Thyroid UK
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High TSH

Hi, I've had two tests with consistent results (latest below). I have the symptoms of hypothyroidism, most recently thinning hair, but my doctor has said that I am "pre-clinical." He has said that they will continue to monitor results annually, but I need something to change now. Is there anything I can do?

Auto antibodies 176

Serum free t4 13.6

Serum TSH 5.7

7 Replies
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Realsmith,

Subclinical hypothyroidism where TSH is between 5 - 10 and FT4 in normal range should also mean the patient is asymptomatic. If you are experiencing hypothyroid symptoms your GP should be treating you with Levothyroxine. Antibodies are positive for autoimmune thyroiditis (Hashimoto's) which causes 90% of hypothyroidism. Hashimoto's progressively destroys the thyroid gland. It would be pragmatic to commence Levothyroxine to delay progression and to relieve symptoms.

Read Dr. Toft's comments in thyroiduk.org.uk/tuk/about_... Email louise.roberts@thyroiduk.org if you would like a copy of the Pulse article to show your GP.

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

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I can't tell you how helpful your response is. I had a strong feeling that something wasn't right with just waiting to become hypothyroid when I have had symptoms from the outset. Thank you.

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Realsmith,

Some GPs do seem to think they have to wait until TSH is >10 to treat. It's not true but if you can't persuade your GP do see others at the practice or change practice.

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Hello, I've just had my levels tested again with the GP, who had agreed that if my TSH was still high, I should be treated. However, my TSH has dropped after being consistently >5 for the last 2 years. In the test last week, it had dropped to 4.1. My T4 level is still low within the range (12). My T4 level has been gradually decreasing since the first test was done at the beginning of 2016. My GP has said she wants to speak with an endocrinologist before treating me. I am very worried that they will say I am now fine, although my symptoms have not changed. I am looking for any advice or explanation which anyone may have for why my TSH may have improved while my symptoms are still present.

To help, I've included the history of my levels below.

Thanks very much

Nov 2017:

TSH 4.1

T4 12

Mar 2017:

TSH 5.7

T4 13.6

Thyroid autoantibodies 176 kU/L

Sept 2016:

TSH 5.7

T4 14.1

Feb 2016:

TSH 6.9

T4 14.7

Reply

TSH fluctuates a lot. One major factor is time of day - TSH has a circadian rhythm. So, can you remember the time of day when you had the two tests you've referred to?

Ideally, thyroid function tests should be carried out as early in the morning as possible and by 9am at the latest, having fasted overnight (except for water which should be drunk freely), and having not eaten or drunk anything (except water) until after the blood test.

TSH is highest overnight (but nobody gets blood taken in the middle of the night, so first thing in the morning is the best anyone can do), and is lowest in the afternoon.

Eating before a test allegedly reduces TSH as well, which is why people are encouraged to fast for 8 - 12 hours or so before testing.

Doctors don't like patients doing what I've just described, so wise patients simply don't discuss it!

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Thanks very much for your reply. I think all of the tests would have been done in the morning, by 9, except the latest one which was at 10AM. Also, it is very possible that I didn't eat before the previous ones and I definitely did before the latest one. I didn't know eating would impact the test. I'll follow the fasting advice for the next one. If TSH can fluctuate that much, and given my declining T4 levels, would it make sense that I am still treated for subclinical hypothyroid?

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You haven't included reference ranges, but at a guess I would think your TSH has been above range for most of the tests you list. You need treating, but your doctors will be quite happy to leave you untreated if they can get away with it, so you will have to keep pushing.

TSH will fluctuate whatever you do, and sometimes the thyroid produces unexpected results no matter what you do. You could try going 100% gluten-free to reduce antibody activity. It may make your TSH rise for your next test, and may make you feel better.

Going gf made me feel a lot better, and I don't have coeliac disease, nor do I have thyroid antibodies. It was worth the experiment, and I've stayed gf for nearly three years.

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