Hi all
Went with my Dad to see GP about memory loss. He said my Dad's TSH was 9.88 and assured us that this was completely normal. We are trying to get hold of a copy of the tests and also get him retested with the full thyroid panel, but in the meantime, I just wondered if we could have your comments on how bad this TSH is? Many thanks.
Your father's TSH is a fraction below what the BTA 'claim' is the ideal number of diagnosing hypothyroidism which is 10. So the doctor should have prescribed but unfortunately, you now realise, it is a hit-or-miss diagnosis in the UK.
If you look at most of the ranges from different labs for TSH you will see the top is around 5, and most countries in the world would prescribe levo whien TSH is above 3, taking clinical symptoms into consideration.
I assume both your Dad's FT4 and FT3 are low too as he doesn't appear to have sufficient thyroid hormone according to the TSH to convert to T3 which is the active hormone required in all of our receptor cells. The brain contains most.
This is a wonderful example of "goalpost thinking". Let's say the GP has swallowed the "don't do anything until TSH reaches 10" story at present the accepted procedure. 9.88 - in the normal range? Plus or minus what - no test gives a number set in stone but "some number plus or minus the uncertainty in measurement". So the 9.88 is just as likely to be 10.5 or 9.4 (i.e. over or under) Anybody so close to the artificial limits imposed of 10 is not normal even by the faulty protocols still accepted, and should definitely be treated - if the rest of the thyroid panel indicate it.
Thanks Shaws. I'm staying with my parents at the moment and we all really appreciate your knowledge and wisdom having had a very difficult and stressful appointment with the GP.
It is beyond belief that people have to struggle with inept doctors - following disgraceful instructions laid down by the Organisations.
How many thousands suffer like those on this forum, people given the same diagnosis as your Dad. It makes me speechless and frustrated, and angry as my sister and I relied on the doctor to know what was going on with my Mother and had faith she knew best - which was destroyed - it was too late when finally admitted to hospital and mother died (not of a thyroid problem) a horrible death which could have been avoided by properly administered B12.
Thanks. Yes I'm absolutely fuming, had a big row with the GP. Now my parents are upset with me because they have complete faith in him 
They are of an era where doctors prescribed due to clinical symptoms i.e. low pulse and temp plus appearance of patient (not reliance of blood tests or ignorance of them) and didn't have a fraught experience where the family have to put an oar in the water so that they get the 'best' treatment they deserve. 
I missed these links and was unable to edit properly.
On link below you will see info re FT3.
Dad should also have Vitamin B12 and Vit D tested, both are 'hormones' rather than vits.
OMG, your poor Dad! This is criminal
I see he is 81, they are very cautious with older people.
Is your other post about a looking for a new GP for your Dad?
You could ask louise.warville@thyroiduk.org.uk for the thyroid friendly doctor list and see if you can go from there.
The doctor will claim he's following the NICE guidelines - cks.nice.org.uk/hypothyroid...
Apart from the fact that the guidelines can be ignored by the GP they also state:
"Treatment of SCH depends on the specific clinical situation "
I would also remind the GP that treating your dad for hypothyroidism is far cheaper to the NHS, especially the practice, than treating him for dementia. For example if your dad stays healthy the GP wouldn't have to do home visits.
Of course, subclinical ought to mean "no symptoms", not that the blood tests have sub clinical results. So hiding behind the guidelines for SCH isn't really acceptable if there are obvious symptoms.
That's why I posted the guidelines.
I don't have a link but I am aware that the doctors in the NHS don't have to stick to NICE guidelines if they don't want to. Someone with an inherited disease was trying to get his family screen and treated if necessary, which under NICE guidelines was advised but NHS England stated the doctors didn't have to do this.
Absolutely. If treatment enables him to remain independent longer it is a bargain for the taxpayer .. let alone the ethics.
It's not something I usually encourage but as your father's TSH is so close to the dogmatic 10.0 limit I would suggest you try and get his blood taken early morning next time. The TSH is higher in the morning than afternoon. This might be enough to tip the balance and get him treated.
The GPs follow the advice from the endocrinologists who are pretty useless on the whole. A GP should be able to follow specialist advice but this field of medicine is an exception.
Also ask for thyroid antibodies to be tested, you need to know if cause is Hashimoto's.
I asked for that but the GP refused point blank. He's the most unpleasant and obstructive man I've ever met.
There's one other thing I should mention. I see your Dad is 81 (snap for me). In us old folk, the TSH rise for a given level of hypothyroidism isn't as big as when you are younger. Even if you take 10 as an operating limit, then this only applies to the general population. So 10 generally for younger people is probably equivalent to around 15-20 in oldies, as regards hypo levels (that a reading of 10 in old people really means at least 50% higher if they had been younger). One of the amazing things found in the early Whickham survey was how many old folk were incapacitated in old folks homes, and how many of them had mildly raised TSH and responded greatly to T4, even though they did not know they were hypo. I got to know about this because my wife then worked for Prof Reg Hall who devised the survey. Undiscovered hypothyroidism is still a major concern for the old. Too many languish without a thought of testing for thyroid problems. And our generation were in awe of the doctor so what he/she said went without question.
Excellent comment. Beware that most endocrinologists will tell you that older people naturally have higher TSHs (and so they justify not treating the elderly). They seem unable to grasp the concept that perhaps the average TSH is higher in the elderly because their old thyroid is having to work harder and a little assistance in the form of levothyroxine would be welcome. In the same way an old pituitary may struggle to pump out the TSH like it used to.
The average pulse in 100 year olds is around zero. This is a consequence of aging, not a therapeutic target. The same applies to TSH in the elderly.
Thanks everyone for all your thoughtful comments and suggestions.
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