Subclinical hypothyroidism? Can I insist on treatment?

Had blood test done Dec + Jan. Results:


F4 8.6

Fsh 4.91


F4 9.5

Fsh 8.46

My symptoms are fatigue, aching joints (mainly hands), slight depression, low libido, slow bowel, irritable, palpitations, brain fog, pins & needles in hands, weight gain. Also now have a smallish lump (nodule?) on one side of what I think is my thyroid.

Gp says that possible nodule needs investigation by that my symptoms are not related to thyroid & recommends a retest in 3 months.

That seems such a long time to wait whilst I feel rubbish. Should I try to insist on treatment now or am I just making a fuss?

I would welcome any advice or thoughts please.

19 Replies

  • Welcome to the forum, tjtjtj.

    You're not making fuss. I don't know how you insist your GP treats you, but you are entitled to a second opinion from a more knowledgeable GP at your practice. Your TSH 8.46 is high enough to warrant treatment. Many GPs start treatment when TSH is >5. It looks as if yours is waiting for TSH >10 which is overtly hypothyroid.

    Ask your GP to test thyroid peroxidase and thyroglobulin antibodies for autoimmune thyroid disease. If positive, progression to overt hypothyroidism is inevitable and a pragmatic view is that starting Levothyroxine will prolong the life of your thyroid and prevent more clinical symptoms accruing. Read the comments of Dr. A. Toft in this link Email if you want a copy of the article to show your GP.

  • Thank you Clutter. I will do that. That's my concern, leaving it longer & feeling even worse.

  • Your tsh is rising, even the crappy guidelines we have in the uk say that you ought to be treated at tsh 10 or tsh 5 if you have antibodies. Has your doc bothered to test for antibodies?

    You are right to make a fuss and the doctor is wrong not to treat your symptoms. Here is a scary story about what can happen with so called sub clinical hypothyroidism.... Its no joke... Show it your doctor. Its from a respected source.

    Suggest you have a read of dr tofts book... Understanding thyroid disorders. Written in conjunction with the bma.. Less than £5 from amazon and your doctor should take notice of dr toft, who has an excellent pedigree.

    Xx. G

  • Thanks Galathea I will definitely get that book.

    Initially the gp said I had tested positive for antibodies but when I asked for a print out of the blood tests they only included my t4 & tsh so I'm not sure. I have an appointment due with him in two weeks for him to check out the nodule. I want to have as much info as I can to try & stay strong & not end up getting the brush off. Iykwim

  • Apologies for crashing your thread tjtjtj, but just wanted to say thanks to Galathea for posting that link. Just goes to show that so called "sub-clinical" is anthing but! And this may well be the first time it was reported, but I wonder how often it happens and is missed? How many patients die because a doctor decides that sub clinical hypothyroidism can't possibly be the cause of the symptoms they're seeing?

    Tjtjtj, hope you manage to get some treatment. It's obvious you should be started on thyroid hormone replacement.

  • Well if you have a positive test for antibodies you should be treated sooner rather than later in order to prevent things getting worse. Suggest you ask for a referral to an endocrinologist who specialises in thyrod, not diabetes. Ask Louise warville for the list of useful Nhs endos.

    Xx. g

  • Yes I will thank you

  • HI It is difficult without the ranges but i would definitely ask for an fT3 test. Then if T4 and FT3 is out of range or just one ask to see a good endo for treatment ,if gP unwilling.Find a good Endo first who will treat you , then ask for a referral.


  • Can't help with the thyroid topic.. as I am still seriously confused about my own subclinical and what's the best thing to do.. but.. i can say that when i started taking a high dose of vit d3 about 3 - 5000 a day and rubbing magnesium oil into my skin. My aches and pains went away quite quickly and I slept better... so that may help you in the meantime.. i also think the vitb drops taken in your mouth help with energy (a little) good luck :)

  • Symptoms not related to thyroid? what planet is your doctor on? Other than that facetious remark, I think all the advice given here is good. In USA you would be treated, full stop.

  • Thank you Marram, jazz, lise & Pam for the recommendations

  • FSH has ZERO to do with thyroid other than side effect of hypothyroid is to screw up all other hormones

    whats your TSH

    Free T4

    Free T3




    Vit d3

    that's what is important in Hypothyroid

  • I rather thought the F was a typo?

  • FSH is sometimes tested as one of the pituitary hormones which can be indicative of hypopituitary.

  • Sorry I meant tsh my phone had corrected! It to fsh + I hadn't noticed. Did I mention the brain fog😉

  • Yes it should also read T4

  • To clarify this is what the lab results say:


    serum free t4 - 8.6 pmol/L (9.0 - 24.0) below low reference limit

    serum TSH level 4.91mu/l (0.2-4.5) above high reference limit


    serum free t4 - 9.5 pmol/L (9.0 - 24.0)

    serum TSH level serum free t4 - 8.46mu/l (0.2-4.5) above high reference limit. TFTs consistent with subclinical hypothyroidism.

  • your tests and your symptoms SCREAM hypthyroid the longer your doctor waits to treat you the harder and longer it is to get better

    INSIST on treatment

  • Saw my GP today who looked at my nodule & said he will send me for a scan (6 - 8 week wait!) & that the thyroid looks generally enlarged.

    Thought I was going to have to battle with him to start levothyroxine as he had previously dismissed my symptoms, however, he suggested I start treatment.

    Also my antibody results were back & they were:

    Thyroid peroxidase Ab - 987 kiu/l (<70.0)

    So I thought the appointment went quite well but when I had walked out I notice the prescription was only for 25 micrograms daily. Having read up a bit this seems very low isn't it? Is it likely to make any difference to how I feel? He has given me a prescription for two months. What do you think?

    I suppose the positive is that I am in the system so to speak & don't need to wait another 3 months to be tested or for my TSH to go above 10.......

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