Puffy lip

[Caroline888]

In June this year i went to my GP with a strange puffy area which had suddenly appeared overnight below my bottom lip. She had no idea what it was. As I'd also had some discomfort at the front of my neck since the start of the year, I asked for a thyroid function test. My results were a bit high with tsh at 8.8 and free T4 towards the bottom of the range. My GP was reluctant to treat but I pushed and am now on 25 mcg and 50 mcg levothyroxine on alternate days, i.e. an average of 37.5 mcg daily. Last result was tsh 5.4, no testing of T4 was deemed necessary by GP or lab since tsh 5.4 was considered to be in range. The puffy area below my lip has never changed in any way despite GP prescribing first antihistamine and then hydrocortisone. Do you think this has anything at all to do with my thyroid? I would be grateful for any advice.

[Clutter]

Welcome to the forum, Caroline888.

I'm afraid I've no idea whether the puffiness is thyroid related. It may be worth seeing your dentist who may have more idea than your GP.

You are undermedicated to have TSH 5.4 while taking Levothyroxine.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

[Caroline888 in reply to Clutter]

Have already asked my dentist and she has no idea either. Thank you for your reply. Glad to have your confirmation that I should indeed be taking levothyroxine. It's difficult when you have to go against your GP's advice. Although I have many symptoms he was reluctant to start me on Levothyroxine in the first place.

[Clutter in reply to Caroline888]

Caroline888,

I would see another GP. If yours was reluctant to start you on Levothyroxine when TSH was 8 and is satisfied that TSH 5.4 is adequately dosed you are never going to feel well.

[Caroline888 in reply to Clutter]

At the moment at least, he has accepted that i would like my tsh level to be lower. If I have trouble getting him to increase my dose if appropriate following my next test results, I will certainly consult another GP. Thank you for your help. I am however still very worried about the puffy lip. If you learn anything more in this connection, i'd be grateful if you would let me know. All other non-thyroid related blood tests were normal.

[SlowDragon Administrator]

You're under medicated to have TSH so high. The aim of Levothyroxine is to increase the dose until TSH is around one and FT4 towards top of range and FT3 at least half way in range

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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 articles from Thyroid UK email [e-mail]. print it and highlight question 6 to show your doctor.

Prof Toft - brilliant article just published

rcpe.ac.uk/sites/default/fi...

Have you had your thyroid antibodies tested? This is to diagnose Hashimoto's disease also called autoimmune thyroid disease

Or vitamin D, folate, ferritin and B12 - all are often too low and need supplementing when hypo

[Caroline888]

Have not had thyroid antibodies tested. Was found to be very deficient in Vit. D (11 nmol) until about 4 years ago but now good at 108 nmol.

Serum ferritin level 33 ug/L [12.0 - 300].

B12 was 856 ng/L [190.0 - 800.0].

Serum folate level was 22.4 ug/L [3.0 - 17.0]

[humanbean]

Serum ferritin level 33 ug/L [12.0 - 300].

Your ferritin is only 7% of the way through the range. That is dreadful. It would be a good idea for you to get an iron panel done. If your doctor won't help (and he doesn't sound like the cooperative type), then you can pay to get it done privately with just a finger prick test with the sample being sent through the post and the results being made available to just you :

medichecks.com/iron-tests/i...

If you want to be really thorough then you could pay for a full blood count as well (this is something your doctor may have done recently, you never know) :

medichecks.com/haematology-...

[Caroline888]

Thanks for that. You trust that if your results are in range and the doctor doesn’t say otherwise, all is ok. Did have full blood count done and will post results later if that’s ok. Am out at the moment. Can I just take a supplement for the low ferritin? I do take a multivitamin as I am a vegetarian.

[Treepie in reply to Caroline888]

Multivits are a waste of money.Not enough of anything in them.

[Caroline888 in reply to Treepie]

Thanks. I do take vitamin d vitamin k and magnesium too. Perhaps I need to add iron?

[Caroline888 in reply to Caroline888]

Have replaced original post photo with copy of full blood count results. Didn’t know how to do it any other way. I would be grateful for any thoughts or advice.