Help with test results

[Kai_63]

Hi

I am female, 39, British Asian and have had a treated underactive thyroid for 8 years.

Last winter I felt cold, tired, tingly tongue and extremities and dry skin. I was also preparing to get pregnant. An endocronologist increased my levo dose to 75mcg from 50 and tried to get me to a TSG dose of 2.5. I also took Vit D, B and iron. By summer last year and I was feeling much better but over winter I felt all the symptoms again. They've inproved a little recently so I wonder if it's linked to the seasons or whether I'm within range but still too low? We are still trying to conceive but I'm not yet pregnant.

My recent blood tests are below, all within range except cholesterol (history of heart disease in family although I exercise and eat well). Any thoughts?

T4 17.2 pmol/L (range 10.3 to 24.5)

TSH 2.75 (range 0.4 to 5.5)

Ferritin 44 ug (range 13 to 150)

Folate (have been taking folic acid) >20.0 ug (range 3.9 to 26.8)

B12 1382 ng (range 197 to 771)

Vit D 69.6 nmo (range 50.0 to 120.0) Note I am Asian with mid brown skin.

Cholestorol is 6.5 (range 3.0 to 5.0)

There are other tests for liver function, electroloytes, full blood count, blood pressure and bone profile, all within range.

Thanks

[jimh111]

A TSH of 2.75 is a bit too high for pregnancy. You should ideally have a TSH below 2.5 but during the pregnancy you thyroid hormone requirement increases. So, I would get your doctor to increase your levothyroxine dose and perhaps aim for a TSH around 1.0 and then review how you feel. Given the clock is ticking (your're 39!) I'd make sure they respond quickly. Usually fT4 has to be in the upper quartile of its reference interval in order to bring fT3 (the active hormone) up to average levels.

The dry skin is specific to hypothyroidism and highish cholesterol is consistent with hypothyroidism although it could just be due to your genetic profile. So, I would push hard to get your medication increased and more attention paid to your symptoms.

[Clutter]

Kai_63,

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 1.0 or lower with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

It is recommended that the TSH of women planning to conceive should be in the low-normal range 0.4 -2.5 with FT4 in the upper range. Ask your GP to increase Levothyroxine dose. When pregnancy is confirmed dose is usually increased by 25-50mcg to ensure good foetal development.

cks.nice.org.uk/hypothyroid...

onlinelibrary.wiley.com/doi...

Ferritin is optimal halfway through range. You can raise ferritin by supplementing iron taken with 1,000mcg vitamin C to aid absorption and minimise constipation.

VitD is optimal around 100nmol/L. Dark skin makes it more difficult to produce natural vitD by taking sun on the skin. I would supplement 5,000iu D3 for 6 weeks and then reduce dose to 5,000iu alternate days.

Folate and B12 are good. Presumably you are taking folic acid as you are planning to conceive.

Cholesterol will probably come down when your Levothyroxine dose is increased and TSH drops.

[Kai_63 in reply to Clutter]

Thank you for the replies. I can't quite believe how little is known by regular doctors about the complexities of thyroid disorders and it is quite frustrating really.

Have you got any recommendations on how to get the doctor to take me seriously? I don't want to look like someone who did some basic research on the net (clearly not the case here)? Why would they believe me over their many years of training?

I'm being referred to a lipid specialist so it will be interesting to hear their point of view.

[Clutter in reply to Kai_63]

Kai_63,

GPs don't get many years of training about thyroid. Your basic research may be as good as the thyroid training GPs get.

You could use the links I provided to support your requests for a dose increase.