Subclinical hypothyroid- should I start treatment?

[Qualia]

I have had thyroid tests done because of having palpitations and was found to have a TSH of 7 and my T4 was 12. The doctor said the cut off for both was 10 but that since I had some symptoms he would be happy to do a trial of thyroxine starting on 25mcg.

I have done some reading and am just not sure whether I should hold off and get retested or go ahead and have a trial of taking thyroxine. I’m also not sure whether 25mcg is enough to make much difference anyway

I did have tests done about 3 years ago when my TSH was 5 but had been told that was normal.

What have other people’s experiences been? On the one hand I’m nervous about going down a path that involves lifelong medication but I would also be really happy if I could feel less tired and mentally slow than I have been feeling.

[SlowDragon Administrator]

If you are experiencing palpitations then your heart is objecting to having too little thyroid hormone

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies.

Plus very important to test vitamin D, folate, ferritin and B12

if your antibodies are raised then your GP should definitely prescribe. As it is you are experiencing symptoms so likely need starting on Levothyroxine

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

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 ideally be done as early as possible in morning and fasting. This gives highest TSH and most consistent results. (Patient to patient tip, GP will be unaware)

If 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.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get antibodies tested.

Yes, you are right that medical advice is to start on 50mcg unless over 50, frail, or heart condition

NHS guidelines saying standard starter dose is 50mcgs

beta.nhs.uk/medicines/levot...

[Qualia in reply to SlowDragon]

Thanks!

I’ve been low on b12 and folate in the past but they are fine now thanks to supplementing. My vitamin D is good too, probably because I take 6000 units a day because I’m breastfeeding. My hb is ok but I don’t know about my ferritin level.

I think I might go for one of medichecks tests to double check all of those and get some the antibody tests done without having to bother my GP about it.

GP was insistent that palpitations were only a hyperthyroid thing but what I’ve read online agreed with you that it can be hypothyroid too.

[SlowDragon Administrator in reply to Qualia]

You can suffer from post-partum thyroiditis a few weeks or months after giving birth

Again antibodies test would reveal more

nhs.uk/conditions/thyroiditis/

[greygoose]

The cut-off is 10! Tell your doctor he's a disgusting quack! You are hypo as soon as your TSH hits 3, and in many countries you would be treated at 3. And, there is no hard and fast rule in the NHS that says it has to reach 10. You are not subclinical, you are overt hypo.

Having said that, low thyroid isn't the only reason for a high TSH. An infection could cause it. So, the normal protocol is to wait about 3 months and retest, giving any infection time to go away. If it's still that high, then you most definitely should start treatment.

I don't know what you mean about not wanting to go down a path that involves life-long treatment. It's not as if there's any alternative. You can't live without thyroid hormone. And, it's not treatment in the sense of taking drugs. So, the sooner you start, the better, I would think.

[SilverAvocado]

Omg! Calling people like you subclinical is an absolute scandal! A healthy person would be unlikely to have a TSH over 2. TSH of 7 is stonking high, and many doctors would have treated you years ago when your TSH was 5.