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[laszla]

Wondering if anyone can advise on whether it's worth my further investigating thyroid, initially by re-testing bloods which I do privately though everything else I do on NHS (no GP to speak of, months for an appointment and most are incompetent).

I still haven't made the progress I'd hoped with HRT and some symptoms persist that make me wonder whether perhaps not strictly related to sex hormones but to thyroid issues.
These symptoms are chronic and acute fatigue, feeling terribly cold, especially in the evening, awful sleep, low mood. I think these are associated with hypothyroidism but my metabolism is fast and weight is very low - and struggling to increase it to no avail - which is associated with hyperthryoidism.

6 months ago bloods were as follows - these are all within the normal range but I wonder if anyone could tell me whether it's normal to have any autoimmune thryoid antibodies at all (which I do) if there's nothing wrong?

My t3 is quite low - could it explain my symptoms?

TSH 1.37 mIU/L (Range: 0.27 - 4.2)
Free T3 3.4 pmol/L (Range: 3.1 - 6.8
Free Thyroxine 15.7 pmol/l (Range: 12 - 22)

Thyroglobulin Antibodies 15.3 IU/mL
Method used for Anti-Tg: Roche Modular
(Range: 0 - 115)
Thyroid Peroxidase Antibodies 10.0 IU/mL

[CLKD]

I would ask for a referral to a specific specialist, because GPs don't often investigate further even when patients continue to complain of symptoms.

[laszla]

You're probably right CLKD - and probably even getting said referral would be a titanic enterprise...

[CLKD]

Well it shouldn't sink  ......... but appts being what they are, from the GP upwards: better to register with a Vet these days 

I do believe that thyroid function may be affected by peri-menopause.

[CLKD]

See 'thyroid issues and support thread'

[laszla]

Well it shouldn't sink  ......... but appts being what they are, from the GP upwards: better to register with a Vet these days 

I do believe that thyroid function may be affected by peri-menopause.

Would that I had the medical support my cats have - home visits, unrushed consultations, the vet's undivided attention and at a time to suit them. Now that would be something

[CLKD]

It used to was that we sat in the Waiting Room until the GP had finished - which might have been a few hours  .  Then he went on his Rounds which included house visits.  Now GP s have so much paper work at the end of each day to tick boxes for the government etc. 

Did U read the other thread?

[Wrensong]

Hi laszla.  Some people do have thyroid antibodies without going on to develop thyroid dysfunction, but if it would give you peace of mind & you can afford it, you could test again after 6 months to see whether the levels have changed in a manner that might indicate an autoimmune problem.  Our thyroid profile can also be askew when there are other transient or chronic health conditions ongoing & repeating thyroid testing after a reasonable interval can help rule out thyroid disease if it shows no deterioration in thyroid status over time.  One less thing to worry about, as it were.

It is possible to experience symptoms of both hypo & hyperthyroidism over time while the gland is under attack from thyroid antibodies as hormones are then released in a more unregulated, haphazard way, but I don't get the feeling from what you say here that this is what's going on with you, though that's obviously not a medical opinion & I could be quite wrong. 

Your T3 is quite low as you say, but I wonder whether your body is being economical with production of thyroid hormones &/or conversion of thyroxine into T3 (the active form as you'll know) because of your low weight.  A kind of protective mechanism to prevent you burning off more calories you can ill afford to lose.  Your TSH looks OK, suggesting your governing pituitary is happy with the levels of the 2 thyroid hormones. 

I sympathise though, as I'm underweight too despite my best efforts over many decades to "correct" that & the coldness that comes with it can be miserable.  Frustratingly, nearly 2 decades after peri started, my sleep is still wrecked every night by intense overheating.  Thermostat is well & truly bust  .  So I sympathise with the poor sleep & chronic fatigue too.  I am hypothyroid btw & not a typical case, so balancing thyroid replacement with HRT has been more than a bit complicated!
Wx

[laszla]

Thanks Wrensong, this was pretty much what I was thinking - to retest, quite soon, as the previous one was about six months ago. I do find testing reassuring in that it always tells you something - better, worse, no change.
 
I too suspect the low weight could be an issue - one that also affects my abilility to absorb HRT and sending my SHBG sky high. But as you well know gaining weight is no easy matter. And understanding the cause of the low weight in the first place is also mysterious.

In the meantime I'll test and also look at some low key interventions such as increasing selenium intake which is said to stimulate conversion to T3.
You have my sympathy with the sleep thing - it's the worst xx

[Wrensong]

Only thing is with increasing your T3 by supplementing with selenium, if that boosts your metabolism you may then find it harder to gain weight.  If sluggish throughput of food is an issue though, a little more active thyroid hormone might enable you to eat more. . .  and gain some weight.  Sorry if this complicates things, just thinking out loud as someone else who's also long been frustrated by inability to gain weight.  I steer clear of supplements that I've found boost my thyroid (selenium included), but I rely wholly on thyroid replacement so it's critical for me to be careful with anything that could jeopardise the essential work of my meds.  I'd just be vigilant if you are supplementing, but I think that's in your nature anyway & I really hope you manage to make some progress.  Be great to hear you are doing well by whatever means.
Wx

[Kathleen]

Hello Laszla

My recent chat to a neighbour about her hypothyroidism made me dig out my latest test results and they are similar to yours :-
TSH 1.69 mU/L ( 0.35 - 5.5)

T4 18.4 pmol/L (10.5 - 21.0)

My surgery rarely test Antibodies but I recall my levels were in the normal range when they were last looked at a year or so ago. Coincidentally I am also small at 5' 2"" and eight stone.

I get the impression that GPs don't worry about antibody numbers because they expect your body to be continuingly producing them until your thyroid has been completely destroyed. I suppose the doctors expect your need to take Levothyroxine will stay the same or increase and that's okay because you are relying on  the thyroxine circulating in your body. The TSH number is probably their guide to how much pressure your thyroid is under.

Personally I am interested in the fact that my TSH levels decreased from about 400 at diagnosis to normal over the course of a year. I wonder if this means my thyroid has not been badly injured and could possibly cope on its own without Levothyroxine but that may all be wishful thinking on my part!  My GP told me that some people had a constant 300 TSH but it was okay because they took their medication.
I would love to speak to an Endocrinologist about this but I can't see that happening.

Wrensong has a lot of excellent information and experience and has seen an Endocrinologist which is quite right as her situation is more complex.

One further point is that I am also on HRT but my remaining symptoms are  similar to yours. I have to say however that my mood swings became an issue in post menopause which was long before my Hashimotos diagnosis in 2019. For this reason I still think sex hormones are the main culprit but a wonky thyroid probably doesn't help!

Sorry to ramble on but I hope my story helps you in some way.

Wishing you well and take care.

K.

[laszla]

Thanks Wrensong and Kathleen,
Wrensong, just to be clear, I'm not on any thyroid medication, this is literally my first foray into even considering any interventions on the thyroid front, so I just wondered if you mean that selenium supplementation possibly not a good idea because of potential for even greater weight loss even if I'm not taking anything else (in the thyroid sphere, I am of course on HRT)?

Kathleen thanks for describing your experience.
I've had no discussions with my GP about any of this, testing was done of my own initiative and I'm not on any thryoid meds. I completely agree that it's very hard to pinpoint what is resposible for these symptoms, I too would love to speak to an endo and if I do further investigate this - depending on my blood results and how I feel - then I will probably try and find one.

[Wrensong]

Hi laszla, sorry to have been confusing, but yes I realise you're not on thyroid replacement & that's right, what I meant was that taking selenium in an effort to increase conversion of your body's own Thyroxine into T3 might be counter productive in your efforts to gain weight.  As I said earlier, just wondering whether your body is limiting production of T4 & T3 (by the thyroid gland) &/or conversion of T4 into T3 (in peripheral tissues) in a kind of protective mechanism to preserve calories & reduce the chance of further weight loss because of your already low BMI, but of course this is no more than speculation on my part.  I suspect we might both fare better if we could put on some weight, but from what you say you've found that as fruitless an endeavour as I have. 

Apologies to anyone reading this who struggles to lose weight as it must sound trivial, but the opposite scenario can also be really undesirable, frustrating & problematic.
Wx

[Wrensong]

Laszla, as an afterthought, is your HRT sequential?  Asking because if you are having regular substantial withdrawal bleeds (or perhaps if you are vegetarian), low iron can be another factor that can lead to suboptimal conversion of Thyroxine into T3.  I imagine you will have had an FBC & ferritin checked out anyway.
Wx

[laszla]

Thanks for clarifying Wrensong, you may well be right, I think I will try out the selenium supplementation though as I'm curious to see if it has any effect, or perhaps just a small amount of daily brazil nuts.
You're right about the iron - I switched from sequi to conti in January  and have been bleeding pretty much continuously since then. I take iron every other day (supposed to absorb better on alternate days) but my serum ferritin is low at 59.