Main symptoms: very little energy, sudden energy slumps, excessive fatigue requiring over 15 hours of sleep daily, weakness, brain fog, dizziness, excessive sweating (cold sweat if anxious or during and long after physical activity), intolerance of excessive temperature, cold feet all the time, excessive fatigue getting worse in the last year, plus horizontal ridges, bumps on weak nails.
PREVIOUS BLOOD TEST RESULTS
TSH and FT4 blood test results over 9 year period:
30/10/2013 - TSH: 8.1 H mu/L (0.3 - 4.2); FT4: 15.6 pmol/L (12 - 22)
09/07/2012 - TSH: 2.5 mu/L (0.3 - 4.2); FT4: not given
30/01/2008 - TSH: 7 mu/L (0.3 - 4.2); FT4: 13 pmol/L (12 - 22)
27/07/2007 - TSH: 7.5 mu/L (0.3 - 4.2); FT4: 13.1 pmol/L (12 - 22)
11/06/2004 - TSH: 4 mU/l (0.3 - 4.2); FT4: not given
But only diagnosed as subclinical hypothyroidism and no treatment offered. So requested tests for TSH; FT4; FT3; Thyroid antibodies; Ferritin; Folate; B12; Vit D3; Calcium; Homocysteine to help throw light on my condition and urge GP to treat and to refer to specialist.
TSH, (not provided this time, previous years above) FT4 (not provided this time, previous years above), FT3 (not provided this time or any other time), Thyroid antibodies (provided); Ferritin (provided); Folate (provided); B12 (provided); Vit D3 (not provided), Calcium (provided); and Homocysteine (not provided astest for homocysteine must be spun and separated within 1 hour, so only available if I attend hospital).
Blood test results for 6 Jan 2014:
ONLY THE FOLLOWING RESULTS GIVEN:
TPO ANTIBODIES - (KT) – normal – no action
Thyroid peroxidise antibody level: 16 iu/mL (0.00 – 34.00 iu/mL)
B12/FOLATE LEVEL- (KT) - normal – no action
Serum vitamin B12: 260 ng/l (190.00 – 663.00ngl)
Serum folate: 8.1 ug/l (4.60 – 18.70ug/l)
BONE - (SDB) – normal – no action
Serum calcium level: 2.21 mmol/L (2.15-2.55mmol/L)
Corrected serum calcium level: 2.09 mmol/L (2.15-2.55mmol/L)
Serum inorganic phosphate: 0.94 mmol/L (0.87 – 1.45mmol/L)
Serum total protein: 77 g/L (66.00 – 87.00g/L)
Serum albumin: 46 g/L (35.00-50.00g/L)
Serum alkaline phoshatase: 46 iu/L (35-129.00iu/L)
IRON – (SDB) – normal – no action
Serum iron level: 15 umol/L (6.60-26.00umol/L
Serum TIBC: 70 umol/L (40.80-76.60umol/L)
FERRITIN – (SDB) – normal – no action
Serum ferritin: 36ug/l (13.00 – 150.00ug/l)
CHOLESTEROL – (SDB) – normal – no action
Serum cholesterol: 6.1 mmol/L (Targets are total cholesterol <5 mmol/l (LDL cholesterol <3 mmol/L in the general population and total cholesterol <4 mmol/L (LDL cholesterol <2 mmol/L) in high risk groups)
DIFFERENTIAL – (SDB) – normal – no action
Neutrophil count: 3.0 (1.70-7.50)
Lymphocyte count: 2.1 (1.00-4.00)
Monocyte count: 0.3 (0.20-1.00)
Eosinophil count: 0.2 (0.00- 0.40)
Basophil count: 0.0 (0.00-0.10)
COMPLETE BLOOD COUNT – (SDB) – normal – no action
Haemoglobin estimation: 134 g/L (115-165)
Total white cell count: 5.6 (3.50-12.00)
Platelet count: 376 (140-400)
Mean corpuscular volume (MCV): 83.4 fL (78-98)
Red blood cell (RBC): 4.76 (3.80-5.80)
Haematocrit: 0.40 L/L (0.37-0.50)
Mean corpusc haemoglobin (MCH): 28.2 pg (27-32)
MCHC: 338 g/L (310-360)
Red blood cell distribut width: 14.4% (11.50-16.00%)
As I don't seem to have elevated thyroid antibodies which would mean I would be offered thyroxine for TSH <5, I will write to GP referring to Dr Toft's answers to questions in Pulse Online article:
Q2 I often see patients who have an elevated TSH but normal T4. How should I be managing them?
A: 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.
Any advice would be much appreciated?