Subclinical hypothyroidism or menopause

[Manda8910]

Hi. I'm looking for advice. I saw my gp 6 weeks ago as I thought I was going through menopause. Tired, brain fog, lost libido. She sent me for a blood test which she said showed i had subclinical hypo. So rather than start on HRT which is what i was expecting she started me on 50mg levothyroxine. I have been taking it for almost 3 weeks and feel worse..Im exhausted and just cant be bothered with anything.

But I'm confused. How do I know what is menopause and what's my thyroid? I have another blood test and 6 weeks but then what. I think she will want me to decide what treatment i want next. From what i have read i would need to find the right dose..but if i dont feel better in 6 weeks is that because the symptoms are menopause or because the dose isn't right? My tsh was 8.9, I think she said my other level was ok.

Finally. If i stay on the medication am I eligible for the prescription costs exemption as its subclinical she is treating me for?

Thanks

[shaws Administrator]

I would not say you had 'sub-clinical' hypothyroidism because your TSH was nearly 10, which in the UK is positive for hypothyroidism. Never mind that in other countries we'd be diagnosed as hypo if the TSH went above 3+.

50mcg of levothyroxine is a starting dose and adding increases is very gradual i.e. every six weeks an increase of 25mcg until TSH is 1 or lower. Some doctors believe that a TSH in the 'range' is fine but it isn't.

You should take levothyroxine with one full glass of water and wait an hour before eating as food interferes with the uptake of the hormone. Many prefer taking it first thing and others prefer at bedtime. If you prefer bedtime dosing, you'd allow about 2 to 3 hours gap between you food and levothyroxine.

If you take an a.m. dose, miss this until after the blood test which should be at the earliest and fasting (you can drink water).

If you prefer a bedtime dose, miss this before blood test next a.m. and take afterwards and at p.m. as usual. If doctor hasn't tested for thyroid antibodies as for these to be tested at your next test. If antibodies are present you will have the commonest cause of hypothyroidism and it is called Hashimoto's due to having antibodies present.

Ask also for B12, Vit D, iron, ferritin and folate to be tested and always get a print-out of your results, with the ranges. Ranges are very important for members to respond as labs differ in their machines.

It takes time for us to reach an 'optimum' dose and optimum means we feel well with relief of all symptoms.

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

[SlowDragon Administrator]

First thing is, do you have any actual blood test results in addition to just the TSH? For example have you also had TPO and TG thyroid antibodies tested?

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 TPO and TG thyroid antibodies tested at least once .

Also very helpful if had vitamin D, folate, ferritin and B12 tested. Add results and ranges if you have them

You are legally entitled to printed copies of your blood test results and ranges

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need enhanced access to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up. They can no longer charge for printing out. (EU rules changed after May 25th 2018)

If antibodies and vitamins have not been tested yet, request that they are at the next blood test

Your Thyroid levels should be retested 6-8 weeks after starting on 50mcg. Dose is increased slowly in 25mcg steps 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)

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

verywell.com/should-i-take-...

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased

Many patients do not get on well with Teva brand of Levothyroxine