Further blood test results - TSH now over range, advice pls!

[MiniMum97]

Just had further Blue Horizon results in and my TSH is now 4.32 (0.27 - 4.2) and now over range. It has been creeping up since last Jul. Previous results: 27/07/2016 (GP) - 3.19 (0.3-4.2)

22/09/16 (GP) - 3.38 (0.27-4.2)

21/11/16 (BH) - 4.15 (0.27-4.2)

My T4 result has fluctuated around the 11/12 mark throughout this time:

27/07/16 - 11.0 (12-22)

22/09/16 - 12.00 (12-22)

21/11/16 - 11.91 (12-22)

29/03/17 - 11.67 (12-22)

T3 results as follows:

27/07/16 - 3.7 (3.1-6.8)

22/09/16 - Not tested

21/11/16 - 3.75 (3.1-6.8)

29/03/17 - 4.06 (3.1-6.8)

Now my TSH is over range was thinking of writing to my GP. Has anyone got any tips for doing this. Was going to send my results and a list of symptoms. Is there any information I should include that may encourage her to do a trial of levo even though my TSH is under 10. At the rate it's going up, it will be another 4 years before it's over 10!

NB I have had tests for B12, D, folate, ferritin and am supplementing (interestingly, my ferritin was coming up (8.9 in July - 55.2 in Nov) when I was supplementing 100mg a day, I dropped the iron to 50mg a day as it had come up quickly and didn't want it to rise to more than mid-range, and it's now dropped to 31.4! Have taken 100mg today! Presumably this could be heavy periods taking more of a toll than I expected or absorption issues due to thyroid/stomach acid?

B12 is looking better - was at 371 and is now at 687; however my active B12 is coming in high at >256 (range 25.1 - 165) - OK to keep supplementing? Was of the understanding B12 needs to be around 1000. I am supplementing 1000mcg B12 and Thornes B Complex.

Folate looks OK I think but interestingly has come down even though supplementing - was at >45.4 in Nov 2016 and is now at 32.56 (range 8.83 - 60.8).

Vit D is at 91, up from 59 in Nov 2016 so OK I think (I have been supplementing 5000iu with K2 MK7 for 2 months and sort of every other day for 2 months (I keep forgetting when I've taken it and when I haven't!). Was thinking of sticking with ever other day even though we are nearly into summer(I am very fair skinned so avoid sun/when high factor suncream to avoid burning and flare up of rosacea which is triggered by sunlight).

Had antibodies tested twice now and both times negative.

Any thoughts on the above particularly on information to include or tips when approaching my GP would be very welcome.

Many thanks

[Clutter]

Minimum97,

I would make an appointment to see your GP to discuss your BH results. TSH is over range and FT4 below range which means you are overtly hypothyroid. Your GP may want to run his/her own thyroid tests so make sure you arrange an early morning blood test when TSH is highest and fast (water only) as TSH drops after eating and drinking.

thyroiduk.org.uk/tuk/diagno...

I believe that B12 may need to be around 1,000 in B12 deficient patients having B12 injections. Your active B12 test is high because you are supplementing. Active B12 >35 makes it unlikely you have B12 deficiency.

If you never allow sun on your skin without sun screen you will need to continue supplementing 5,000iu once or twice a week.

[MiniMum97 in reply to Clutter]

Thanks Clutter. So you think once or twice a week then rather than every other day for D3?

I wanted to write to my GP rather than make a appt as I wanted to present all the information and give her to get a chance to think about it - I am concerned her go-to approach will just be not to treat as TSH is under 10. I also find I get flustered in appts and don't think of everything I need to say. I also find that GPs tend to make an off-hand dismissive comment which throws me and I can't think of a suitable response so say nothing. I am much better at communicating in writing generally (eg also rubbish at job interviews, I am not good at thinking on my feet!).

What do you think the likelihood of getting treatment while my TSH is under 10?

[Clutter in reply to MiniMum97]

MiniMum97,

You should get treatment because your FT4 is below range (for the second time since November) which means you are overtly hypothyroid. It has nothing to do with TSH having to be at any level.

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

Having corrected my vitD deficiency I continued supplementing 5,000iu and vitD levels rose to 350 (toxic). For Two years I have been supplementing 5,000iu per week (10,000iu per week during Dec/Jan) and vitD level has been 130 and 100+. I'm due another test in the next week or two.

[MiniMum97 in reply to Clutter]

OK great. Many thanks for your replies that's really helpful.

[Clutter in reply to MiniMum97]

MiniMum97,

If your GP fixates on the TSH insist on a second opinion or ask your GP to contact an endocrinologist for advice.

[MiniMum97 in reply to Clutter]

Hi Clutter,

Just read the link you've provided and it says for overt hypothyroidism, in addition to a low T4, the TSH also has to be above normal reference range, but then says "usually 10mU/L" - to me that reads as above normal reference range (ie lab range), with an example of 10mU/L, but are GPs taking this to mean TSH needs to be above 10?

Is there any document you are aware of that I can provide my GP showing that prescribing above reference range but below 10 may be beneficial for those with symptoms?

Many thanks

[Clutter in reply to MiniMum97]

MiniMum97,

Ignore (usually above 10mU/L). FT4 is usually within range when TSH is <10. Your TSH is over range and FT4 is below range so you are overtly hypothyroid.

Overt hypothyroidism (OH) — TSH levels are above the normal reference range (usually above 10 mU/L) and free T4 is below the normal reference range.

[cazza1001 in reply to MiniMum97]

email [e-mail] and ask Louise for a copy of the Pulse article re treatment levels ( think it is section 6 ?)

[Hidden in reply to MiniMum97]

MiniMum97 I think that writing a letter with numbers and dates and pointing out the things which Clutter has mentioned is worth trying. It's an approach I used and I think it gives the GP the info you want to get across, which as you say is often difficult in a normal visit. If you mention too that you have been seeking information from Thyroid UK he/she might well visit the website too. Perhaps you'll be able to get this in before your next appt.

Best of luck 😊

[MiniMum97 in reply to Hidden]

Thank you. Have written my letter now. Hope it stays the right things. Will report back!

[cazza1001 in reply to MiniMum97]

Last week I emailed my practice ( and asked to forward to my doctor because I too always get railroaded ) with My symptoms - what are yours ? ... My results and a great article PULSE article that Louise form T.UK emailed me on treatment levels - namely TSH < 1 and T4 and T3 to at least top 25% of range ...

I requested in writing that my doctor would think about treating me to these higher levels as had been kept at borderline for 7 years - and had horrible symptoms . It worked wonders - good luck ...