Thyroid UK
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Sub clinical- reversible?

Hi

After further discussions with the doctor my hypothyroidism is subclinical.

Is it possible that this is reversible? Has this happened to anyone. Or is it more likely it will progress.

Just wondering as I'm in my 20's so scary I may be dealing with this for life.

Thanks :)

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Hi Dewberry, after getting private bloods done my daughter is subclinical & is having to self treat as NHS won’t treat her.

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Hi

Sorry forgot to mention I am being treated with levo 50 as my tsh was about 10.

Sorry to hear about your daughter. I thought if you shower symptoms they have to treat?

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It would appear not. She slo has adrenal insufficiency so she is very unwell.

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Dewberry

Why is your GP saying it is subclinical? If you were diagnosed with a TSH of 10 that is primary Hypothyroidism.

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Hi

He said it is because t4 is in normal range. Is 13.8

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He doesn't know what he's talking about. If you have been diagnosed with primary hypothyroidism originally (which you would be with a TSH f 10), then you have primary hypothyroidism, it doesn't magically change to subclinical hypothyroidism when your results come back into range. All that proves is that the Levo is doing it's job.

Please post your full results. You will have TSH and FT4, with any luck you might even have FT3 and thyroid antibodies tested to.

Please give the ranges as well so that your results look like this

TSH: 2.5 (0.2-4.2)

FT4:17 (12-22)

(I made those figures up obviously).

So post your latest results and we can tell you if your dose of Levo needs increasing.

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06/09

Tsh: 11.17 mu/l (0.27-4.0)

Tpo: 42iu/ml (0-50)

T4: 13.5 pmol/l

As of 17/10

Tsh: 1.79 mu/l (0.27-4)

T4: 19.1 pmol (12-22)

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Dewberry1

Tsh: 11.17 mu/l (0.27-4.0)

T4: 13.5 pmol/l (assuming range 12-22)

I believe your GP has said subclinical hypothyroidism because your FT4 is in range, albeit very low in range. However, subclinical is usually used when TSH is over range but below 10 - see bestpractice.bmj.com/best-p...

Diagnostic testing

......

TSH levels are elevated in primary hypothyroidism, although in sub-clinical disease levels may only be mildly elevated.

Free T4 should then be obtained to quantify the degree of hypothyroidism or establish a diagnosis of sub-clinical hypothyroidism. [3] [14] Normal free T4 range is 9.00 to 23.12 picomol/L (0.8-1.8 nanograms/dL). In cases where the TSH is only mildly elevated, the patient is not symptomatic and the serum free T4 is normal, the diagnosis is sub-clinical hypothyroidism. [3]

So as your TSH is over range (elevated), not mildly elevated, I believe your diagnosis should be of primary hypothyroidism

Your latest results on 17 October

Tsh: 1.79 mu/l (0.27-4)

T4: 19.1 pmol (12-22)

show that Levo is doing a good job, your TSH has lowereda nd your FT4 risen to a good level. Most treated hypo patients feel best when TSH is 1 or below, but if you feel well with those results then your dose is fine.

However

Tpo: 42iu/ml (0-50)

even though your TPO antibodies are below the limit where you would be positive for autoimmune thyroid disease aka Hashimoto's, they are quite high. I wouldn't be ruling out Hashi's at this stage. I would be wanting Thyroglobulin (TG) antibodies tested, you can be negative for TPO and positive for TG. Also, if TPO was repeated there's every chance they would show up over the limit at some point.

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Thanks for the info! Has been very helpful.

Funny that I mention my antibodies were high end of normal could this mean anything . of course he said they are normal nothing to worry about.

He basically said see how it goes if i don't feel well come back which I definitelywill. Physically i'm feeling better but mentally I do not feel myself. I feel anxious and emotional. I feel its the thyroid as neveR felt lile this before. will give it a few weeks as I don't want to be sent away saying its stress.

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Dewberry

Anxiety is actually a symptom of Hypothyroidism, see thyroiduk.org.uk/tuk/about_...

Scroll down to Mental and Emotional at the bottom.

This may improve in time when optimally medicated.

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Thanks for all your advice it had been very helpful :)

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I wish that Doctors would use the correct terms, even if they get the medicine wrong. The definition of sub clinical is:

“SUBCLINICAL

sʌbˈklɪnɪk(ə)l/Submit

adjectiveMEDICINE

relating to or denoting a disease which is not severe enough to present definite or readily observable symptoms.”

I presume you went to the doctor in the first place because you had symptoms? Therefore, whatever they want to call it, it is not sub clinical.

A report which I read but cannot find at present was of an older lady who never saw the doctor for many years as she was perfectly healthy, eventually went for a minor illness, and the doc took the opportunity to do a battery of blood tests, of which only the TSH came back abnormal, with low T4. So despite her protests that she was not ill, he prescribed Levothyroxine. She brought them back a couple of weeks later complaining that they made her feel ill and stopped her sleeping, so she did not want them, and to please leave her alone, she was absolutely fine! Now, THAT is subclinical, no symptoms.

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As SeasideSusie says, a TSH of 10 is not subclinical! And 50mcg is a starter dose - how long have you been on that dose? Hopefully your doctor has asked you to go back for more thyroid function tests? Should be done every 6-8 weeks until the right dose to relieve symptoms is achieved (though doctors often only go by the numbers rather than symptoms...)

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I have had a test after around 5 weeks as still wasn't feeling great and tsh had gone from 11.97 to 1.79. So we are sticking at 50mcg for now

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Hmm, ok. Just be aware that 1.79 is still higher than most of us hypothyroidies feel well at, and that you will almost certainly need a raise in dose sooner rather than later. Don't get fobbed off with "it's in range" - that's not the name of the game with successful treatment of hypothyroidism.

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