Hollie2016 Well, you are over range for TSH and very low in range for FT4, and in another country you would have a diagnosis of hypothyroidism as soon as your TSH hit 3; however, here in the UK doctors wait until it reaches 10.
Have a look at the list of signs and symptoms of hypothyroidism here thyroiduk.org.uk/tuk/about_... and if you have some of them, print it and tick them off, then ask your GP to consider subclinical hypothyroidism and give you a trial of Levo - see bestpractice.bmj.com/best-p... click on High TSH - associated with a normal FT4 and/or FT3 and you will see:
High TSH - associated with a normal FT4 and/or FT3
•Subclinical (or mild) hypothyroidism occurs when TSH is above reference range with a normal FT4 and FT3. The risk of progression to overt hypothyroidism is 2% to 5% per year. [42] The risk is higher in patients with positive TPOAb. [43] The decision to treat these patients is controversial. Generally, thyroxine replacement is not recommended when TSH is below 10 mIU/L. [44] TSH and FT4 should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in thyroid status in untreated patients. [42]
If not already done, ask for thyroid antibodies to be tested.
There are two types - Thyroid Peroxidase (TPO) and Thyroglobulin (TG), the NHS rarely does TPO and almost never does TG; however, you can be negative for TPO but positive for TG.
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You should also ask for vitamins and minerals to be tested, they need to be at optimal levels and especially ferritin needs to be at least 70 for thyroid hormone to work, and that's our own as well as replacement hormone:
That's a huge difference in the TSH, Hollie2016 . Is last week's result before or after the results in your initial post? Were they taken at very different times of the day and had you eaten within a couple of hours before the test in your initial post?
ETA: A TSH of 32.5 is a very clear marker for hypothyroidism. Have you discussed this result with your GP?
You and your GP are going to have a lot to talk about - and you'll be well primed by reading Seaside Susie's information in advance of your appointment and knowing what additional testing you might request.
Oh well Holie, that TSH/FT4 should get you an immediate diagnosis of hypothyroidism. Don't leave the surgery without a prescription for 50mcg Levo.
Make sure you are retested every 6-8 weeks with an increase of 25mcg following the result, continue with this retesting/increasing until your symptoms abate and you feel well.
When booking thyroid tests, always book the very earliest appointment of the morning, fast overnight (water allowed) and leave off Levo for 24 hours. This gives the highest possible TSH 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.
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As you have Hashi's, read an learn as much as you can because most doctors dismiss antibodies as being of no importance and don't understand the nature of Hashi's. The antibodies attack the thyroid and gradually destroy it, and as the antibodies fluctuate test results and symptoms can also fluctuate.
You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
Hashi's and gut/absorption problems go hand in hand and low nutrient levels also seem to be very common. It's important to get your vitamins and minerals tested because unless they're at optimal levels thyroid hormone can't work. So ask for the tests I mentioned above.
If you can post the results and say what supplements you are taking and the doses, we can see if you are anywhere near optimal or need to boost the levels.
If your TSH is above the range but less than 10, discuss a therapeutic trial of thyroxine with your doctor.
Subclinical hypothyroidism (where there are elevated TSH levels, but normal FT4 levels, possibly with symptoms) has been found in approximately 4% to 8% of the general population but in approximately 15% to 18% of women over 60 years of age.
Subclinical hypothyroidism can progress to overt hypothyroidism (full hypothyroidism with symptoms) especially if there are thyroid antibodies present.
If thyroid antibodies are found, then you may have Hashimoto's disease. If there are thyroid antibodies but the other thyroid tests are normal, there is evidence that treatment will stop full blown hypothyroidism from occurring.
Dr A Toft, consultant physician and endocrinologist at the Royal Infirmary of Edinburgh, has recently written in Pulse Magazine, "The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat the thyroid function tests in two or three months in case the abnormality represents a resolving thyroiditis.2 But if it persists then antibodies to thyroid peroxidase should be measured.
If these are positive – indicative of underlying autoimmune thyroid disease – the patient should be considered to have the mildest form of hypothyroidism.
In the absence of symptoms some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow-up."
It goes on to say:
Treatment should be started with Levothyroxine in a dose sufficient to restore serum TSH to the lower part of it's reference range, Levothyroxine in a dose of 75-100mcg daily will usually be enough.
You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org print it, highlight question 2 and show it to your GP when requesting a trial of Levo.
Hollie2016 It might also be worth asking your doctor to rule out PCOS which can cause facial hair growth. I don't know much about it but there's some info here.
These are the guidelines the doctors follow. You can discuss them with your doctor. If you think your symptoms warrant further investigation or treatment then you can raise it with the Doc based on the guidelines.
Im hashi too and dont know why docs dismiss it soo much as its a auto immune disease and is listed as a disability, cant remember where i saw it though. X
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