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What further tests would be helpful for determination?

Hi all. I have been feeling rubbish for the last 3 months, with all joints aching, starting in hands and spreading to all, stiff, numbness and tingling like pins and needles, exhaustion, major anxiety (which I do suffer from PTSD and anxiety anyway), irritability, nausea, vertigo, very poor cognitive function, memory loss, very weak, hard to get to sleep and sleep very broken, vision often poor and any physical activity such as even a shower exhausts me.
I have just turned 40 (currently feeling 80) and otherwise been of good health historically.

I got tests but only a nurse has followed up so I would like to know what you all think I should do next and what I could/should  expect from when the Dr follows up. I would like to get to the bottom of this with the Dr quickly so I can resume my normal life. Thank you.

RF immunoturbiodometric: 14IU/ml (<14)

T4 (Free): 14.8pmol/L (12.0 - 22.0)

No T3 (Free) test which I understand would be a helpful test

TSH: 0.36 mIU/L (0.4 - 4.00)

FERRATIN: 12ug/L (20 - 200) which is obviously terrible. Would Thyroid function be low due to low ferritin or would ferritin be low due to thyroid function? I have only just run out of carbonyl iron I was taking so I am not sure why ferratin is so low.

My cholesterol tests are also of concern which makes no sense to me as I have a relatively healthy diet and my job is very physica so I am not lacking in exercise. I don't smoke, drink, take drugs and I am not on any medications.

CHOLESTEROL: 5.7mmol/L (<4.0)
CHOLESTEROL LDL (calculated): 3.3mmol/L with no normal range provided for me

If anyone could give advice or make sense of this chaos I'd be very grateful.

Carrie
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Avatar universal
Just a thought. But  you may also want to test your sex hormones. And be specific being a woman to ask for TESTOSTERONE.

At age 40 women start to lose the ability to make or have enough testosterone. It is not well known or even accepted by the medical community, but Testosterone is extremely important to women (just as estrogen is extremely important to men), in the proper levels and balance.  By volume, women have up to 10 TIMES the amount of testosterone than estrogen in their body.  Which proves two things  1) how important testosterone is to women and should NOT be ignored and 2) Just how powerfully potent estrogen is, that such a small amount has such large effect.

Also for consideration is that all sex and thyroid hormone is made from the base cholesterol molecule, so if you are very low cholesterol, your body would not have the building blocks to even make steroid and other hormones.  Low thyroid typically causes high cholesterol.

I am not saying you have a sex hormone imbalance. But you have many symptoms that cross both Hyper and Hypo thyroid.  And I am wondering if other hormone issues are adding into your overall state of feeling poorly.

Night sweats for example is common symptom of low estrogen (Estradiol).  Other symptoms of low estrogen are similar to low thyroid include: frequent UTI., menstrual irregularity,  Dry skin and brittle hair, brain fog and inability to concentrate.  All of these are also consistent with low thyroid.  And your very low in range FT4 level also points to low thyroid.  As Gimel stated the fact that your TSH is low I would agree points to central hypothyroidism.  Joint pain is also associated with low thyroid, and for MEN, joint pain can be due  to low estrogen.  But I do not see that as a common symptom for low estrogen in women.

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Hi Flyingfool,
Thank you for the brilliant information. I am just about to head to the Dr and will discuss (PUSH) for hormone tests.
Thank you so much for your help. I have a new Dr so hopefully this Dr will see the body as a whole system and not just systems the function independently of each other!
Avatar universal
If you will read a paper I co-authored in the following link, you will learn about the importance of symptom evaluation, along with both Free T4 adn the biologically active thyroid hormone Free T3.  

https://thyroiduk.org/further-reading/a-patients-guide-to-the-diagnosis-and-treatment-of-hypothyroidism/

When I look at the full list of your symptoms, you have quite a number of symptoms typical of hypothyroidism.  In addition your FT4 is too low for many people (everybody can be different in the thyroid levels needed to feel norma).  And more importantly you need to insist  on a Free T3 test.  Free T3 largely regulates metabolism throughout the body.  I expect that low thyroid levels are your number one problem.  

In addition your TSH is lower than I would have expected in view of your FT4 level also being low in the range.   This makes me think of central hypothyroidism where the pituitary is not producing enough TSH to adequately stimulate the thyroid gland.  Do not allow the doctor to tell you that you don't have a thyroid problem because your tests were within range.  

Also, your ferritin is terribly low.  Ferritin is a storage form of iron that is readily available for use by the body.  It needs to be at least 100 ng/ml.,  which is same as your micrograms/L.  In similar circumstances it would take about 195 mg of iron daily to get up to around 100.  Along with that much iron you would probably need to take a good  amount of Vitamin C to avoid gastric problems from the iron.  

Although I don't have a strong reason for suggesting it, I do think you should request a test for calcium. If you can get these done, then please post results and we will try to advise further.  
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4 Comments
Thank you for that information Gimel.
Calcium was part of my test panel and my Calcium results are as follows:
2.3mm/L (2.2 - 2.6)

I am wondering if this is auto immune related in consideration of the rheumatoid factor test.

I am going to read the paper now.

Also, as I asked, would low thyroid activity cause low iron or vice versa? I am curious as to the reason for my low iron.

Carrie
And my understanding was that a low TSH test result was indicative of hyper, not hypothyroidism.

Sorry I am just trying to makes sense of it and understand.
Yes, low thyroid levels can cause reduced levels of hydrochloric acid in the stomach which results in less absorption of iron.   If your diet is low in iron that is another reason for low ferritin.

"And my understanding was that a low TSH test result was indicative of hyper, not hypothyroidism."     What you said is usually true; however, it is not true when there is central hypothyroidism.  With central hypothyroidism the pituitary is not producing enough TSH to adequately stimulate the thyroid gland.  Central hypothyroidism is not rare, but it is an uncommon cause of hypothyroidism.  It is barely covered in the AACE/ATA Guidelines for Hypothyroidism, and is generally overlooked by doctors, due to their misguided belief that TSH always indicates a person's thyroid status.  The only time TSH is useful as a diagnostic is when it is at extreme levels.  Otherwise diagnosis should be based on an evaluation for symptoms, along with Free T4 and Free T3 levels.  
Thank you so much for explaining.
I also found your paper very interesting and see that FT3 should have been tested along with the other tests mentioned.

I have written these tests down along with the need for Vitamins d and b12 and Ferratin.

Hopefully my registration for the Dr goes through this week and they are open to providing a decent standard of care. If not, I shall use your information as suggestions. I just want to get back to being able to function normally as I'm really unwell at the moment.

Again, thank you for taking the time to explain things, I really appreciate it.
Avatar universal
Oh sorry, I am female and forgot to add some symptoms as there are many haha.
I get very hot from little exertion even on a cold day, I have dry skin and hair, and my body odour smells very weird to me and is not my normal smell! Definitely perspiring more and having night sweats. I think that is all...I should really write them down so I can keep track of what is happening
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