'Normal' thyroid test results? Should I pursue them?

[Katewood80]

Hi!

About a year ago I was diagnosed with borderline hypothyroidism but my doctor didn't feel it was necessary to prescribe anything. I did a follow-up test about 6 months letter and get the same results and response from the doctor. We recently started trying for a baby and I had a early miscarriage in Dec and my fertility clinic recommend that I have my thyroid test again. I got my results back last week and my doctor said they are normal but my serum free T4 level is at the low end of normal 12.5 (their range is 10.30-24.50) and my serum TSH level is on the higher side of normal at 4.8 (their range is 0.30-5.5).

Would you recommend me getting any other tests or pushing the doctor to prescribe medication?

If we weren't trying to conceive, I would probably accept the 'normal' diagnosis but I'm 37 and not getting any younger so I want to make sure my body is working with me rather than against me

Thanks!

[Nanaedake]

For full evaluation you need TSH, FT3, FT3, thyroid antibodies TPO and TgAb testing. If doctor won't do them you can use a reliable lab such as the ones listed on Thyroid UK's website. They list Medichecks and Blue Horizon.

[Clutter]

Katewood80,

I'm sorry for your miscarriage.

The TSH of women planning conception should be in the low-normal range 0.4 - 2.5. When preg-nancy is confirmed dose is usually increased by 25-50mcg to ensure good foetal development. NICE also recommends that hypothyroid women planning pregnancy should be referred to en-docrinology. cks.nice.org.uk/hypothyroid...

Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee

13. The serum TSH reference range in pregnancy is 0·4–2·5 mU/l in the first trimester and 0·4–3·0 mU/l in the second and third trimesters or should be based on the trimester-specific reference range for the population if available. These reference ranges should be achieved where possible with appropriate doses of L-T4 preconception and most importantly in the first trimester (1/++0). L-T4/L-T3 combination therapy is not recommended in pregnancy (1/+00).

onlinelibrary.wiley.com/doi...

According the ATA First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss

thyroid.org/patient-thyroid...

[Katewood80 in reply to Clutter]

Thank you so much for this info. I’m really struggling to get my GP to acknowledge there’s an issue.

[Maxxxx]

Hi - I am so sorry about your miscarriage. Your doctor should start you on 50 mcg of levothyroxine immediately and get your TSH level down or you will find it difficult to impossible to conceive/carry a full term pregnancy. According to NICE guidelines ladies trying to conceive should be referred to an endocrinologist.

Don't accept any less than to start immediately on levothyroxine.

I wish you the best of luck.

[SlowDragon Administrator]

A TSH of 4.8 strongly suggests you are hypothyroid

You definitely need to know if you have high thyroid antibodies

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

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available, very many here have to get private tests as NHS won't test

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.

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

Link about antibodies

thyroiduk.org.uk/tuk/about_...

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Print this list of symptoms off, tick all that apply and take to GP

thyroiduk.org/tuk/about_the...

If you have Hashimoto's then looking at strictly gluten free diet to significantly reduce symptoms

So getting antibodies tested essential

[Katewood80 in reply to SlowDragon]

Thanks for your help. I’ve just ordered the Blue Horizon thyroid +11 finger prick test so hopefully it will provide a fuller picture. If my doctor still refuses to treatment me, would you recommend seeking a consultation with a private endocrinologist?

[SlowDragon Administrator in reply to Katewood80]

Get full results first. Come back here on a new post and ask advice.

You can email Thyroid UK for list of recommended thyroid specialists

please email Dionne:
[e-mail]

No point seeing an average Diabetes specialist who knows little about thyroid

[Katewood80]

Thanks all for your help. I got in touch with my doctor again yesterday and they’re still refusing to help unless my fertility doctor insists.

Here was their response:

Firstly, you should have the normal reference ranges stated in brackets next to the results on the printout, and that your levels are within the normal range.

The reference ranges will vary across the country according to the equipment and analysers used in the local vicinity so we should used the local reference ranges not the ones you have seen on the web.

As such we cannot prescribe you thyroid replacement medication, but if your fertility specialist directs us to do so then we would.

Secondly, your thyroid peroxidase antibody level was raised indicating that you are at risk of becoming underactive with your thyroid in the future and you should therefore have a routine annual blood test to check your thyroid function every year.

[Marz in reply to Katewood80]

What a shame they haven't a clue ! Due print off the links given by Clutter - as they are NHS directives which your GP should follow.

[SamanthaVictory]

I'm sorry to hear of your miscarriage. I know you've already received excellent advice above but just to say that I was 'borderline' and fighting for treatment (and getting it) has been life changing. Hopeful for pregnancy soon, too! xx

[Sv_cy]

Hi, TSH is too high and FT4 is low.... You must test also FT3 as it is MORE important than! Optimal FT4 and FT3 must be in high range. Optimal TSH in low range (0,5-2,0)

[Katewood80]

Thanks everyone for your help. I saw my fertility doctor today and she’s prescribed 50mg thyroxine so hopefully that will lower my TSH level.