Hypothyroidism symptoms, but normal lab results

[Imane]

Hello, I’m new here.. I was wondering what opinions others may have on my situation.

I have been suffering from many of hypothyroidism symptoms for the last 6 years (weight gain and it's very hard to lose weight ,fatigue, hair loss , dry skin and hair, constipation, depression, muscle and joint pain, poor memory & concentration..). I've consulted many doctors and was told that my lab tests were within the normal ranges and that I should eat less and exercise more...

I had some tests at June 2017 and the results were also within the normal range:

TSH 2.67 ulU/ml ( Ref range: 0.35 - 4.94)

Free T4 0.83 ng/dL (Ref range: 0.7 - 1.48)

Free T3 2.61 pg/mL (Ref range: 1.71 - 3.71)

However, the doctor prescribed me Levothyroxine 50mcg because of the symptoms I had and told me I'll try it for a year. If I feel better then I'll continue using it forever, otherwise I should stop it and my symptoms will not be related to the thyroid.

I felt better only for about 3 months, and noticed some improvement (specially fatigue,weight and hair loss).

I had new tests a few days ago, and the results were:

TSH 2.14 ulU/ml ( Ref range: 0.35 - 4.94)

Free T4 0.86 ng/dL (Ref range: 0.7 - 1.48)

Free T3 2.5 pg/mL (Ref range: 1.71 - 3.71)

reverse T3 15 ng/dL (Ref range: 8-25)

TPO 1.48 IU/ml (Ref range: less than 5.6)

Anti Thyroglobulin Abs 100.82 IU/ml (Ref range: less than 4.11)

The doctor told me I should stop the Levothyroxine since I don't feel better and that my tests are normal.

Can anyone tell me what to do next? If it's not my thyroid, what could it be??

[shaws]

The fact that you felt an improvement on 50mcg of levo, shows that you need it. I shall also give you a list of clinical symptoms and your TSH (you are taking levo) is high at 2.14 as we feel best when it is around 1 or lower. If your GP refuses an increase you can source your own levothyroxine. Many on the forum have done so.

Also you have Anti Thyroglobulin Abs 100.82 IU/ml (Ref range: less than 4.11). Your 100.82 is far above 4.11) So your doctor should treat if antibodies are present. You can email Dionne @ TUK:-

[e-mail]

and request Dr Toft's article in which he states that if antibodies are present we should be prescribed.

We instinctively know something isn't right. and rely on GPs to tell us why. Unfortunately in the UK the instructions to doctors is that they've not to prescribe until the TSH is 10 but in other countries if it goes above 3+ we get diagnosed.

Once we start levo a 25mcg increase should be every six weeks until relief of symptoms but that is difficult as GP doesn't believe you are hypo.

You can tell him as you've had a benefit with 50mcg you will try to source your own to reduce TSH to 1 or below.

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

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

You can tell him you've taken advice from the NHS recommendation, Thyroiduk.org.uk.

[Imane in reply to shaws]

Thank you for your reply, it's very helpful. The doctor told me that thyroid antibodies were not "that high" and that I should just ignore it. I'm consulting another doctor after a couple of days..

[greygoose]

So, you stayed on 50 mcg levo for a whole year, and then he stopped it because you didn't feel better? He set you up to fail! No-one should stay on 50 mcg for a whole year. You should have been retested after six weeks and the dose increased by 25 mcg, and that process should have been repeated until you felt well. So, either he is very ignorant, or he did it deliberately to 'prove' that there was nothing wrong with your thyroid.

[Imane in reply to greygoose]

Thank you for your reply, I think he wanted to prove that I had no problem with my thyroid , in addition he mentioned that he usually prescribe this dose for people who need to lose weight ...

[greygoose in reply to Imane]

Levo won't make you lose weight. But, yes, as I said, he set you up to fail.

[shaws in reply to Imane]

What a cheek. We are not needing a 'weight loss' of prescribing. It is not up to him to 'trial' our hormone replacement and in fact 50mcg will make someone gain weight not lose. If you were paying him money it would be a waste.

[SlowDragon Administrator]

NHS guidelines saying standard starter dose is 50mcgs and that dose should be increased in 25mcg steps. This repeats until, TSH is around one and FT4 towards top of range and FT3 at least half way in range. Typically majority of patients need somewhere between 100mcg and 200mcg

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

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

If your GP doesn't know who Professor Toft is, he was President of British Thyroid Association 1996-2009

Past President of the Royal College of Physicians of Edinburgh

Physician to the Queen in Scotland

Consultant of Endocrinology, specialising in thyroid disease, at Royal Infirmary of Edinburgh 1978-2009.

[SlowDragon Administrator]

Bloods should be retested 6-8 weeks after each dose increase in Levothyroxine

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

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.

If on Levothyroxine, don't take 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)

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 .

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

[Imane in reply to SlowDragon]

Thank you for your reply, it's very helpful, and I totally agree with you regarding changing Levothyroxine brands.