Thyroid UK
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Hi all,

I had block and replace therapy a couple of years ago for an overactive thyroid. It was successful and I stablished for a year and a half. My recent bloods reveal that my thryoid is fluctuating, sometimes just over sometimes a fair bit over. My GP seems to think I will go underactive at some point and that we should just watch and wait, treating the underactive throid when it finally burns out. Is this good practise? My hair is coming out in small handfulls and I have a very slight tremour in my hands but other than that there are no other symptoms.

Thank you.

1 Reply

Has your doctor taken a new thyroid hormone blood test and also include antibodies? If so, please get a print-out with the ranges and post if you have them to hand, otherwise put them on a new post.

Has your doctor recently taken antibodies, B12, Vit D, iron, ferritin and folate tests as we are usually deficient.

If your GP thinks you are becoming hypo, what is he waiting for. An excerpt from a Specialist if you have antibodies and if you wish to have a copy of the article from Pulse Online, email and as for Dr Toft's article.


2 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.


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