Thyroid UK
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Advice needed

I am new. I just had diagnosed with subclinical hypothyroidism.

My blood test results are TSH 4.94 (0.3-4.2)

And T4 is in norm range, but what I am worried about is TPO is 215 (0-30).

I am tired all the time, have depression, headache, mood swings.

The doctor said she will repeat bloods in six months. She will do scan, because my sister has the same condition.

Any advice would be grateful.

I already eating gluten free.

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Hi, Rima. Has Levothyroxine been prescribed?

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No, they said I don't need it.

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Rima. I hope that someone with a greater knowledge than me will pile in. However, I have to say that in my limited experience, you probably do need thyroid hormone replacement. Since you have elevated antibodies - ie. Hashimoto's disease, they should start you on a course of Levothyroxine. I don't understand why your medicos feel you don't need hormone replacement. It can only be ignorance of the condition. Gluten free often helps with Hashimoto's, however, six months wait for treatment is bonkers. I would suggest, and I must tell you I am not a medical professional, that you ask for a trial of Levo at the earliest opportunity. I know that in the UK they will often not treat until TSH reaches 10, but you have raised antibodies, which would suggest treatment is required without waiting for some notional point in the distant future. You may need to go into battle. Good luck :-)

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Thank you. I already been told that everything is OK and I worry too much. I didn't mention, that my weight is critical as well.

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Yes. This the the normal response from doctors who know little about the condition. Your TSH is outside upper lab limit and you have Hashimoto's. You need to ask for a trial of Levo or a referral to an endo. Since you feel so dreadful, what have you got to lose?

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Yes true, nothing to lose.

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Rima5 This may be helpful, from ThyroidUK's main website > About the Thyroid > Hypothyroidism:

thyroiduk.org.uk/tuk/about_...

"Subclinical hypothyroidism can progress to overt hypothyroidism (full hypothyroidism with symptoms) especially if there are thyroid antibodies present.

If thyroid antibodies are found, then you may have Hashimoto's disease. If there are thyroid antibodies but the other thyroid tests are normal, there is evidence that treatment will stop full blown hypothyroidism from occurring.

Dr A Toft, consultant physician and endocrinologist at the Royal Infirmary of Edinburgh, has recently written in Pulse Magazine, "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.2 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."

You've already had confirmation of antibodies so the most appropriate part of that quote is the last sentence so you need to try and persuade your doctor to prescribe Levo to 'nip things in the bud'.

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org.uk

Also, to reduce antibodies, as well as being strictly gluten free (well done on that :) ) supplementing with selenium L-selenomethionine 200mcg daily and keeping TSH suppressed are supposed to help.

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It's not for me, but I'm so glad you piled in, Sea - I was floundering a bit :-)

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Thank you! I will email later for the article.

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Whenever you have a thyroid blood test, have it done first thing in the morning. The TSH varies throughout the day, and in order to be treated you need the TSH to be as high as possible. First thing in the morning, without having eaten breakfast or had anything except water to drink, will maximise your chances of getting a high TSH reading and therefore being treated.

In many other countries you would already be prescribed Levothyroxine - they have lower limits for diagnosing hypothyroidism than we do in the UK.

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Thank you. Maybe this was my mistake, that I gave blood in afternoon and after food.

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