First post - is it hypothyroidism or something else?

[drmje]

Hi, this is my first posting and I wanted to see if anyone could help me work out if my symptoms are thyroid related or not. I was diagnosed with hypothyroidism about 20 years ago and put on levothyroxine. I knew nothing about underactive thyroids and assumed I'd been successfully treated. However, I never felt quite the same and over the years have suffered from very cold feet, sensitivity to very hot weather, constipation, etc. Over the last few years I've noticed a worrying pattern of increased illnesses and taking much longer to recover from them. The last three years have been particularly bad - there are days when I feel as though I've been drugged I feel so tired. but then I'll have long spells when I feel fine. I've been an insomniac for about 12 years. I'm also now menopausal. I'm seeing a very sympathetic GP (realise how lucky I am on that) but as far as the GP is concerned my blood test results consistently show that I'm fine as far as my thyroid is concerned. I've printed my latest set of results below. What I'm wondering is, given that I have periods of time when I feel okay (although rarely wake up feeling refreshed) might this by hypothyroidism or in fact something else? I'm seeing the doctor again tomorrow so any ideas in advance of that would be very gratefully received. For info, I take 100 mcg levotyroxine each day, a vitamin D and B12 supplement, and I'm on HRT

Thanks

Serum vitamin D 81.000 nmol/L - nmol/L

Serum vitamin B12 339.000 ng/L 180 - 900 ng/L

Thyroid function test

Plasma TSH level 0.830 mU/L 0.3 - 4.2 mU/L

Plasma free T4 level 15.200 pmol/L 9 - 19 pmol/L

Plasma free T3 level 4.300 pmol/L 2.6 - 5.7 pmol/L

[SeasideSusie Remembering]

drmje

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.

Your FT4 is 62% through it's range and it might be better above 75%, so that would mean around 16.5+

Your FT3 is 54% through range, so not quite in balance with FT4 and it might be better around 4.0+

A small increase in Levo would achieve this and your TSH would lower but probably still be in range.

You could ask your GP for an increase using the following information from thyroiduk.org/tuk/about_the... > Treatment Options

Dr Toft 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)."

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] print it and highlight question 6 to show your doctor.

And you can say you have taken advice from NHS Choices recommended source of information about thyroid disorders - which is ThyroidUK. Don't mention the internet or forums as they don't like that.

What I'm wondering is, given that I have periods of time when I feel okay (although rarely wake up feeling refreshed) might this by hypothyroidism or in fact something else?

That could possibly be that you have raised thyroid antibodies which would confirm autoimmune thyroid disease aka Hashimoto's. Ask your GP to test antibodies - Thyroid Peroxidase (TPO) and Thyroglobulin (TG). You may be able to get TPO antibodies tested, but it's unusual to get TG tested. However, you can be negative for TPO but positive for TG and that would confirm Hashi's. If you can't get them tested, come back and we can tell you where to obtain a private home test which can be done either by fingerprick or venous blood draw.

What dose supplements are you taking for Vit D and B12?

There are cofactors needed when taking Vit D - magnesium and Vit K2-MK7, and when taking B12 we need a good B Complex to balance all the B vitamins.

[drmje in reply to SeasideSusie]

Thank you so much for all the detail - that's really helpful. I'll wait to see now what the doctor says in response to some of the suggestions here. Thanks so much again