At my wits end...

[Harko1980]

I have been feeling tired a lot with little energy, mood is all over the place, anxiety, struggling to loose weight, cold, irregular or no periods and occasionally dizzy/light headed for around 18 months now. I have a very strong family history of under active thyroid. Saw my GP about a year ago & had some blood tests which showed a TSH of 4.8, thyroid antibodies of just over 200, free T3 4 and free T4 of 15.8, got told that was all normal but as my periods had stopped was referred to endocrinologist, he did various non thyroid related tests & said this was because I’d stopped taking the pill 9 months ago - which I did not believe & then discharged me. Still feeling no better & just been back to GP, periods have returned but not regular as sometimes happen every 2 weeks & other times can be around 6-7 weeks between. I’ve had another blood test, only done TSH this time which is 3.9. GP says everything is normal, moods & irregular periods are to do with normal progesterone patterns during monthly cycle & I’m just a bit depressed. I just don’t buy what they are saying as I’ve never felt this rubbish before, I’m sure it must be to do with thyroid as other members of my family became affected around my age (37). My husband & I are trying for a baby & I’m also worried about how these levels of TSH might be affecting my fertility esp given irregular periods. Just feel like I get no help or explanation from the GP, want to feel better & don’t know where to turn. Any suggestions greatly appreciated, thank you.

[SeasideSusie Remembering]

First of all, don't try for a baby with a TSH that high, the risk of miscarriage to too great. I have 4 grandbabies who didn't take breath due to undiagnosed Hypothyroidism.

You don't give any reference ranges, they are needed to interpret results because ranges differ from lab to lab. However TSH might have been over range or very near to the top.

When you had your results a year ago, TSH 4.8 and antibodies of 200 you really should have been started on Levo as that indicated possible autoimmune thyroid disease aka Hashimoto's. See thyroiduk.org/tuk/about_the...

"The 'UK Guidelines for the Use of Thyroid Function Tests' state that, "There is no evidence to support the benefit of routine early treatment with thyroxine in non-pregnant patients with a serum TSH above the reference range but <10mU/L (II,B). Physicians may wish to consider the suitability of a therapeutic trial of thyroxine on an individual patient basis." 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."

Dr Toft is past president of the British Thyroid Association and leading endocrinologist. You can obtain a copy of the article by emailing Dionne at [e-mail]

TSH on its own isn't enough, you need a full thyroid panel including antibodies. If your GP won't or can't do it then I would suggest you do a home fingerprick test with one of the labs we recommend.

medichecks.com/thyroid-func... or

bluehorizonmedicals.co.uk/t...

If you want to include vitamins and minerals, always useful especially when Hashi's is present then look at Medichecks Thyroid Check Ultravit or Blue Horizon Thyroid Check plus Eleven.

Post results (with reference ranges) on a new post for members to comment before seeing your GP.

[Harko1980 in reply to SeasideSusie]

Thanks SeasideSusie I should have said the TSH range was 0.3-4.5, T3 2.8 - 7 & T4 10-25 so all technically within the ‘normal’ range. I’m fairly certain these issues are the root of the problem but just getting nowhere with GP as I have read on here that a lot of people also have, I would like to see a medical professional who would be able to give me some decent advice.

[SlowDragon Administrator]

If your trying for a baby NICE guidelines recommend that you are treated and TSH to be under 2

Clutter has some links

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

Essential to test vitamin D, folate, ferritin and B12.

Always get actual results and ranges. Post results when you have them, members can advise

Good levels of B12 and folate essential for baby development

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

[Clutter]

Harko1980,

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