refers to your pituitary not reacting as it should. Sometimes happens if you've ever had a blow to the head at some point in your life. But the treatment is the same as for standard hypothyroidism - replacement thyroid hormone, levothyroxine. That's what you need.

When you GP said 'your FT4 has gone up' - what, by 0.1 point?! That is so small it could be natural variation. It hasn't 'gone up'. You may also begin to encounter the lack of knowledge of most GPs when it comes to hypothyroidism.

You could either return to your GP and insist on getting the missing labs done (especially the antibodies!) or you could buy a home fingerprick test that includes them, such as Medichecks do. However not all doctors will accept those even though they are done by the same NHS lab!

Push for the antibodies test. I was in a similar situation to you and it wasn’t until I had the antibodies test done, which confirmed there was an issue that the GP took my symptoms seriously. I’ve been on levythyroxine for 7 weeks now and feel so much better. Recent blood test confirms levels are back within range.

GP has agreed to the antibodies test, though there's no blood test appointments for a month! They're not allowed to do the T3 test unless there are specific circumstances, I can't quite remember what they are but they don't apply to me. The GP thinks it's my hormones that explain the fatigue and other symptoms. So we're looking at my hrt.

I recently developed Hashimotos and when my T4 was that low in range my TSH was climbing up to 60! That does seem too low to feel well. There's good advice on the Thyroid UK forum on Health Unlocked as well as here. Pushing for more tests definitely sounds like the right approach. If you can afford it, I've used private blood tests a couple of times as you'll get a more complete read out - my GP surgery will add them to my record if I take in a print out

How do you look into getting private blood tests? I would be very interested in that.

Your FT4 is low and your TSH is normal and possibly rising.

This could indicate central hypothyroidism as a pp said, or it could be your TSH is slow to catch up with your low FT4 levels. I had the exact issue and had to wait over a year of feeling increasingly unwell while my TSH slowly crept up, until it went out of range and I finally got a diagnosis and treatment.

I would push for thyroid antibodies testing if the first instance. You won’t get FT3 on the NHS as that is controlled by the lab who only test FT3 in specific circumstances. Or you can get a private test from somewhere like Medichecks they covers both. This will give you a bit more info about what you might be dealing with, and you may be able to argue for levothyroxine on the basis of thyroid antibodies being present.

I would strongly recommended that you join the Thyroid U.K. Forum on Health Unlocked. Post your results there. You’ll also likely need ongoing advice, and you’ll get much better support and advice there than on MN.

Good luck.

a ferritin of 11 will be a more likely driver or hair loss and fatigue, tbh. It s very low, regardless of the lower limit of the reference range

@RelocatingtoFrance thanks, just to clarify when I said "in my experience they'll say ferritin is ok" I meant in the past. My ferritin is genuinely ok this time. When I spoke to the GP yesterday she said it was 73. This is the highest it's ever been, I was in shock!

I will join health unlocked and see what my antibodies test results are next month.

ah i had misunderstood
outbof interest, how long did it take to go up above 70 / what did you do?

@RelocatingtoFrance I wish I knew!! I'd say 9 years ago my ferritin was around 12 (after a year of taking floradix). Then a year ago, it was around 48. The only changes I think are going into the perimenopause, going on hrt. Maybe that has helped - having fewer periods though I still feel like I have some heavy ones, maybe it's just not as much as before? Maybe having a bit more money and buying more red meat? I take a multivitamin more regularly? I can only guess.

I'm not sure I feel much different to be honest. I'm having some Ent/ sleep investigations.

I've also looked at my thyroid results from a few years ago, they're very similar. Though the 'normal limits' are different.
TSH 2.13 [0.35-5.5]

T4 12.0 [10.0-19.8]

Well if anyone is interested, I asked for the thyroid antibodies test, it came back positive!! So my GP is going to ask the endocrinology dept if we can try medication in view of my symptoms. Any advice or tips? Are we talking about Hashimoto's?

I meant to say thanks to @RigIt @Wittering2020 @GentleSheep and anyone else who advised on getting the antibodies test

Yes hashimotos (mine was positive)

Yes, Hashimoto's - welcome to the Club!

As for tips, well it's always suggested to go gluten free as gluten can be involved in inflammation and 'leaky gut'. Up to you whether you want to tackle that, it's not the easiest thing to do. You should also remember you have an autoimmune disease which is a whole body thing. Even though it's affecting your thyroid right now, it's always possible to get another autoimmune disease later, which is why gluten free and generally watching your diet and trying to eat healthily is really important.

I'm glad you are going to get treatment now!

Thanks @GentleSheep you prompted me to make this post on another thread and this what made me pester the GP for more tests, so I'm very grateful!