hypothyroidism - Subclinical

I will start medication with low does 12.5 micogram of Levothyroxine (where my TSH is subclinical 5.9). But I feel cold most of the time and have pain in my foot & hands. My GP told me to start the medication as above. I'm 62 years with a controlled diabetes HbA1c 6-7.

What worries me is the fact that once you start taking Levothyroxine, you cannot stop it. Do I really have to start taking it as my GP said or try other supplements that can help my body to produce the required level of thyroid hormone.

20 Replies

  •  Welcome to the site DrHafez  People have been known to take it and stop. Either because they have become euthyroid ( their thyroid has returned to normal ) or they want to switch to something else to treat it. You are still under active. Your TSH is way too high. It is only 'subclinical' by various lab ranges which are rarely efficient to base treatment on. Most people don't feel relief from their symptoms until they have a suppressed TSH of below 1. I would be suprized if the minute amount of 12.5 did anything, it is no where near enough to treat hypothyroidism with that TSH reading

  • Pastille,

    ... [ ... Most people don't feel relief from their symptoms until they have a suppressed TSH of below 1.... ] ..

    The O/P hasn't started medicating yet and as subclinical may find relief through other means or medicating with a higher TSH.

    Many on this forum only function well with a low TSH because the majority have Hashimotos and are in the very small subset of patients who don't tolerate T4 well.

  • That's a good point, do you have antibodies, Mr Hafez? 

    I am not sure, Radd, that the percentage which needs t3 has yet been robustly established. 

  • No.. Don't have antibodies. My Ft4 & Ft3 are normal

  • Your dose is far too small to have a positive effect - in fact it may well cause more problems.  I recently read that all diabetics should be tested for their thyroid levels - chicken or egg ? - it is all endocrine.  In healthy people a TSH of around 2 is the norm.  Levothyroxine is not a drug but a replacement hormone your body is lacking.

    I would suggest having the FT4 and FT3 also tested to know the true levels of thyroid activity - the TSH is a poor indicator of what is going on. Also check out your Thyroid anti-bodies - Anti-TPO and Anti-Tg.  The upper level of the TSH was reduced to 3.5 in the States back in 2003 - and still people struggle on with their lives whilst Docs want people to wait until their TSH reaches 10 in some areas of the UK.

    Also have the following checked - B12 - VitD - Iron - Ferritin - Folate.  They all need to be OPTIMAL and not just in range for your thyroid medication to work.  The VitD and B12 at good levels will help with aches and pains.

  • My Ft4 & Ft3 are normal. I will request for the other tested you propose. Thanks

  • Normal is an opinion - and not a result :-)   Was that your opinion ? - or your Doctors ?  Maybe he/she meant in range - which of course is different.  Where you are in the range is so important especially as you have other health issues.  FT4 and FT3 need to be in the upper part of the range and not bumping along the bottom .....

  • I was diagnosed as sub clinical several years ago. I also have antibodies. No treatment was offered, my TSH was similar to yours. I saw Dr P and ever since I have been taking Nutri Thyroid and Nutri Adrenal Extra. These supplements changed my life. I also checked ferritin and I used Spatone to gently increase my level. I have vit D checked every 6 months. 

  • DH,

    Welcome to our forum and sorry to hear you have some health issues.

    Medicating thyroid hormone replacement is usually for life and dosing only 12.5mcg Levo might have the opposite effect on a struggling thyroid gland (by giving it a break so it produces even less) creating a need for more med replacement.

    Subclinical means "without symptoms" but coldness is a common symptom of hypothyroidism. Good thyroid function depends on good health and adequate levels of iron, nutrients and cortisol (adrenal stress hormone).

    Missing thyroid hormones need to be replaced, or good thyroid function further encouraged but this can not be evaluated without known levels of T4 and T3 (thyroid hormones). Ask your GP to test these together with Vit B12, Vit D, folate and ferritin as deficiencies are common in these nutrients that are vital for good thyroid hormone synthesis. If you post results complete with ranges (numbers in brackets) members will comment. If your GP is uncooperative there is a link below for private labs that members use.

    Stable blood sugar levels are important as is protein intake because it contains the amino acid tyrosine, which is a precursor to thyroxine (most abundant thyroid hormone) and a variety of vitamins and minerals (minute proportions) to produce and convert thyroxine into the more potent T3 that will make you warm.

    I would say be careful with the many thyroid enhancing supplements (tyrosine, mach, etc) as these can create further imbalances but if your diet, life style and nutrients are all healthy, another option are thyroid glandulars that many have success with either alone or supplementing together with thyroid hormone replacement.- links below.









    Private labs testing


  • Hi DrHafez, did your doctor tell you that once you start Levo you have to stay on it for life? If so, he - like so many of his kind - just hasn't grasped the concept.

    If you start taking Levo and you Don't need it, you will feel so ill, you will have to stop it! There is nothing in the Levo itself that is habit forming or addictive, the reason most people have to stay on Levo for life is that their glands are sick, and not going to get any better. However, you cannot live for long without thyroid hormones, so you have to take some form of thyroid hormone replacement - Levo is just one of them.

    Thyroid hormone replacement has no permenant effect on the gland itself. When you start taking something like Levo, it may stop producing hormone altogether, but if - for any reason - you stop taking Levo, the gland will Wake up and start making what little hormone it can to keep you alive. But, the gland cannot repair itself if damage has been done to it by something such as Hashimoto's disease. Have you had your antibodies tested?

    There is no way you  can replace hormone with nutrients, it just doesn't work that way. They are two different things. And, trying to stimulate the gland with suppléments isn't a good idea, either, you will probably just hasten its demise.

    Doctors are rather stupid with their terminology, and Don't really understand what 'subclinical' means. It doesn't mean that the TSH is only a little over-range - the ranges are rediculous, anyway. It means, as Radd said, that your TSH is high but you have no symptoms. If you have symptoms, it doesn't matter what your TSH, you are hypo.

    The TSH of a healthy person, with no thyroid problems, is between 0.85 and 1.25, so you can see that 5.9 is quite high. At 2.0, the gland is starting to struggle, and at 3.0, you are hypo. But doctors have been very badly educated in thyroid and really have no idea what they're doing - as witnessed by the stupidly low dose you doctor has given you. No matter what your TSH, a starting dose should be between 50 and 100, depending on your age and heart health.

    So, all that to say that if your TSH is 5.9, you really, really do need to start Levo. Did your doctor tell you to go back for a test after six weeks? Because that's what you should do. Did he test anything other than the TSH? Did you get a print-out of your results? Because it's your legal right to have one. Always ask.

    When you go for your next test, go as early in the morning as you can - at least before nine. Fast - you can drink water - and leave a 24 hour gap between your last dose of Levo and the test. And if you have any other questions, Don't hesitate to ask them on here. :)       

  • Thank you for your comment. My Ft4 & Ft3 are normal & no antibodies. I've been reading about thyroid problems and found that many suggest for my age (63) to start at low dose 12.5 mg. My gp did the same & will make another test in 3 months later.

  • mg or mcg? There's a huge difference. Normally, a starting dose if 50 mcg. 12.5 mg wouldn't be a low dose at all. But 12.5 mcg is much, much too low for anyone. I Don't know where you've been reading but I've never ever seen it suggested that one should start on 12.5 mcg.  

    And retesting in three months is just rediculous. It's too long. Six to eight weeks is the norm. But, if you think your doctor is right in everything, why did you come on here for advice?

    What do you mean by 'normal'? What most doctors mean by 'normal' is 'in range'. The range is vast. It dépends where in the range your results fall. Most people need their FT4 and FT3 to be up the top of the range to feel well. But, of course, we're all different. However, I've never met anyone who felt well with their results at the bottom of the range. But, that's just my opinion, for what it's Worth.   

  • Thanks again greygoose.  Yes.. I mean 12.5 mcg (microgram). The values of my FT4 is 1.2 ng/dl - Reference interval (0.7-1.8) while FT3 is 2.9 pg/ml  (2 - 4.4). TSH is 5.9 ulU/ml (0.3-5.5). 

  • Your FT3 is right at the bottom of the range. that is far from normal. And 12.5 mcg Levo is not going to do anything about increasing it.

    And your FT4 is a bit low, too. You aren't converting terribly well, but then you haven't got much to convert.

    If you are happy to start on a dose that is much too low, at least go and get tested after six weeks and Don't wait three months. Being on a low dose for too long can screw up your metabolism.

  • OK. Thank you very much for your opinion. I'll let you know after 6 weeks when doing the test again. Many thanks...

  • You're welcome.

  • DH,

    If T4 & T3 are "normal" then you should wonder why your TSH doesn't reflect a result corresponding ! ! ...

    You could have a pituitary adenoma (benign, slow-growing tumor) ? .... .. or pituitary resistance ? ? ... meaning even when you have enough thyroid hormone your pituitary doesn't recognise this and continues to encourage thyroid hormone by secreting further Thyroid Stimulating Hormone (TSH) ... 

    You can discuss with your GP or ask for a referral to an endo.

    If you would like a list of sympathetic endos/doctors that members have had positive experiences with, you can email louise.warvill@thyroiduk.org.uk. 

  • Hi DrHafezgreygoose has a lot of experience and gives very sound advice, you really do not have to fear taking this hormone replacement therapy.

    Diabetic patients have a higher prevalence of thyroid disorders than the general populace but that isn't really surprising given that they are both recognised as autoimmune disorders (this isn't a 100% guarantee but as a general rule of thumb comes pretty close). But all is not doom and gloom, autoimmune disorders can be successfully treated with diet - so successfully that the condition is reversed.  This is not the same as the maintenance diet that most diabetics are recommended to adopt in order to control their condition, it is more radical since the intention is not to maintain anything but also more effective.  Do a google search on such phrases as 'curing diabetes with diet' and/or 'reversing autoimmune disease with diet'.  Also check out things like 'the Wahls Protocol' (sorry there isn't a lot available without buying the book but there are some videos on youtube).  This is a diet designed by a doctor suffering from MS (another autoimmune disorder).  Even though she was wheelchair bound, she never gave up and is now a walking testament to its success.

  • It's only really sub-clinical if you have no symptoms at all. Most healthy people have a TSH of around 1, and FT4 at least half way up the range. Such a tiny dose of levo is likely to make you feel worse. not better. If you have no symptoms, I'd try to find out what was causing raised TSH. Is ferritn at least 70, B12 well over 500 and folate around halfway up the range?

  • Im new on this site so don't know much about thyroid but if you are diabetic (controlled or not) and you have pain in your feet then I would suggest that you have this monitored because of neuropathies related to diabetes can be a cause for concern. best wishes

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