new here need advice for my daughter

Hi, my 17 year old daughter was told she has sub clinical hypothyroid last sept, when she was tested her FT4 was 16.2 (12.6 -21) and TSH was 5.39 (0.51 - 4.3). The doctor didn't treat her, just said come back and get tested in 3 months. She did and FT4 14.9 and TSH 6.1 he also said she had antibodys but didn't give me a number. Again no treatment just said come back in three months. So i started giving her selenium, zinc, vit D, vit b complex, Iron and vit c. Next test FT4 13.9 and TSH 4.7 The doctor said these result were better and to keep giving her what ever i was giving her. But she was still suffering with symptoms. The last test he done in June this year her FT4 was 15.1 and her TSH was 10.1. He still didnt want to treat her because he said she still wouldn't be considered hypothyroid. I got upset and said she is suffering with hair loss, tiredness, anxiety etc all this time please tell me what i can do for her. So he has reluctantly put her on 25mg of Levo. its been about 4 weeks now and i am a little worried i might have done the wrong thing because her hair seems to be falling out more and her skin on her face has gotten worse too. Doctor also said anxiety isn't a symptom of hypo and sent her for C.B.T. Should i take her off it, or stick with it for a while, she has to go back for tests in about 3 weeks.

[Nanaedake]

Your doctor knows nothing about thyroid disease, find a new one. If your daughter's TSH was over 10.0 then even the guidelines recommend treatment. If she has thyroid antibodies then she has Hashimotos' disease and her thyroid results may vary due to antibody activity. Treating with levothryoxine should help to prevent the antibody activity.

In addition, many people with thyroid conditions have low vitamin levels so it would be advisable to get an iron panel, ferritin, B12, folate and vitamin D blood tests. Levothyroxine works best when these vitamins are all optimal.

There is a period of adjustment when starting on Levothyroxine and your daughter will need blood tests every 6 weeks after a dose adjustment. Most people feel best when their TSH level is around 1.0 so she will need dose increases until she reaches 1.0 or feels well.

I'm sure others on here will have lots of good suggestions but it sounds like you are doing the right thing but not getting much help from your GP.

Anxiety could very well be a symptom of low thyroid and it could also be a result of not getting timely help from GP! Once your daughter's treatment is optimised with good thyroid levels and adequate vitamins she will most likely find any anxiety disappears. It can take a while to recover so it need patience.

CBT is not going to sort out the physical problems. When people have thyroid imbalance, things that would normally be tricky but they would manage well become overwhelming but in my non-medical opinion, it doesn't mean they have a psychological problem, it's the result of not getting adequate and timely thyroid care.

[Hidden in reply to Nanaedake]

hi Nanaedake, thank you for getting back to me so quickly. She had a full blood panel done back in September, her B12 was 348 (197-771) folate 9.7 (4.6-18.7) Iron MCHC 310 (320-360) I did point out to the doctor that this was low but he said it was normal for a teenage girl and didn't treat her, that's why I started giving her iron. I read recently that frerritin levels affect hair loss so i asked for this to be tested and it came back serum ferritin 46 (13-150) serum iron level 19 umol/L , i said I have been giving her Florazene three times a day for three months i thought the test would com out higher but he said its within range so he wont give her anything, She hasn't had a Vit D test, I will ask for that with the next tests. I never know if I am giving her too much or too little vits etc with no input from the doctor

[Nanaedake in reply to Hidden]

Unfortunately NHS will not offer supplements if you are in range,even if low in range. If your daughter supplements and your GP won't test vitamin levels then you can get blood tests done through private laboratories. See Thyroid Uk's website for reliable laboratories. It's important to keep a check on iron and vitamin D as your body stores these and you can get too much.

[SeasideSusie Remembering]

Hidden

Anxiety IS a sign of Hypothyroidism - see under Mental and Emotional thyroiduk.org.uk/tuk/about_... "Nervousness/anxiety"

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TSH of 10.1 is definitely considered hypothyroid. 10 is the level most doctors wait until patients reach before they will diagnose (some will diagnose when it is lower if FT4 is below range, if antibodies are present, or if patient is symptomatic).

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

"The 2006 Thyroid Function Test Guidelines state, “There is no evidence to support the benefit of routine early treatment with thyroxine in non-pregnant patients with a serum TSH above the reference range but <10mU/L.” which in layman’s terms means that patients who have a TSH of less than 10 need not be treated because it doesn’t help. However, they also state that, “Physicians may wish to consider the suitability of a therapeutic trial of thyroxine on an individual patient basis.”

If your TSH test is above the range but less than 10, it might be an idea to discuss these Guidelines with your doctor as it may persuade him to give you a trial of thyroxine. In our experience, patients with signs and symptoms of hypothyroidism who have a normal TSH and low normal FT4 also benefit from a trial of thyroxine.

**

Four weeks isn't long enough to see an improvement, particularly since she's only on 25mcg which is usually prescribed for children, the elderly and those with heart problems. You haven't done the wrong thing, she needs to be retested 6 weeks after starting Levo and have a 25mcg increase, then retested again after another 6 weeks and another increase, etc, until she feels well and symptoms abate.

Always book the first appointment of the morning, fast overnight (water allowed) and leave off Levo for 24 hours. This gives the highest possible TSH which is needed when looking for an increase in dose or to avoid a reduction. TSH lowers during the day and after eating so a fasting, early appointment is important.

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges.

**

"So i started giving her selenium, zinc, vit D, vit b complex, Iron and vit C"

I hope you had some tests done then. Iron and vit D must be tested before supplementing. Too much iron is as bad as too little. Excess Vit D gets stored and can reach toxicity level. Best to test Vit D, B12 folate and ferritin as all these need to be optimal, not just in range, for thyroid hormone to work and that is our own as well as replacement.

**

Form the Hashimoto's (confirmed by high antibodies) she needs to be strictly gluten free as gluten contains gliadin which is a protein thought to trigger antibody attacks. Supplementing with selenium L-selenomethionine 200mcg daily can help reduce antibodies.

[SlowDragon Administrator]

With Hashimoto's your daughter really needs to try gluten free diet. A very high number of us with Hashimoto's find it helps significantly to reduce symptoms.

amymyersmd.com/2017/02/3-im...

chriskresser.com/why-changi...

The guidelines say that if a patient has high antibodies and symptoms, even if thyroid results are within range that treatment should be started.

25mcg is a small starter dose and can make us feel worse initially. Retest should be 6-8 weeks after each dose change. All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after.

Important not to take any supplements with biotin in 3-4 days prior to any future blood tests (most B complex have biotin in) Biotin can falsely affect test results

endo.confex.com/endo/2016en...

Also anxiety can be result of gluten intolerance too, as part of Hashimoto's. Going gluten free may reduce anxiety

Google gluten and anxiety - you will see lots of articles

[Hidden]

Hi thank you so much for getting back to me, I did have her Iron tested and she was low, I will stop the Vit D until she is tested. I have also started her on gluten free diet (not easy with a 17 year old). She has been a vegetarian for a few year now and i have read that teenage girls can be low in iodine so i am going to have her tested for that, do you think i should not give her the Levo for 24 hrs before being tested for Iodine deficiency.

[SlowDragon Administrator in reply to Hidden]

Never supplement iodine with Hashimotos - it can make it much worse

Levothyroxine contains iodine- no point testing

I would keep taking the vitamin D supplements and retest whilst on it - just don't take morning you do test

Vegetarian- likely B12 low and it's VERY difficult to be vegetarian and gluten free and not eat any soya and have high protein diet

Read the thyroid Pharmacist website about importance of high protein

Vitamin C and Zinc can be helpful

[Hidden]

Oh no I already paid for the iodine test, yes we are finding it very difficult to get protein for her, it's so hard because we can't force her to eat meat at her age😁 thanks again for these great links

[SlowDragon Administrator in reply to Hidden]

Can you swop iodine test for b12 and folate test?

[Hidden in reply to SlowDragon]

I'll try that thanks