Repeat testing for Subclinical Hypo

[AmieL]

Hi

I first had hypo symptoms about 15 years ago, as a teenager. My then GP ordered blood tests as he was fairly sure it was a thyroid issue. Unfortunately, I’ve been severely needle phobic for about 20 years and didn’t have the tests done so I have no idea what the figures would have been. I eventually had a general screen done following breathing problems in August, which by chance included thyroid tests. My tsh was 5.2. I don’t know whether any other tests were done. I understand protocol is a repeat after 3m, which I’ve just had done and will be discussing the results on Monday. If, as I understand things, I’m unlikely to be treated unless my tsh has doubled in 3 months what is the point in the repeat test?

[SlowDragon Administrator]

For full evaluation you need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

If antibodies are raised this is autoimmune thyroid disease.

thyroiduk.org.uk/tuk/testin...

If you can't get full thyroid and vitamin testing from GP

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

Would you be able to manage a finger prick test?

All thyroid tests should ideally be done as early as possible in morning and fasting. This gives highest TSH and most consistent results

[AmieL in reply to SlowDragon]

I’ve been brave and had my bloods done already, so now I’m just waiting for results. At the moment I’ve not a clue what tests have been done (the form just said thyroid screen) or what normal range for my previous test was. All I was told over the phone was that tsh was 5.2 and that was over range by some way.

[SlowDragon Administrator in reply to AmieL]

Make sure to get copy of actual results and the ranges (figures in brackets after each result)

Come back with new post after you get them

[Gambit62]

a single, slightly elevated test could be the result temporary damage that will heal which is why it is left 3 months and then retested.

usually the general investigation only includes measuring TSH. The follow up is likely to include more tests - TSH and T4 (but not necessarily both total and free) and possibly T3 (again, may not be T3 and T4) but not likely to include tests for antibodies (TPO and TG) unless these were specifically requested by the GP.

All tests need interpretation in the context of symptoms. In general there is a tendency to keep the tests to a minimum to reduce costs rather than doing the full suite of possible diagnositic tests, and the use of clinical evaluation in the UK is almost non-existant, which fails completely to recognise the fact that people are individuals and an averaged range doesn't necessarily tell you the whole picture.

Are you still wrestling with the needle phobia?

I'm not aware of any requirements about TSH doubling over the last few months - if its raised at the second test then my understanding would be that that would be the point at which they should be starting treatment (which will mean more blood tests until they manage to get the levels right for you).

[Gambit62 in reply to Gambit62]

sorry - slight addendum

if you are symptomatic and TSH is elevated then definitely proceed to treatment.

some divided opinion over whether to treat if no symptoms - though the sensible thing to do in that instance would be to at least look for the cause of the raised TSH by eg evaluating existence of antibodies.

[AmieL in reply to Gambit62]

Thank you for the explanation.

My reference to the figures doubling was more in that they need to reach 10. I doubt that would have happened this quickly, would it?

The fact that I have had the test done is a huge improvement on the needle phobia (I hadn’t got close to a blood test at all in 20 years). It wasn’t great though. 6 attempts to get anything out of me and then I passed out.

[Gambit62 in reply to AmieL]

there are very divided views on treating subclinical hypothyroidism - some suggest not treating if you aren't symptomatic until it gets to 10, just to monitor until it does - others that it should be treated, particularly if there are antibodies.

if the result comes back still high but below 10 then you could ask if they would look at antibodies to find out if that is the cause - which could argue for not delaying further but if you are symptomatic try to push on that basis regardless of it not being at 10.

I've had auto-immune gastritis (leading to problems absorbing B12) for a few years and that's easy to deal with (though not if you rely upon a GP). Was diagnosed as hashimotos (anti-bodies) just over a week ago and started on a very low dose of levo that just left me feeling awful compared to more-or-less symptomless just before. Feeling a bit better now but not sure if that is just because it started to kick in after a week or because I decided to take double the dose I'd been prescribed (based on an absorption problem and the probability that dose was far too low). Haven't spoken to GP about it yet but guess I'll have to at some point at the next test around whether I'm on the right dose or not.

Glad that the test gave you a bit of confidence in dealing with the phobia. Is it something that you have discussed with your GP as it's possible that they might be able to refer you for some support - a friend of mine has a needle phobia and did get some support for it. Likely that having to deal with a number of tests over a period of months etc may give you plenty of opportunity to practice getting over the problem.