New here. Hashimotos with Low normal T4 and High normal TSH. What can I expect from my GP?

[TBirdGT0]

Hello. I've been experiencing problems of fatigue, depression, poor sleeping due to waking at night with cold sweats for a long time - possibly as much as 10 years.

Visited GP 5 or 6 years ago with Tired All the Time symptoms (which he reassuringly referred to as TAT). GP carried out a standard Thyroid blood test (presumably TSH) which came back as normal. Never really got a satisfactory conclusion to this and I just suffered and carried on to the best of my abilities.

At the start of May 2017 I completed a MediChecks WellMan UltraVit test as a general health check. The majority of tests were normal within range, except for Free Thyroxine which was low at 11.5 pmol/L (range 12 - 22 pmol/L) and TSH 3.88 mIU/L (range 0.27 - 4.2 mIU/L). Also my Vitamin B12 was high which I anticipated as I've been supplementing with B12 for at least a year. The report accomonying the test results recommended completing a more comprehensive Thyroid test in the following 3 month's.

At the start of this month I completed a MediChecks Thyroid Check (the suggested more comprehensive Thyroid test) to further investigate Thyroid function. Results: -

TSH = 3.2 mIU/L (range 0.27 -> 4.20 mIU/L)

Free Thyroxine = 12.41 pmol/L (range 12.00 -> 22 pmol/L)

Total Thyroxine (T4) = 74.9 nmol/L (range 59.00 -> 154.00 nmol/L)

Free T3 = 4.78 pmol/L (range 3.10 -> 6.10 pmol/L)

THYROGLOBULIN ANTIBODY = 611.40 IU/mL (range 0.0 -> 115.0 IU/mL)

THYROID PEROXIDASE ANTIBODIES = 351.5 IU/mL (range 0.0 - 34.0 IU/mL)

It appears from test so far that I have Hashimoto's, with Free T4 = 12.41 which is at the lower end of normal and TSH = 3.2 in approximately the top quarter of the normal range.

What can I expect when I discuss these results with my GP: -

* Will he treat with Levo?

* Will he refer me to an Endo?

* Will he wait and see and request bloods every twelve weeks until T4 comes back below range?

* If the GP wishes to wait and see, which could leave me soldiering on for years. Should I self medicate?

Look forward to your advice and guidance.

Thanks.

[Hidden]

Unfortunately your TSH is still within the 'normal' range so your GP may not act on it nor give you any Levo until it goes over range, even then, some will wait till it reaches 10! I went to my GP with test results which showed, like you, I have Hashi's, but at that point my TSH was still (just) under the top end of the range and my GP said to wait and re-test in a few weeks. I felt dreadful at the time, but fortunately for me the next test showed my TSH had gone over (4.95, same range as you have). Then I got a paltry 25 mcg Levo. I highly doubt you'll be referred to an Endo at this point. You may need to wait a few more weeks and do another blood test and see how it is going, but your TSH is really too high (ideally it would be below 2 or even 1), however depending on your GP's knowledge of the thyroid they may not think it is. Your T4 is very low, though, so maybe if that goes below range your GP will act, but honestly he/she should already be acting based on how you are feeling.

In the meantime you can help yourself by reading as much as possible on the subject and it can help to go gluten-free (and even dairy free) if you aren't already, that might help reduce the antibodies. Have you had ferritin and Vit D levels tested? Worth doing if you haven't, as if either or both are low they will affect your body's ability to utilise thyroid hormone optimally.

As for self-medication, I'd think it's too early to go down that route as yet, but others more knowledgeable than myself will advise.

[TBirdGT0 in reply to Hidden]

Thanks jadzhia. I appreciate your observations on what I'm likely to expect from the average NHS GP. Would you happen to know if there is some specific course of action \ Vitamins \ herbal medication etc. that I could use to temporarily nudge my T4 below range, and to push my TSH higher\high?

[Hidden in reply to TBirdGT0]

No I don't know, I'm sorry. As TSH110 says, the best you can do is get your blood test as early in the morning as possible and fasting (water allowed). That should give you the max TSH.

[TSH110]

3.2 is not a good TSH reading, most people feel better if it is below 1 - I felt dire when mine eventually came down to around this number. I never felt vaguely human until it was well below 1.

If you doctor abandons you to suffering all alone with obvious symptoms of autoimmune hypothyroidism I would seriously consider self medicating. It is not worth going through hell to keep a doctor happy - they don't have the problems. I would try and persuade the doctor to start treating you. This TSH of 5 or even 10 before treating someone is plain cruelty. It is much lower in other countries where you probably would get hormone therapy. It helps control the antibodies too which are the real problem, so it is insane not to start treatment as soon as possible. Jadziah's advice on diet and vitamins are very sound.

I can't see any point in suffering unnecessarily with this disorder. If you feel ill you should be treated - with what other illness would you be told to wait until l you feel even worse before the doctor would deign to do anything to alleviate the symptoms. Doctors seem to forget we have to do things like work to survive and it is often a hostile and highly competitive environment where you will be ditched at the first opportunity if you cannot perform at 150% and there is also life beyond work - why do they think we are not entitled to be well enough to enjoy it? They could help but choose not to. Talk about power games - makes me mad. TAT for 10 years that should stand for the standard of job they do - that doctor should be ashamed to have not got to the bottom of your problem and got it rectified long ago. 100k a year to do nothing - nice money if you can earn it.

Did you read the thyroiduk page here it is very good - your results show you have autoimmune thyroiditis:

thyroiduk.org/tuk/diagnosis...

[TBirdGT0 in reply to TSH110]

Thanks TSH110. I would be happy to be performing at 100%, let alone 150%. I've already had to abandon one job and take something less pressured because of my health. I'm just thankful that I can just about manage my current job.

Would you happen to know if there is some specific course of action \ Vitamins \ herbal medication etc. that I could use to temporarily nudge my T4 below range, and to push my TSH higher\high?

Thanks.

[TSH110 in reply to TBirdGT0]

TBirdGT0

Not that I know of I'm afraid. You should get the blood draw as early in the morning as you can cos the TSH is highest then. It can vary a lot with hashis I even used to go into hyperthyroidism for short periods.

That is a bummer about the jobs - I really struggled towards the end of my untreated and overt hypothyroidism. I had a hideous bully of a boss. Glad to get out of that place for sure but It destroyed my confidence I never feel secure in any job now - very stressful. You could nip this stuff in the bud I am sure. Well hardly the bud after 10 years of it. Mine took decades to die.