Needing some feedback before I go to my G.P.

[ariel701]

I have been ill for some time. Sweating profusely but also very cold, hair thinning tiredness, muscle weakness. Have tested positive for thyroid antibodies in the past but a very recent blood test doesn't show anything. Developed cold urticaria a few years ago and the feeling of coldness sets it off. Its a daily thing. Test results show TSH 4.99. Free thyroxine 16.200 and free T3 5.17. Would medication help in any way? Had enough of this now.This has been going on for 24 years. Any response would be helpful. Thank you

[SlowDragon Administrator]

If your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto's

A TSH of 4.99 is NOT normal. You should be started on Levothyroxine

Median TSH graph

healthunlocked.com/thyroidu...

SeasideSusie has a link for guidelines saying if you have symptoms and high thyroid antibodies then treatment with Levothyroxine should be started

Essential to test vitamin D, folate, ferritin and B12. Always get actual results and ranges. Post results when you have them, members can advise

See you already know you have low B12. Have you managed to improve this. Are sublingual B12 lozenges any good, or do they too contain cobalt?

Very likely folate, ferritin and Vitamin D may be low too

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

Urticaria is linked to autoimmune thyroid disease

verywellhealth.com/thyroid-...

thyroidpharmacist.com/artic...

[SeasideSusie Remembering]

ariel701

SeasideSusie has a link for guidelines saying if you have symptoms and high thyroid antibodies then treatment with Levothyroxine should be started

Yes, it's to with subclinical hypothyroidism and antibodies.

Your results are

TSH 4.99

Free thyroxine 16.200

free T3 5.17

(ranges are alway necessary but I'm assuming FT4 and FT3 are in range and that TSH is above range)

and a TSH between 4 and 10 is classed as subclinical hypothyroidism - see cks.nice.org.uk/hypothyroid...

Scenario: Subclinical hypothyroidism (non-pregnant)

If TSH is between 4 and 10 mU/L and FT4 is within the normal range

◾In people aged less than 65 years with symptoms suggestive of hypothyroidism, consider a trial of LT4 and assess response to treatment 3–4 months after TSH stabilises within the reference range — see the section on Prescribing information for further information on initiation and titration of LT4. If there is no improvement in symptoms, stop LT4.

And from thyroiduk.org/tuk/about_the...

The 'UK Guidelines for the Use of Thyroid Function Tests' state that, "There is no evidence to support the benefit of routine early treatment with thyroxine in non-pregnant patients with a serum TSH above the reference range but <10mU/L (II,B). Physicians may wish to consider the suitability of a therapeutic trial of thyroxine on an individual patient basis." If your TSH is above the range but less than 10, discuss a therapeutic trial of thyroxine with your doctor.

Subclinical hypothyroidism (where there are elevated TSH levels, but normal FT4 levels, possibly with symptoms) has been found in approximately 4% to 8% of the general population but in approximately 15% to 18% of women over 60 years of age.

Subclinical hypothyroidism can progress to overt hypothyroidism (full hypothyroidism with symptoms) especially if there are thyroid antibodies present.

If thyroid antibodies are found, then you may have Hashimoto's disease. If there are thyroid antibodies but the other thyroid tests are normal, there is evidence that treatment will stop full blown hypothyroidism from occurring.

Dr A Toft, consultant physician and endocrinologist at the Royal Infirmary of Edinburgh, has recently written in Pulse Magazine, "The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat the thyroid function tests in two or three months in case the abnormality represents a resolving thyroiditis.2 But if it persists then antibodies to thyroid peroxidase should be measured.

If these are positive – indicative of underlying autoimmune thyroid disease – the patient should be considered to have the mildest form of hypothyroidism.

In the absence of symptoms some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow-up."

You can obtain a copy of Dr Toft's article in Pulse magazine by emailing Dionne at ThyroidUK

[e-mail]

and the information is in response to Question 2.