Borderline thyroid but feeling well

[Bagster]

Hi. I'm new here. And confused as to the way forward. I recently had a blood test for a non related health issue (suspected psoriasis) which revealed borderline hypothyroidism - TSH 6.5, T4 11.9. I was quite shocked because I don't have the classic symptoms: no fatigue or weight gain, although I do have a slow pulse, lowish body temperature and low blood pressure. My GP gave me the option of a low dose of thyroid medication or do nothing for 6 months and see what happens. I'm 70 and quite fit so I opted for doing nothing at the moment. However, after many hours on the Internet I'm wondering whether it might be more sensible to start medication before I get the symptoms (I did tick 9 boxes on the checklist). What is stopping me are the many reports of things getting worse after starting levothyroxine. Has anyone had a similar experience? I'd be grateful for any advice,

[Clutter]

Welcome to the forum, Bagster.

Slow heart rate, low temperature and low BP are symptoms of hypothyroidism. However, you may want to have TSH and FT4 tested after 3-6 months to see whether levels have changed before making up your mind.

You may be interested to read the following article:

Underactive Thyroid May Be Overdiagnosed, Overtreated in the Elderly

(Reuters Health) - Older people may too often be diagnosed with an underactive thyroid and prescribed thyroid hormones, which can cause new troubles and expenses without improving their lives, researchers say.

A recent case study provides a snapshot of the larger problem, they point out in JAMA Internal Medicine, October 3rd.

Just 1 percent to 2 percent of people have hypothyroidism, which requires treatment, coauthor Dr. Juan P. Brito of the Mayo Clinic in Rochester, Minnesota, told Reuters Health. But about 15 percent of people have subclinical hypothyroidism - hormone levels that are between the healthy range and the diagnostic cutoff for hypothyroidism and that cause few or no symptoms.

Clinical hypothyroidism can cause constipation, depression, fatigue, dry skin, unexplained weight gain and greater sensitivity to cold.

Brito and colleagues present the story of a 72-year-old obese man with type 2 diabetes, hypertension and coronary heart disease who complained to his doctor of fatigue. At presentation, his serum thyroid-stimulating hormone (TSH) level was 7.2 mIU/L (reference range 0.3 to 5.0 mIU/mL) and his free thyroxine level was 1.3 ng/dL (reference range 0.8 to 2.7 ng/dL).

The elderly patient was prescribed 75 micrograms daily of levothyroxine to treat subclinical hypothyroidism.

A month after starting the medication, the patient came to the emergency room with heart palpitations, dyspnea and chest pain.

An electrocardiogram revealed a new-onset atrial fibrillation with rapid ventricular response and an echocardiogram showed mild left ventricular hypertrophy without myocardial dysfunction. His TSH level was 0.1 mIU/L.

The patient received anticoagulation drugs and beta-blockers for heart rate control, and levothyroxine was withdrawn. Three months later the patient returned to sinus rhythm, and his TSH level was 5.6 mIU/mL.

"There is some evidence linking subclinical hypothyroidism to cardiovascular events," Brito told Reuters Health. "But there's no really good argument or data to support treatment."

Despite that, levothyroxine is the most prescribed drug in the U.S., he said. A 30-day supply of generic levothyroxine costs about $13, according to Healthcare Bluebook.

"This is what happens when we pay too much attention to values and not to the patient," Brito said.

The medication is relatively safe but may push TSH levels so low that it causes side effects, like the ones this elderly patient experienced, he said. Not all subclinical hypothyroidism may require drug treatment, especially for the elderly.

"I don't think it's the spirit of the guideline to treat everyone," Brito said.

For the elderly, the healthy reference range may be higher than the adult range, he said.

Healthy ranges may also differ by individual, said Dr. Jennifer Mammen of Johns Hopkins School of Medicine, who was not involved in the case study.

Testing TSH levels more than once in a three to six-month period may also give a clearer picture of whether the thyroid is truly underactive.

"Our recommendation for diagnosis of subclinical hypothyroidism is to check the levels twice with a separation between them," Mammen told Reuters Health by phone.

"The vast majority of people with symptoms (like fatigue) do not have thyroid problems to begin with," she said.

SOURCE: bit.ly/2cWFJ8X

JAMA Intern Med 2016.

medscape.com/viewarticle/86...

[greygoose in reply to Clutter]

Well, they obviously started him on too high a dose. I don't think that proves anything. They don't tell us how he felt a year later with a TSH of 5.6.

[Bagster in reply to Clutter]

Thanks Clutter. Really interesting article. I have seen a similar one about holding off on treating subclinical hypothyroidism in the elderly. This guy seems to have quite a lot wrong with him in the first place though. I'm quite fit and strong and not overweight or suffering from any other conditions. But I do believe my thyroid is truly underactive - based on my low basal temp (36 - 36.3). My GP suggested starting on 25mgs, but I think I'll get a more comprehensive blood test done first. This is such a great forum. Brilliant! So pleased I found it.

[greygoose]

Hi Bagster, welcome to the forum!

There are over 300 known symptom of hypothyroidism, and you don't have to have them all to qualify! Very often, we have little niggles and put them down to our age, when they are in fact due to low thyroid. And, if you ticked 9 symptoms on the list, that is quite a lot!

It might very well be a good thing to start on levo before things start getting worse - a TSH of 6.9 is high-ish. But, before doing that, I would recommend getting more comprehensive labs done - privately, if you can, because doctors don't like doing most of these tests - and the NHS refuses out-right to do some of them!

So, what you want are :

TSH

FT4

FT3

TPOab

TgAB

vit D

vit B12

folate

ferritin

The most important number for the thyroid is the FT3, but it's very hard to get it done on the NHS. You want the TPO and Tg antibodies to see if you have autoimmune thyroiditis - because there are things you can do yourself to help if you have - and the nutrients because they all need to be optimal for you body to be able to use the hormone you're going to give it. You have probably been hypo for quite a while without noticing it, so you could have a few nutritional deficiencies, no matter how good your diet.

Once you have a clearer picture of what's going on, you will be able to make a more informed decision, and prepare yourself better for the treatment.

As to the reports of things getting worse after starting treatment, well, putting it bluntly, they're probably going to get worse if you don't. But, just because some people feel worse after starting treatment, doesn't mean you will. It happens, I won't deny it. But, if you sort out any nutritional deficiencies you might have before you start, you stand a much better chance of it not happening to you. We're all different, and we all react differently to things. And there are millions of people in the world who don't have problems with levo and soon get their health back once they start it. But, if you read on here, all you are going to find are the exceptions, not the rule. So, please don't let that put you off. There's no reason why you should be one of the exceptions, is there?

[Bagster in reply to greygoose]

Many thanks Greygoose. That's really helpful. I'll get that test done before I make a decision. I had been kidding myself low pulse rate and low blood pressure were signs of my robust health! Thanks again for such a comprehensive response to my post.

[greygoose in reply to Bagster]

You're welcome. )