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Help with blood results subclinical

Katy14 profile image
11 Replies

Posted re teva problems anxiety tiredness ect feeling a little better now 3 weeks back on my original brand but not back to my normal self.

Can someone explain if i should be still feeling anxious depressed tired tinnitus as doc says my last test was subclinical so should not have symptoms

Dont always remember all test results but these are my last few

March 2015 tsh 0.06 t4 19.1

June 2015 tsh 0.6

Oct 2015 tsh 1.1

JJan 2017 tsh 0.23 t4 19.7

Doc decrease throxine to 75mcg

Apr 2017 tsh 1.6

Sept 2017 tsh 12 t4 15.3

Doc increase thyroxine to 75 100 alternate days result subclinical

Anyone help explain how i should be feeling please?

Many thanks kate

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Katy14
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SeasideSusie profile image
SeasideSusieRemembering

Katy14 It's always useful to give reference ranges when quoting test results, as ranges vary from lab to lab it's not really possible to interpret them without the ranges your lab uses. However, TSH is the one exception, that's fairly standard and most ranges come reasonably close. FT4 isn't even worth guessing, as ranges can be 7-17, or 9-19, or 12-22, or anything in between.

From your results:

Jan 2017 tsh 0.23 t4 19.7

Doc decrease throxine to 75mcg

What was the reason for decreasing your Levo? Was TSH suppressed (if it was, that's of no importance). Where was FT4 within it's range?

Apr 2017 tsh 1.6

Well, the decrease in Levo certainly made a difference to your TSH. Was FT4 not done?

Sept 2017 tsh 12 t4 15.3

Doc increase thyroxine to 75 100 alternate days result subclinical

Is your TSH here 12?

Where in it's range is FT4?

Why is the result being classed as subclinical?

If your TSH is 12 then you didn't need an increase from 75 to 75/100 alternate days. You needed an increase of 25mcg unless there's a reason you can't increase in 25mcg increments.

*

What is your GP's plan? Are you being retested 6-8 weeks after this dose increase with a further increase on the cards?

*

Have you had thyroid antibodies tested? High antibodies confirm autoimmune thyroid disease aka Hashimoto's. Do you have that?

*

Have you had vitamins and minerals tested? If so, what were the results, are you taking any supplemements - if so what and the dosage?

Katy14 profile image
Katy14 in reply to SeasideSusie

Hi

*Lab Ranges TSH 0.27 - 4.7

Free t4 12 - 22

Free t3 2.8 - 7.1

*My doc only ever doTsh + t4

Dont always get results unless i ask and then they only usualy give me tsh result

Never had a t3 or antibodies test or vitamin tests

What is hashimotos?

She said tsh 12 t4 15.3 just means thyroid struggling and subclinical anxiety nothing to do with thyroid

Repeat tests in 8 weeks

Although i have always been a worrier and easily get anxious over things since tevo just not felt well

Is she right Should i not be having any anxious symptoms?

Kind regards kate x

SeasideSusie profile image
SeasideSusieRemembering in reply to Katy14

Oh Kate, I do despair :( you are being fed a pile of poo.

Sorry for the length of my reply, bear with me and I hope you can follow it, if not, ask and I will try and explain further.

***

First of all, there is primary hypothyroidism which is where the thyroid fails to produce enough thyroid hormone, it's diagnosed with a high TSH and low FT4 and FT3 and usual hypothyroid symptoms.

Then there is subclinical (or mild) hypothyroidism which is where there is a high TSH and the FT4 and FT3 are normal but you are showing hypothyroid symptoms.

So, depending on what your results were when you were first diagnosed you would have had a diagnosis of primary or subclinical hypothyroidism. It would not be possible for you to have had an initial diagnosis of primary hypothyroidism and they now telll you that you have subclinical hypothyroidism. I am finding it hard to understand what she means by saying you are 'subclinical', it doesn't make much sense.

***

Let's start with your latest results:

TSH: 12 (0.27 - 4.7)

Free t4: 15.3 (12 - 22)

She said just means thyroid struggling and subclinical anxiety nothing to do with thyroid

I don't think our doctor knows much about thyroid, she's waffling to cover her ignorance, and she doesn't know how to treat hypothyroidism.

There is nothing subclinical about these results. Your TSH is over range, if you hadn't already got a diagnosis then this would give you a diagnosis of primary hypothyroidism, no question about that. Hypothyroidism is diagnosed in the UK when TSH hits 10 and the aim of a treated hypo patient is to get TSH down to the lower part of the range, most people feel best when it's 1 or below.

You need to have an increase in your Levo.

*

Does she mean that the anxiety is nothing to do with thyroid? Then she's wrong. Anxiety is one of the symptoms of hypothyroidism - see the list of signs and symptoms here thyroiduk.org.uk/tuk/about_... and it's listed under 'Mental and Emotional' - nervousness/anxiety. So there you have it, if you are having symptoms of anxiety it's because you are still very hypothyroid due to your TSH being so high.

*

Repeat tests in 8 weeks

When a dose change has been made, it's normal to retest 6-8 weeks later to see where levels are then and give another increase if necessary (and repeat testing/increases every 6-8 weeks until you feel well). You appear to have had a dose change from 75mcg daily to 75/100 alternate days. So yes, you are due for the repeat test, but you really should have been increased to 100mcg daily. If you are willing to wait until the scheduled test, then fair enough.

Make sure you always book your thyroid tests for the very earliest appointment of the day, fast overnight (you can have water but breakfast when you get home) and leave off Levo for 24 hours (take after blood draw). This gives the highest possible TSH which is needed when looking for an increase or to avoid a reduction in dose. This is a patient to patient tip which we don't discuss with doctors or phlebotomists.

If you follow these guidelines for blood tests, then you will be able to compare your results accurately every time. If you have blood drawn at different times of the day, TSH will vary, it will be higher in the very early morning, it will lower throughout the day and be lowest during the afternoon. So it's important to get an early morning, fasting blood draw every time.

*

Dont always get results unless i ask and then they only usualy give me tsh result

No, they wont voluntarily give them to you. We have to ask. We are legally entitled to them under the Data Protection Act 1998. And always ask for a print out, never let them tell you verbally or write them down for you. Ask at reception for a print out every time then there will be no mistakes.

***

Never had a t3 test

A FreeT3 test is the most important, it tells us more than the others, yet they never do it.

TSH is for diagnosing hypothyroidism. Once you've been diagnosed and on thyroid meds it's useless. TSH is a pituitary hormone not a thyroid hormone. The pituitary looks to see if we are producing any thyroid hormone, if not it sends a signal to the thyroid to make some - that signal is TSH (Thyroid Stimulating Hormone). When we're not producing any thyroid hormone the TSH will be high because the pituitary sends the signal. Once we're on Levo, we are taking thyroid hormone, the pituitary detects there is thyroid hormone there, so it doesn't have to send the signal for some to be made, then the TSH is low. So, if we're on Levo and we're getting enough, the TSH will be low.

T4 is a storage hormone and the FT4 test tells us how much 'free' T4 we have. T4 converts to T3, and it is T3 that is the active hormone that every cell in our bodies need (which is why it's so important to know the level of this hormone). The FT3 test tells us how much 'free' T3 we have.

If FT4 is high and FT3 is low, this means that our conversion is poor, and we may still have symptoms of hypothyroidism, despite the fact that we may have a low TSH and a high FT4.

Here is some information about where our levels might need to be for us to feel well - thyroiduk.org.uk/tuk/about_... > Treatment Options:

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor.

Also -

Dr Toft states in Pulse Magazine, "The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org and can discuss with your doctor.

*

Never had antibodies test. What is hashimotos?

There are two types of thyroid antibodies - Thyroid Peroxidase (TPO) and Thyroglobulin (TG). The NHS rarely does TPO and almost never does TG. However, it's very useful to have antibodies tested because if they are positive it means you have autoimmun thyroid disease aka Hashimoto's. This is where antibodies attack the thyroid and gradually destroy it. There's no particular treatment for Hashi's, it's the resulting hypothyroidism that's treated.

If you have Hashi's there are ways to help reduce the antibodies, which helps reduce the antibody attacks and should slow down the destruction of the thyroid.

Having Hashi's can mean that you can swing from normal hypothyroidism to having what look like overmedicated results (and maybe symptoms), but the swings are temporary and things settle down again.

*

Never had vitamin tests

It often happens with hypothyroidism that our nutrient levels are low. Unless nutrient levels are optimal, thyroid hormone can't work properly. So it's important to have the following tested:

Vit D

B12

Folate

Ferritin

and if ferritin is low then:

Iron panel

Full blood count

If there are any deficiencies or low levels, we need to supplement to get them to optimal levels.

***

Although i have always been a worrier and easily get anxious over things since tevo just not felt well

As mentioned, anxiety can be a symptom of hypothyroidism.

As far as Teva levothyroxine is concerned, many members have found they have felt unwell when changed to Teva. If you have previously felt better on a different brand, ask to go back on to the brand which suited you and make a yellow card report about Teva yellowcard.mhra.gov.uk/ If your GP wont name a specific brand on your prescription, either tell your regular pharmacy that you wish only to have that brand, or ring round local pharmacies to see who can supply the brand you want.

***

If I've left anything out, or you want to ask about anything, just ask :)

Carly0987 profile image
Carly0987 in reply to SeasideSusie

Great reply. Thanks for taking the time to include all the details. X

Katy14 profile image
Katy14 in reply to SeasideSusie

Hi again

Since posting

TSH 12 T4 15.4 on here and getting your kind advice

been back saw different doc finaly got him to do more bloods was not easy!

Can you tell me if theze are the right ones

Copied this from blood request form

CLINICAL DETAILS:

tatt normal t4 hightsh.no problem with compliance.? t3 problem

TESTS REQUIRED:

(B12) Vitamin B12 and Folate

(IRON) IronTransferrin saturation

(FBC)

(TFGPRX) Thyroid on t4

(FOLATS)

(TPO) Thyroid Peroxide Antibodied

SeasideSusie profile image
SeasideSusieRemembering in reply to Katy14

Katy

What he's written on the form means:

tatt - tired all the time

normal T4 - your FT4 is within range

high TSH - that's your TSH result of 12 (but it would have been better if he'd made it clear that it was a long way over range)

No problem with compliance - he is saying that you are taking your Levo properly and not missing doses

?T3 problem - questioning whether there is a T3 problem

He has included

B12 and Folate (good because they work together)

Serum iron and transferrin saturation - part of the iron panel, ferritin really should have been listed too

Full blood count - this should show any signs of anaemia

TFGPRX Thyroid on t4 - I don't know but guess it is a code for some thyroid tests, we don't know if FT3 is included in this and he's telling the lab you take Levo

FOLATS - no idea

(TPO) Thyroid Peroxide Antibodies - testing one type of thyroid antibody. There are two, the other one is Thyroglobulin (TG) which is rarely done but you can be negative for TPO but positive for TG so if TPO comes back negative you need to ask for TG to be tested

It would have been good if Vit D was included, this is as important as the other vitamins and minerals and it would have been good to know if FT3 has been requested.

As there appear to be thyroid tests included, make the appointment for the blood draw the very first one of the day, fast overnight (water allowed) and leave off Levo for 24 hours (take after blood draw). This is a patient to patient tip which we don't discuss with doctors or phlebotomists.

Post your results when you have them for comment.

Katy14 profile image
Katy14 in reply to SeasideSusie

Thank you have to wait 1 week then get blood test will post results then

Only gone wrong since getting tevo instead of usual brand

never will accept tevo again!!!

X regards kate

Angel_of_the_North profile image
Angel_of_the_North in reply to Katy14

What an idiot! A TSH of 12 is primary hypothyroid especialy if you are on meds. Your january results looked good - how did you feel? I'd find another doctor as this one seems intent on tinkering because she can instead of keeping you well. You aren't there to a be human guinea pig for her weird ideas on dosing.

Katy14 profile image
Katy14 in reply to Angel_of_the_North

Thank you for reply yes felt well untill my levo was changed to Tevo then started feeling so ill tired anxious went docs to ask for my normal tevo brand i had always had before she said cant be the tevo the brands are all identica

Which i now know from postings on here is incorrect.

She did the blood tests

Tsh 12 f4 15.3

She said tsh raised but t4 ok so subclinical just struggling thyroid and my symptoms nothing to do with thyroid anxiety is anxiety.

She raised my levo to 75 +100 alternate days

Wonder if the tevo raised the tsh? Since finding a chemist with my old brand started feeling better but still symptoms tired tinnitus anxiety.

Just hope levo increase helps

Kind regards kate

Katy14 profile image
Katy14

Wow! SeasideSusie Thank you so much for your very informative info I have learnt so much .

Will ask for the tests you mention dont hold out much hope though may consider getting them private would it be expensive dou you know?

Think maybe the meds only increased so low dose because i am 67 what do you think?

Thanks again very kind regards kate x

SeasideSusie profile image
SeasideSusieRemembering in reply to Katy14

Katy, age shouldn't really have anything to do with it (unless maybe when first diagnosed and then they tend to start an elderly person on 25mcg rather than 50mcg), a normal increment is 25mcg unless just a tiny tweak is necessary. I honestly don't understand where your doctor is coming from if she thinks an increase of 12.5mcg daily is going to have much impact on a TSH of 12!

Lots of us do private tests, can be fingerprick or venous blood draw (at extra cost unless you know a friendly nurse or your GP surgery/local hospital will do it).

Best value for vits and mins is when they're with a thyroid bundle, and that will include both types of antibodies too. £99 although Medichecks have random offers on Thursdays and sometimes it's the Ultravit, usually £20 off.

bluehorizonmedicals.co.uk/t... (you get a nice large chocolate 'coin' with their kits :) )

medichecks.com/thyroid-func...

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