underactive thyroid?

[ssyewtree]

I had blood tests on 20/4/18 and results came back that I have signs of underactive thyroid. TSH level 6.0 and T4 level 12.3. (vit B12, ferratin and folate all satisfactory). I have been prescribed Levothyroxine Sodium 50micrograms. Do I need to take it or should I wait and have another blood test in a few weeks? might it right itself? I have struggled with extreme tiredness/low mood/weight gain then bursts of losing a bit of weight/energy/but feeling unable to properly rest/anxious for years. I have been taking an SSRI (40 mg citalopram for 10 years - my highs and lows are not as extreme as they used to be, but not resolved. I have also had lots of psychotherapy to work on psychological factors and am currently working through some big emotional/psychological stuff and making positive changes in my life. Now wondering if thyroid problems could actually be contributing to/causing my symptoms? or should I wait til I have worked through current difficulties and see if I thyroid rights itself? it all feels very confusing at the moment! hoping for some inspiration.... thankyou in advance.

[shaws Administrator]

Welcome to our forum and you have hypothyroidism with a TSH of 6 and I am glad your doctor has prescribed levothyroxine as most wait until the TSH is 10. It is an autoimmune condition and doesn't right itself.

Our thyroid gland is now not producing sufficient for our whole metabolism to work efficiently and the brain and heart need the most T3. Levothyroxine is T4. T4 has to convert to T3. T3 is the only active thyroid hormone required in our T3 receptor cells and we have millions.

Levothyroxine is usually taken first thing with one full glass of water and wait about an hour before eating. When having a test next a.m. miss the a.m. dose and take after test.

These are clinical symptoms but thankfully we don't get all of them.

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

We gradually become unwell but doctors don't always test our thyroid hormones but will give us medication for the symptom(s) and maybe another diagnosis.

I would ask for your Free T3 and Free T4 to be checked, rarely tested, as you have had mental health issues which could be due to low FT3. Phsychiatrists can prescribe T3 for their depressed patients.

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All blood tests should be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between last dose and test and take afterwards. This helps keep the TSH at its highest as it reduces during the day.

Your doctor should test B12, Vit D, iron, ferritin and folate as everything has to be optimum (not just in range).

Levothyroxine is T4, T4 should convert to T3. T3 is the active hormone required in all our T3 receptor cells.

Always get a print-out of your results with the ranges for your own records and you can post if you have a query.

The aim is a TSH of 1 or lower with FT4 and FT3 in the upper part of the ranges. Most times members get FT4 and FT3 privately as NHS doesn't usually do these.

[ssyewtree in reply to shaws]

Thank you for taking the time to respond to me - I am totally new to this, so I will take the Levothyroxine and have blood tests again in 6 weeks and ask for vit D too - didn't have that last time. Will also ask for FT3 test just in case my doctor can get this done!

You say the aim for TSH is 1 or less. mine is 6 and the range is 0.4-5.5 - that sounds like I need to make a huge change - hope this levothyroxine works! I am thinking that if I feel loads better after 6 weeks on it and my next TSH is as you suggest and FT4 and other results are in upper ranges, and I feel good, then I wouldn't need the FT3 test - is that right?

Also, will I need to continue to have regular blood tests to see the numbers, or once I have got the numbers as they should be do they tend to stay ok and I would just stay on the Levothyroxine for life?

[SlowDragon Administrator]

Ask for vitamin D to be tested at next test. You don't seem to have had that done

When you say folate, ferritin and B12 are satisfactory, are the results optimal or only just in range?

Might be helpful to add the actual results and ranges if you have them

Also have you had TPO and TG thyroid antibodies tested?

If high this gives cause of being hypothyroid as due to autoimmune thyroid disease also called Hashimoto's

Ask for these to be tested when Thyroid bloods are retested after 6-8 weeks on 50mcg Levothyroxine

Read as much as possible about hypothyroidism. Yes it's often missed or misdiagnosed

[ssyewtree in reply to SlowDragon]

Thankyou for this. No I didn't have vit D or TPO and TG thyroid antibodies tested but will request next time as you suggest.

This is all completely new to me - I went to see a doctor about my tiredness and mood to ask if he would change my antidepressant and he wanted to do some blood tests first, (new doctor that I hadn't seen before!) so it is down to him that I even know about having an underactive thyroid - I rarely go to doctors, just struggle on!

The results you mentioned are: Vit B12 '284 satisfactory' (range 190-910) , ferratin '84 satisfactory' (10-291), folate '5.1 satisfactory' (3.9-26.8)

[SlowDragon Administrator in reply to ssyewtree]

B12 is on low side. Anything under 500 can cause symptoms

Folate also low

GP unlikely to agree to further testing of B12 as it's within range

Do you have any low B12 symptoms? If so ask GP to run further B12 testing

b12deficiency.info/signs-an...

Otherwise just Supplementing a good vitamin B complex will help improve both B12 and folate.

Lots of info on here about importance of good B vitamins

Igennus Super B complex is good option to try as full dose is two tablets per day (am & pm) but you could start with just one tablet in morning after breakfast.

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Ferritin is OK, but not brilliant. Eating liver once a week should help improve levels

Depression is extremely common symptom of low thyroid

List of hypothyroid symptoms

thyroiduk.org/tuk/about_the...

Good that your new GP took more enlightened approach

Essential to test vitamin D and thyroid antibodies at next test

Link about antibodies and Hashimoto's

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

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

Eventually, once adequately treated for thyroid, you may be able to reduce or stop antidepressants. But first it's best to concentrate on getting Thyroid and vitamins optimal

Blood tests should be done 6-8 weeks after any dose change and then at least annually

If you have Hashimoto's (high thyroid antibodies) then bloods may need testing more frequently as levels can go up and down a bit

Dose change should only be in 25mcg steps upwards, retesting after each change, until TSH is around one and FT4 towards top of range and FT3 at least half way in range

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

About 90% of all hypothyroidism in Uk is due to autoimmune thyroid disease (Hashimoto's) usually diagnosed by high thyroid antibodies. Low vitamins are especially common with Hashimoto's. Food intolerances too, especially gluten. So it's important to get antibodies tested.

[ssyewtree in reply to SlowDragon]

Thanks again for your help. I feel such relief in finding out about all this and beginning this journey of hopefully being able to get and stay well!

[Rapid1]

Why do you suggest Tg antibodies ?? This is something not mentioned before. I have heard about TPO antibodies and found high levels in Hashi. What do we call if Tg Ab are high ? Thanks

[Cooper27 in reply to Rapid1]

As I understand it, high TG antibodies also show autoimmune thyroid disease, but can be present with both graves or Hashimotos. High TPO is Hashimotos specific.

Steps to reduce antibodies are the same for both.

[SlowDragon Administrator in reply to Rapid1]

With Hashimoto's we can have high TPO and/or high TG antibodies

Most people have either high TPO or high TPO and high TG antibodies

A few only have high TG antibodies. This can be difficult as NHS don't test TG if TPO are not high. Even with private testing they are reluctant to diagnose from just high TG antibodies as they can be high for other reasons

healthline.com/health/antit...

Just to confuse things you can have slightly raised TPO or TG antibodies with Graves' disease as well.

Graves can only really be diagnosed by high TRab or high TSI antibodies

TPO antibodies seem to respond and slowly lower for many people when go on strictly gluten free diet. TG antibodies seem to relate to how high TSH is