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[SundayGirl]

If you have your previous TFT results to hand we could always take a quick look.

I suspect your GP won't do anything more than TSH. Even if they request T4 and T3 the labs very often overrule and don't do them especially if TSH is within range. (Being in range doesn't necessarily mean that all is ok though)

[joziel]

Crispy, your GP won't test anything beyond TSH. Sometimes you can get them to test T4 but usually they can only do that for people already known to have a thyroid condition. Personally, I wouldn't be happy having your symptoms and not having had a full thyroid panel done.

Sunday...

"Well if you have a low T3 then it stands to reason that you'll have a higher rT3. T4 has to be converted to something."

No, not at all. There are many people all over FB posting thyroid labs with low T3 and mid-range and perfectly acceptable rT3. Having low T3 does not necessarily mean you also have high rT3.

"And if you have a low T3 then there's not much point in paying for a rT3 test as it will be high."

Again, not true. Here are my own labs off meds:

TSH        2.38
free T3    2.6L (3.1-6.
free T4    12.3 (12-22)
Total T4    64L (66-181)
rT3            17    (10-24)
Reverse T3 ratio 0.15

You'll see my free T3 is so low, it is below range. My rt3 is mid-range and would be completely fine if my T3 were decent. Completely disproves what you've just said.

"Also, low T3 and higher rT3 doesn't necessarily mean you have issues with your T4/T3 conversion."

In the absence of any other cause, like fasting, severe illness (being in intensive care), and other obvious causes, the most common cause of low T3 and high rT3 is indeed conversion issues. And when someone has a lot of symptoms of hypothyroidism along with a high rT3, it makes sense to treat the high/low T3 and see if that helps them to feel better.

My original thyroid labs, 3 years ago, were:

TSH        1.37        (0.270-4.2)
free T3    3.9        (3.1-6.
free T4    18.6        (12-22)
rT3            32            (8-31)

And that is indeed what was done for me, I was given a trial of low dose T3 as a result of these labs. If I had not tested rT3 and the only results you were looking at here were the others, I would not have been prescribed thyroid meds with these results. As most functional medicine doctors will tell you, rT3 is an essential test.

Crispy, if you're confused you can have a read of Dr Child's info: https://www.restartmed.com/reverse-t3/?srsltid=AfmBOorqFGdRS3-OBg4qDHKXlzHateLLJO5TWNXeAn4gQU5gcF0lmMnV

[Mary G]

Sorry to barge in here but am I right in thinking that a lot of women have thyroid issues around the menopause but do not necessarily thyroid disease?  We've had a lot of women on here with a borderline low TSH who don't have thyroid antibody issues but still have a sluggish thyroid.  I'm pretty sure someone on here said they had no thyroid disease and a TSH of 5 ish so they started taking low dose thyroid medication.

HRT and birth control pills can mess with thyroid blood results apparently.

Crispy, I also think Professor Panay privately would be a good idea.  He's flexible on dosage and he has a lot of experience having worked and trained with Professor Studd.

I think the Gluck Clinic would have spotted a thyroid problem.  I remember one of the doctors there telling me that she liked her patients to take thyroid medication if their TSH is over 3. 

[CrispyChick]

Ok. I might go to paney. I have been looking at Tina Peers clinic as I defo do have some mcas type reactions going on.

I'm just not sure if it's all MCAS reactions or not.

I'm not sure Paney will deal with MCAS??? 

I'm thoroughly confused by the thyroid issue.

So, if someone in the know can help. These are my Marion Gluck results from 2021:

TSH - 0.93
Free thyroxine -14.8 pmol
Free T3 -4.2 pmol

Thyroglobulin antibody - 13
Thyroid peroxidase antibodies - 16.2

Then I have some GP results from 2023

TSH - 1.2
Free T4 - 13 pmol

Anti tTG IGA - 0.48. (I don't know if this is thyroid or not).

So, did Marion Gluck do the full panel???

[CrispyChick]

Mary.

I can see my bilirubin levels have been tested for the last 4 years. All completely fine. No where near high.

[SundayGirl]

CrispyChick do you have ranges for those results?

[joziel]

Crispy, you always need to post ranges with any thyroid results. Nothing jumps out there as being obviously 'off' but it would be best to test both thyroid antibodies tests and rT3. Most comprehensive thyroid lab you can order yourself is, as above, Blue Horizons Platinum test.

Mary, you can't spot a thyroid problem if you're only testing TSH and T4 - no matter if you are superhuman, let alone Marion Gluck herself. Not running the right tests isn't going to get you the results you need. And as you can see from the results I just posted, going by TSH isn't advisable - seeing my TSH was 2.38 and my T3 was way below range.

It is a bit of a grey area, the thyroid, not so black and white as to whether someone 'definitively' has thyroid disease or not. Interestingly most older people have low T3 but this is just considered to be what 'happens' as you get older and isn't fixed typically (unless it falls below range). I think it's worth considering this in the light of fixing sex hormones into their biological optimal ranges for younger women (and men too, on T replacement): Why correct some hormones and not others? Arguably older people would be less at risk of disease if their thyroids were optimised as much as their sex hormones.

[SundayGirl]

Sorry to barge in here but am I right in thinking that a lot of women have thyroid issues around the menopause but do not necessarily thyroid disease?  We've had a lot of women on here with a borderline low TSH who don't have thyroid antibody issues but still have a sluggish thyroid.  I'm pretty sure someone on here said they had no thyroid disease and a TSH of 5 ish so they started taking low dose thyroid medication.
 

You can't fully diagnose thyroid disease with just one set of blood results. In early thyroid disease the numbers can fluctuate between very high and very low and some people are mistakenly diagnosed with Graves when it's actually Hashi's.
The vast majority of euthyroid (no thyroid disease) people have a TSH towards the lower end of the ranges. A TSH of 5 is indicative that the thyroid is struggling at that point in time. You'll not receive a hypothyroid diagnosis from any medical professional with just one result outside the ranges unless it's extremely high.

[CrispyChick]

Sure. Hold on...

Marion Gluck:

TSH 0.93. - range 0.27 - 4.2 ml/l
Free Thyroxine 14.8 pmol.  Range 12-22
Free T3 - 4.2 pmol.  Range 3.1-6.8

Thyroglobulin antibody - 13.  Range 0-125 IU/ml
Thyroid peroxidase antibody -16.2   range 0-34 IU/ml

GP tests:

TSH - 1.2 Mu/l. Range 0.23 -5.6
Free T4. 13 pmol. Range 9-28
Anti tTG 0.48. Range 0.1-5 U/ml


And what is my GP missing here if I ask for new tests???

Thank you. X

[SundayGirl]

TSH 0.93. - range 0.27 - 4.2 ml/l
Free Thyroxine 14.8 pmol.  Range 12-22. 28%
Free T3 - 4.2 pmol.  Range 3.1-6.8 29.7%

TSH - 1.2 Mu/l. Range 0.23 -5.6
Free T4. 13 pmol. Range 9-28 21%

The percentage through range on both sets of testing is really low. (Are you sure the GP range is right as the top number looks high) Most people feel good when the numbers are up in the top third of the ranges. Everything is within ranges though so I doubt if your GP will give you any sort of thyroid disease diagnosis.

Your antibody tests are negative but that doesn't mean you don't have thyroid disease. A significant minority of people never test positive for antibodies but still have thyroid issues. Me included.

If I had those sort of levels I'd be crawling on the floor. To function as a normal person my T4 needs to be really high (20 or 21) and my T3 at 6 or above.

I'm not a medical professional, this comes from many years of dealing with this myself and learning along the way. Sometimes learning the hard way.

[SundayGirl]

Joziel

My original thyroid labs, 3 years ago, were:

TSH        1.37        (0.270-4.2)
free T3    3.9        (3.1-6. 21.6%
free T4    18.6        (12-22) 66%
rT3            32            (8-31)

Percentage through range added by me
Your TSH is where the majority of euthyroid people sit within the ranges. But ....Even you must be able to see that your T4, which seems slightly low, wasn't being adequately converted to T3. You don't need rT3 to tell you that.

TSH        2.38
free T3    2.6L (3.1-6. -13.5%
free T4    12.3 (12-22) 3%
Total T4    64L (66-181)
rT3            17    (10-24)

Percentage through range added by me.
Your TSH has risen from your initial test. Again, no need to look at rT3 to know your thyroid is struggling.


Please stop being fixated on rT3 and please stop trying to pick holes in everything I say. You've been given very similar information as to rT3 being a red herring by people with much more in-depth knowledge of thyroid issues in the past. You chose to ignore that advice once several people were saying the same thing.

Yes, TSH should not be relied on as a monitoring tool in people with thyroid disease but is useful as a tool during diagnosis. Even the people who developed TSH testing have said that

[CrispyChick]

Thank you Sunday girl. Appreciate you taking this time.

Yes, that GP range is correct.

I'm not sure I understand though. So everything is in range. Agreed.

But if you had my levels you'd be 'crawling on the floor' so are you saying I do likely have a thyroid issue, but not one the NHS would pursue?

So therefore it would be worth my while seeking opinion elsewhere???

And what would your 'crawling on this floor' feel like??? I'm a bit confused by this.

[CLKD]

It's in the condition: Thyroid disease : so full investigations are necessary and with it being a hormone, any other upheavals may well impact.

R U particularly tired with no energy: do you have Bulging goldfish eyes: both indicative of thyroid disfunction.

[SundayGirl]

CrispyChick 

Yes everything is in range so your GP would say that everything is fine and dandy. However......

Looking at your numbers your thyroid is struggling but your TSH doesn't reflect it. That's all GP's are really concerned about.

Before my diagnosis I was a walking zombie and I use the word walking loosely.

I could barely move.
Exhaustion but not able to sleep properly.
Extremely weak muscles so much that I could turn around and hurt my back.
Terrible constipation.
Depression
Uninterested in everything
Unable to eat but gaining weight
Freezing cold and wearing a sweatshirt when everyone else was wearing summer clothes.
Several bouts of tonsillitis
Everything was so dry and hair like straw and shedding.

There's probably more but that's what I can remember off the top of my head and I felt like my body was shutting down ready for death 

Have a look at this website and see how many boxes you tick
https://thyroiduk.org/signs-and-symptoms/hypothyroid-signs-and-symptoms/
And crawling on the floor - I meant that literally as I could barely stand upright. The carpet on the stairs got a good close inspection every time I needed the loo.



Edited to make link work

[SundayGirl]

R U particularly tired with no energy: do you have Bulging goldfish eyes: both indicative of thyroid disfunction.

The first is usually linked to hypo although some people feel like this with hyper.
As for the bulging goldfish eyes, that's just one symptom of TED or Thyroid Eye Disease, it's usually associated with hyper although not always and not everyone gets bulging eyes. That's a fallacy.  As is the thought that everyone with thyroid disease develops a goitre.