what does doc mean when he says i am sub-clinical - Thyroid UK
what does doc mean when he says i am sub-clinical
Just off normal - or what nhs terms normal anyway. Means they won't treat you until you fit neatly into their little box. I'm sure you are familiar with the nhs motto of "prevention is not better than cure"
This an explanation from Dr Toft. Ignore the fact he still states at TSH of 10 before getting meds.
I often see patients who have an elevated TSH but normal T4. How should I be managing them?
The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat the thyroid function tests in two or three months in case the abnormality represents a resolving thyroiditis.
But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive – indicative of underlying autoimmune thyroid disease – the patient should be considered to have the mildest form of hypothyroidism.
In the absence of symptoms some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow-up.
Treatment should be started with levothyroxine in a dose sufficient to restore serum TSH to the lower part of its reference range. Levothyroxine in a dose of 75-100µg daily will usually be enough.
If there are no thyroid peroxidase antibodies, levothyroxine should not be started unless serum TSH is consistently greater than 10mU/l. A serum TSH of less than 10mU/l in the absence of antithyroid peroxidase antibodies may simply be that patient’s normal TSH
"A serum TSH of less than 10mU/l in the absence of antithyroid peroxidase antibodies may simply be that patient’s normal TSH".................Now that confuses the hell out of me because of the previous paragraph........"Treatment should be started with levothyroxine in a dose sufficient to restore serum TSH to the lower part of its reference range. Levothyroxine in a dose of 75-100µg daily will usually be enough." I've seen a reference range as high as 6 but my normal NHS is 5.0 ???? Confused.
You are not the only one that gets confused and patients get extremely ill. That is the guidelines laid down by the BTA and RCoP. TSH must reach 10 although some do treat if we have clinical symptoms.
In the USA patients are treated when their TSH reaches 2.7 and this is an excerpt from Thyroiduk.org
In this country recent suggestions, sadly approved by the British Thyroid Foundation and certain senior endocrinologists, have placed the cut-off point now at 10mU/L, well above previous levels of 4 or 5mU/L, which were far too high anyway.
The thinking behind these proposed guidelines is beyond rational explanation; and the amount of illness and suffering which will result is heartbreaking. A problem with interpreting TSH results is that, firstly, it assumes that the hypothalamus and pituitary are working normally, and secondly, that the thyroid status is normal and is not being influenced by medication or other illness. It is further pointed out that the test must have a sensitivity of below 0.02 mU/L or false negatives may occur. Many tests are not as sensitive as this. An abnormally low result is usually the result of higher than normal levels of T4 (due to hyperthyroidism or over-dosage), and if associated with thyroid peroxidase antibodies Hashimoto's disease is likely to be present.
thyroiduk.org.uk/tuk/testin...
This is from the BTA:-
Some patients, particularly those whose TSH level is greater than 10mU/l, may benefit from treatment with thyroxine in the same way as for hypothyroidism as above, as indicated in national guidelines (Thyroid function testing, Association of Clinical Biochemists, British Thyroid Association, British Thyroid Foundation, July 2006:
british-thyroid-association...
TFT_guideline_final_version_July_2006.pdf)
thank you for your help friends . the doc tells me i may go over active in 1-3 years but he cant treat me at the moment ...so very confused
This is exactly what happened with my TESTOSTERONE levels, I found an Endo who understood and treated at 13.00. Yersterday my new GP said that my recent test of 8.00nmol was 'ok' perhaps just a little low. 8.00nmol is great for a 100 yr old man, I had this reading at 50 yrs of age. My thyroid is out of whack, my 'T' is low, I have reactive hypoglycemia diagnoased. My treatment has been to give me Zopiclone for 10 years!!!!. Now my new GP is saying my TSH at 3.9 is normal. Ok, rant over, I'm on testosterone gel but my GP wants me to stop it because of possible prostrate cancer issues. My PSA is normal. If I stop 'T' after 10 years the world becomes a scary place. Is the NHS trying to kill us older people off? Oh and my DHEA is one digit below reference range. Cortisol x 4 is on the low side. I'm becoming a grumpy old guy
I'm shocked. Toft is not saying simply 'above 10' he's saying 'consistently above 10' for people like me. Thank god my GP hadn't picked up on that little pearl of wisdom. I'm really not impressed with Toft.
Hi Philby,
Have a look at the androids.org.uk Testosterone Deficiency Centre forum for help, support and advice on low Testosterone.
I can relate to your case as a 33yr old male with Hypothyroidism and low Testosterone. My Testosterone result at the GP came in at mid 11's with free T scraping the bottom of the lab reference range. My GP tried to pass that off as normal (along with my crappy Thyroid results) but I managed to get him to refer me to an Endo of my choosing. He confirmed lowT with a result mid 10's and also Hashimotos. He treated my Thyroid first 'til I seemed to be on a stable footing and I've only just started on Nebido injections for lowT.
GP's seem even less clued up on male sex hormone issues / male HRT and treatment than they are on Thyroid issues and that's saying something!
tDR1980, The same problem exists with male HRT as Thyroid replacement, the medical profession work to the lab 'range'. Testosterone doesn't work like that, some of us need to be in the upper end of the range, some don't. Most below 13 will suffer according to some endos. I had to go to London to find one knowledgeable. Hormonal insufficiencies may point towards metabolic syndrome (yes, they don't know much about that either). I use Testogel which costs the NHS around £28.00 per month. I had to fight for this because my Nebido injections were overdosing me in week one and underdosing week 4. Nebido is an awful lot cheaper for the NHS, I've been told around the £2.50 mark.
'If there are no thyroid peroxidase antibodies, levothyroxine should not be started unless serum TSH is consistently greater than 10mU/l.' I have low thyroid peroxidase antibodies, yet was almost disabled by the time mt TSH level reached just above 10! If my GP had waited until 'consistently' I would have lost my job. How many more years would I have suffered and how much more damage would have been done? This is scarey stuff, but I suppose helps GPs avoid offering treatment to yet another group of sufferers... I'm really not very impressed with some of Tofts sweeping statements 
Although the word "sub clinical" means "few or no symptoms" this is untrue for hypothyroidism in my opinion. This is because I was diagnosed with sub clinical hypothyroidism and had so many debilitating symptoms that I was practically an invalid.
Some people can be diagnosed as "sub clinical" with no or few symptoms, some with many. Although blood tests are useful indicators in thyroid disorders, symptoms are more important in my belief.
I'm much, much better now on medication and almost have my life back
- Totoro
It means the GP has picked up that there is a problem, but they will not offer treatment.
Make sure you have the results of your blood test - you need the actual figures.
Have blood taken in the morning as your TSH changes through the day. You can be hypothyroid in the morning and 'normal/subclinical' by the afternoon.
If you have symptoms (I guess you do!) check here, scroll down for who to treat; bmj.com/content/337/bmj.a80...
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