Subclinical Hypothyroidism

Some advice please:

I had a blood test back in March which showed subclinical hypothyroidism, and my gp said to retest in 8 weeks... I've had that test and the results also came back as subclinical, but with a slight improvement. I've been advised by the nurse practitioner to retest in another 8 weeks (I don't have the actual levels for either test ). The thing is I don't think I can wait another 8 weeks! In 6 months I have put on 2 1/2 stone of the 3 stone I lost, and am struggling to control my weight. I am constantly cold - even when everyone else is warm. I'm tired most days to the point that I sometimes have to go back to bed for an hour or two whilst my husband has our son. I am quite irritable but have been putting this down to tiredness.

My thyroid antibodies were also checked this time and we're normal.

I'm just wondering how many times does a test come back subclinical before anything is done? Are there other questions I should be asking my GP?

12 Replies

  • Hello Mrs C. I am so sorry that you are suffering. You will find that many of us on this Forum are sub-clinically hypothyroid. It may not be much consolation, but at least your doctor seems to be taking your problems seriously. Sadly the thyroid blood tests which are seen as the Holy Grail by the medical profession - to the extent that they ignore their patients' symptoms - are far from perfect. The only way I got thyroid medication was to go to a doctor who had seen the light, Dr Gordon Skinner, but he was hounded by the medical profession and, maybe as a result of the pressure he was under, died following a stroke. My GP - like many others - refuses to prescribe my medication or entertain any of Dr Skinner's views. Your only avenue may well be to buy your own medication. Others will be able to PM you sources. Dr Skinner prescribed me Levothyroxine privately but said that he would move me on to T3/T4 if the Levo did not suit. Sadly he died before he could come to that conclusion...

  • MrsC2748, we really need to see your thyroid results with the lab ref ranges to advise.

    Subclinical hypothroidism usually means TSH is over the top of range, usually between 4.5-6.0, but should also mean the patient is asymptomatic. If you have hypothyroid symptoms they should, but don't, consider a hypothyroid diagnosis. TSH >10 or FT4 below range is overt hypothyrodism.

    If you have to have another blood test make sure it is early in the morning and fast, except for water, as TSH is highest early and before food.

    If your TSH is close to the top of the range you could ask your GP for a 3 month trial of Levothyroxine to see whether symptoms improve. A low dose of 25mcg can be problematic as it may be enough to shut off your own thyroid hormone production but insufficient to relieve symptoms.

  • Hello mrsc2784,

    Welcome to our forum and sorry to hear that you feel so unwell.

    Subclinical Hypothyroidism isn't usually treated above the TSH serum reference range but below 10.0 without symptoms. However, sometimes if symptoms are clearly identified, then doctors may chose to give you a trial of Levothyroxine thyroid hormone replacement.

    TSH has a circadian rhythm (24 hour cycle) and levels peak between midnight and 6am. It is therefore a good idea to have your next thyroid tests done at the very first morning appointment when TSH levels will be at their highest.

    People with untreated or undermedicated thyroid issues are often low in Vit D, Vit B12, folate, ferritin and iron. Low levels can inturn further interfere with thyroid hormones and therefore it might be prudent to have these blood tested as well.

    Good news that your antibody count was normal but check that your doctor tested for TPOAb and TGAb.


  • mrsc2784,

    Having read your previous posts, I just wanted to advise you that I suffered terrible pelvic pain accompanied by a sensitive bladder, for years.

    Once medicated on Levothyroxine 4 years ago, it all went away and has never returned.

    Hormone imbalances can bring many unbelievable and strange symptoms which doctors simply not believe. I think you need to concentrate on getting thyroid meds a sap.


  • Thank you all for your replies. I have decided to go back to the GP and talk through what my options are as to how many times they will let me have a sub clinical before treatment or if there is anything else they can look at. What I have found odd is I went for my tests in the afternoon - I did ask my GP before the second test whether it made a difference what time I had my blood taken and he said no but like in the replies here and other threads have said it is best to do in the morning.

    I managed to get my results which are:

    Free T4 ref range 7.86-14.41pmol/L

    March result 9.2

    May result 8.4

    TSH ref range 0.35-5.50mu/L

    March result 7.97

    May result 6.90

  • While your TSH has slightly improved your Free T4 has slightly dropped. Can you get the numbers for your thyroid antibodies test? There are many types of thyroiditis and many causes. Not sure how young your son is but thyroiditis can occur postpartum.

  • I think the antibody was 7 but I'm not 100% sure. Would that sound right? I know it was definitely in the normal range.

    I'm assuming that it's not a good sign that my free t4 has also dropped?

    I've never heard of postpartum thyroiditis. My son is 3 though x

  • MrsC, your March and May TSH are both above the ref range and your FT4 is now barely above the bottom of range so I don't understand why your GP isn't prescribing Levothyroxine. Ask whether s/he intends to wait until you are overtly hypothyroid ie FT4 below range or TSH >10 before commencing treatment. If the answer is yes, find a new GP.

  • TSH levels fluctuate and depend on several factors: Time of day. 2. sleep deprivation. 3. Whether or nor you have fasted before the test.

    Having the test in the morning, preferably as early as you can and fasting for 12 hours before the test, will push your TSH levels up. Furthermore, if you are woken up during the night, your TSH level will also increase. These factors have been well documented in a number of studies (The Circadian rhythm of the TSH). If you want your doctor to put you on medication, his decision will be based upon whether or not your TSH increases. Therefore, follow all the above guidelines. Doctors reliance upon this very faulty test is absurd, but many sufferers have been forced to resort to measures that will 'tweak' it in our favour.

  • I just want to add that my friend fell into the category...he had a high tsh almost 8 in two test but his free t4 was at the top of normal and he was soooo fatigue,headaches and tired all the time and moody, dr wanted to put him on meds but I think I was put on meds too fast at menopause he went to a nature path dr that figured out his acne medicine was bad for thyroid, that he was eating way too much soy and took him off soy, he was deficient in b12 so put him on 5000 under the tongue daily for 2 months, did a food sensitivity test and it turns out although he isn't allergic he was highly sensitive to peanuts which he ate all the time so took him off of those and the dr said it caused inflammation,put him or liquid omega 3, told him he had to move and exercise every day, had to eat whole foods breakfast lunch and dinner , took him off acne meds, also started him on cranberry pills , a good high grade multi, organic veggie/fruit capsules,probiotic before bed every night and in two months....he was totally fine.......this is after 6 months of him dragging himself literally and feeling many times it is something else actually causing the thyroid to malfunction and he is elated that he doesn't have to take thyroid meds for life...and just put him on a 3 step regiment for acne at home available over the counter and put him on turmeric....acne is under control too....

  • This sub clinical makes me so cross.

    YOU CANNOT BE HALF PREGNANT! We are either hypothyroid or we are not!!!

    You are hypothyroid. You have awful symptoms and the sooner you replace your thyroid hormones the better.

    Change doctor, see everyone in the practice, especially see locum doctors as they often seem more helpful.

    I was a lucky one that my tsh went to 10.1 after a year. Some people never have a tsh above 10. I certainly believe that it took longer for me to get well because of the delay in diagnosis.

    The crazy thing is that the people with a tsh of 100 often wonder why they are taking medication when they don't have symptoms!

    Hope you can get enough energy to bang fist on GP desk every day. You know what is wrong with you, you have done their job for them.


  • Just a little update...

    I had another Thyroid function test mid November, which again came back as sub-clinical, although the levels had improved slightly. The nurse practitioner, who has been very good, suggested looking at my iron stores (ferritin), B12 and folate, and also checked my HbA1c, and if these came back normal he suggested seeing one of the GPs. They did all come back normal (although I know that some were the lower end of normal), so I followed the advice and went to see one of the GPs. I went prepared, with my Slimming World book to show I've been trying to lose the weight with no luck, and all psyched up ready for a bit of a battle, but after scanning through my blood results my GP turned round a said "I think, although your bloods show subclinical, they're not really getting any better, and your symptoms aren't improving so I think we should try you on a low dose of thyroxine to see if things improve". Talk about dumbstruck!!!

    So I started the levothyroxine on Saturday, so it is early days, but fingers crossed the symptoms will start to improve soon!

    Just want to say a big Thank You to everyone for the advice - this forum has been invaluable to me in helping to understand my results and not letting myself be fobbed off. Thank You all!

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