TSH level query: Hello, I have read that the GP... - Thyroid UK

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TSH level query

SOBS
SOBS

Hello, I have read that the GP/Endo will not medicate you for primary hypothyroidism unless your TSH level is 10 or higher, is that still applicable if your FT4 is low and out of range? How do they know that secondary hypothyroidism isn’t the cause?

Also, at what point do they check for the antibody factor, again is it only checked by GP/Endo if TSH level is 10 or over?

Thanks.

10 Replies
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HIGH (above range ) TSH and LOW below range FT4 indicates Hypothyroid.

Request a copy of your blood tests reports from the hospital via the Medical Records Legal Department (phone and ask for department then ask for a name and email address or postal).

If your report says that your TSH is above range and your FT4 below range I think you'll find the lab comment will say Hypothyroid.

You can ask for Thyroid Antibodies to be tested but I thought Endocrinologists did these and FT3 anyway??

Sorry, don't understand what you mean by secondary Hypothyroid.

If you give your results with full information ie dates of tests , numbers and ranges also a list of symptoms; then members on here can make informed comment.

What has your Endo /GP said - have you had diagnosis yet?

Hi Mary, I have already been to gp and bloods show TSH high but in range, and FT4 low and out of range. I already posted levels and ranges on another thread. The gp says my thyroid is underactive but will test bloods again in 6 weeks, but if TSH is still not above 10 I’m guessing I won’t be treated or tested further as yet?

Secondary hypothyroidism can occur with a pituitary gland problem, and TSH levels can be within range with this whilst FT4 levels will be low out of range.

1) Why guess in advance you may have a TSH above range but below 10 ? Why not just go by actual result, if it's above range isn't it most likely due to Hypothyroidism?

2) Can't comment on personal experience of Pituitary Gland problem - but wouldn't the secondary Hypothyroidism caused by this have low TSH and low T4 ? Not high TSH? Because the Pituitary Gland is not functioning correctly so not producing enough TSH ? Therefore not enough T4 being produced by Thyroid gland.

Your TSH is high in range and FT4 below range and you have symptoms.

Don't you think that's more like primary Hypothyroidism, possibly caused by Hashimoto's?

Has GP mentioned Pituitary Gland problem, doing any tests for this?

If you don't want to wait the 6 weeks because you are unwell, I would go back to doctor with list of symptoms, say you are not well and would like to see an Endocrinologist (due to symptoms ) or have the Thyroid Antibodies blood tests + FT3 and be started on Levothyroxine. I would also want my Adrenals checked first before starting Levo.

ps

With Hashimoto's Autoimmune Thyroiditis the Thyroid function blood tests can fluctuate. And fall just within range, even following previous Hypo results and not on medication yet. Mine did. You could get copies of your hospital records and see if you had Thyroid tests done in past. If reported as Euthyroid you may not have been told but they could have been low in range T4 or high in range TSH. As far as doctors are concerned if they are in range they are "normal".

Hope this helps.

If this were me, I'd want Thyroid Antibodies tested now. Adrenals tested, then 50mcg Levothyroxine as a start dose. Retesting in 6 to 8 weeks.

I agree that I should get my adrenals tested, and possibly the antibodies test as I have Graves’ disease although no hyper symptoms for years, but somehow I doubt the gp will care if I have an active autoimmune until my TSH levels is more extreme 😏.

Will a gp allow an adrenals function test or will I have to get an Endo referral to get one?

SlowDragon
SlowDragonAdministrator
in reply to SOBS

If TSH is above range and FT4 below range, then GP should also test both TPO and TG thyroid antibodies and FT3 as well at next test

Plus also vitamin D, folate, ferritin and B12

Many GP's will treat if TSH is above range, but under ten, if patient has symptoms

SOBS
SOBS
in reply to SlowDragon

Thank you SlowDragon, for answer my question.

Jazzw
Jazzw
in reply to SOBS

Mary asked, “wouldn't the secondary Hypothyroidism caused by this have low TSH and low T4 ? Not high TSH?”

I don’t think so - not necessarily anyway.

SOBS - as you know, your TSH is “only” 4 point something but the FT4 is below the reference range. If the pituitary was reacting properly, it would pump out lots of TSH to stimulate the thyroid to produce more T4. But it isn’t producing much TSH considering. I’d expect the TSH to be much higher than 4 point something given FT4 is so low - something seems to be wrong with the feedback loop - the pituitary isn’t shouting loudly enough at the thyroid gland.

So it does seem possible that a pituitary issue might be the cause.

It saves time if posters mention if previously posted.

I would ask GP to test for Thyroid Antibodies.

The basic problem is that to minimise measuring and treating patients with TSH above the top of the normal reference range who do not go on to overt hypothyroidism and whose TSH returns back to normal, an arbitrary figure of 10 for TSH was devised as a cutoff. This of course is a statistical figure. It ignores the fact we are individuals, and respond to hypothyroidism differently. Some patients are overtly hypothyroid just above 4 and are struggling at 2.5 and others may not feel anything until TSH is significantly higher than that. We must return to doctors raising eyes from the computer screen with the displayed biochemistry figures to the presenting patient, their symptoms and physical appearance. There is a question as the morality of denying patients who need treatment just because they don't fit an arbitrary decision point.

GPs aren't taught to recognize secondary/central hypo. I f you have low everything or normal TSH and low FT4, ask for an endo referral.

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