Confused over diagnosis!

[Boady1974]

Hi all. I am 43 and a mum of 4. I was recently diagnosed with subclinical hypothyroidism after recent blood tests and many months of severe symptoms. I have also been tested for hypopituitarism but bloods came back within normal range for these. I have also being going through menopause since age 38 so also on HRT. My recent bloods were

TSH 1.25 (0.3 - 4.2), FREE T4 10.4 (12 - 22) B12 347 (200 - 660) SERUM FOLATE 6.9 (3.3 - 17.2) No TPO done at the time.

Dr prescribed Levothyrozone 25mcgs daily and to have bloods retested in 8 weeks. My query is (is the diagnosis correct)?

Thanks for any feedback.

[Raventhorpe]

Hi yes gp's right as you t4 is below range at 10.4, I'm surprised your tsh isn't higher with the t4 being that low. Now that your in levo You need t4 to be towards top quarter of range and tsh to be 1.0 or below so you will probably need an increase in meds when your tested again, normally increase would be in 25mcg at a time then tested again in 6 weeks and so on till you feel well.they have started you on a very small dose normally you would start on 50mcg unless your old or have heart problems.t4 take 7 -10 days to get in system and six weeks to feel full benefit, sometimes when you are stared on small dose you start off feeling better then go done hill again this is normal and it can take a while with a few increases in meds before you feel well as everything takes time with the thyroid.

[Boady1974 in reply to Raventhorpe]

Thanks for that just so much information out there in relation to the thyroid. Just delighted that I am on the right road after years of thinking I was going mad.

[Clutter]

Welcome to the forum, Boady72.

You are certainly hypothyroid but it is not primary hypothyroidism because TSH is not high. Was it an endocrinologist who ruled out hypopituitarism? Low-normal TSH with FT4 below range indicates central hypothyroidism which is usually due to pituitary dysfunction or hypothalmus dysfunction causing TSH deficiency. Without sufficient TSH the thyroid cannot produce sufficient T4 and T3 hormone.

Levothyroxine is the treatment for all types of hypothyroidism but I think your dose of 25mcg is too low. Dose will need increasing until FT4 is between 18-22.

[Boady1974 in reply to Clutter]

Hi. Thanks for the reply. I had a range of bloods done to rule out hypopituitarism (gp carried these out) hypopituitarism would explain my early onset of menopause also. GP was happy with them (all in the normal range). Would it be thyroiditis from recurring sore throats? I have so many symptoms that I don't know what's going on anymore! 😣

[Clutter in reply to Boady1974]

Boady1974,

You have central hypothyroidism which should be managed in endocrinology as they will investigate whether there is sex and growth hormone deficiency in addition to TSH deficiency.

NICE CKS recommends:

Secondary or central hypothyroidism is the result of insufficient production of bioactive TSH due to a pituitary or hypothalamic disorder.

Urgent referral to an endocrinologist should be arranged if:

Secondary hypothyroidism is suspected.

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

When your GP checks your thyroid levels ask for thyroid peroxidase antibodies to be tested to rule out autoimmune thyroiditis (Hashimoto's). Patients with central hypothyroidism don't often have Hashimoto's but it does happen. It's likely any tenderness you are experiencing is due to the thyroid being enlarged as it struggles to produce T4.

[Boady1974]

Thanks I'll ask for a referral to Endo and get to the bottom of this. Thank you for your help.