Doc wont prescribe Levothyroxine, help with results please.

[Shirls67]

My cousin, who has Hashimotos, encouraged me to get checked due to my symptoms. Sure enough my antibodies were at 460. (Range under 6)

In June 16 my tsh was at 3.21 and T4 at 12.2.

In Jan 17 tsh 4.95 and T4 12.7.

I think the range was tsh under 6 and t4 9-23.

I was told my thyroid was coping. I returned to doc complaining of aches and tiredness and numerous other symptoms and he wrote to endocrinologist who said I was not suitable for thyroxine and asked for some bloods to be checked. My vit d was at 23 and I have been given tablets for this.

Can anyone offer any advice as to why they won't give me a trial of thyroxine. Many thanks

[bluebug]

I presume you are in the UK.

In the UK until you have a TSH of 10 even though you are above the range then NICE guidelines state you have subclinical hypothyroidism. It is therefore at the doctors discretion whether they give you levo. Some will prescribe levo if your TSH goes above 6.

As you also have a severe vitamin D deficiency so your signs and symptoms will be attributed to that.

[bluebug]

In future even if you have to make up excuses always make sure you have your blood tests first thing in the morning after overnight fasting - you can drink water.

Make up excuses if you have to avoid having a blood test later in the day e.g. work, caring responsibilities.

[Shirls67 in reply to bluebug]

Thanks so much for the reply. Yes I'm in the UK, in Scotland. I'll make sure I go for tests in the morning next time. I'm 49 and the aches, brain fog and exhaustion are causing real problems now. I really wish the doctors could treat symptoms and not bloods. This is a great site. Thanks so much, once again.

[humanbean in reply to Shirls67]

Not just in the morning - it has to be early morning, by 9am at the very latest. TSH varies according to time of day, and therefore the time blood is taken is very important if you are seeking a diagnosis.

Take a look at the graphs on page 2 :

reboundhealth.com/cms/image...

[roseabi]

Your thyroid test results are within the ranges you have specified - your TSH was below 6, and your T4 was between 9 and 23 - so the endocrinologist probably described them as normal. In hypothyroidism you would expect to see high TSH (greater than 6, or in fact 10 according to bluebug) and low T4 levels (i.e. below 9).

Sounds like you have other health problems that may be causing your symptoms, good luck xx

[Shirls67 in reply to roseabi]

Thanks for the reply. Maybe the vit d will improve symptoms. Do you know why prescribing thyroxine is based on tsh and not t4 levels? X

[bluebug in reply to Shirls67]

It is based on T4 but yours are in range.

You have to below the range to be prescribed it and if you are below the range you will likely be referred to an endo as it means you have a rarer form of hypothyroidism.

As many people with one nutrient deficiency frequently have another I would suggest you get your doctor to test your vitamin B12, folate and ferritin levels plus a full blood count if you haven't had one.

If you have had any of these tests then edit your post and put these test results in with ranges. Often people are within the normal range but are sub-optimal for B12 and folate, and are virtually iron deficient so their ferritin and/or haemoglobin is too low. The NHS will only treat you if you are definitely deficient in these as there are disagreements amongst doctors about what levels they should treat you.

[roseabi in reply to Shirls67]

The pituitary gland produces Thyroid Stimulating Hormone (TSH) to tell the thyroid gland to produce the hormone Thyroxine (T4). If the thyroid gland does not then produce enough T4, the pituitary will produce more TSH. If the thyroid gland is clinically "underactive" it still will not produce enough T4, and the body's metabolic processes will be affected, producing unpleasant symptoms.

This is why, in the person with hypothyroidism, the blood test will usually find HIGH levels of TSH, and LOW levels of T4. If TSH levels are normal or low (and T4 is also low), there is likely an additional problem with the pituitary gland.

I'd guess that the thinking is that if they prescribe thyroxine when your levels are normal, there is a risk of throwing your endocrine system off-balance. The antibodies, however, suggest that something may be amiss, so I imagine it would be a good idea to continue monitoring your hormone levels - is that what the doctor said?

In the meantime, you could think about what else might be causing symptoms xx

[Justiina in reply to Shirls67]

Vitamin D can lower your TSH and increase your ft3 as vitamin D increase the conversion from T4 to T3. But it might result in short period of feeling better.

That happened to me, my tsh dropped a bit , so did ft4 as vitamin D caused more t4 to converted that produced. I felt quite good for three weeks on vitamin D.

So you might feel very good at first. Continue vitamin D even though the good feeling would fade away as vitamin D is needed anyway.

Your antibodies are very high so you have hashimoto and most probably get more hypo. You should get levo because of high antibodies regardless not being hypo enough. Don't give up.

Going gluten and dairy free could help lowering antibodies.

[SlowDragon Administrator]

Have you also had B12, folate and ferritin levels checked? These are also commonly low and need checking.

Have you got high antibodies?

[Shirls67 in reply to SlowDragon]

Thank you for your response. I will pay another visit to the doc and ask for these to be checked. Antibodies were 460 around a year ago x