Am I ready for medication?

[Goforitmum]

Hi everyone. This is my first post.

I've been feeling drained of energy, cranky, low, cold for a while. I am aware that my thyroid is starting fail - hypothyroid (I knew that from a blood test last year) and because I felt drained and cranky etc.

I am not medicated yet. I am 54, usually very active (I run, go to spin classes, gym and ski) but at the moment I just feel drained and do not have the spare energy for any fitness activities. I am also going through menopause.

Here are my results, my question is should I be medicated yet?

TSH Ultrasensitive Result 4.37 - Ref range 0.27 - 4.20

T4 Free Result 12 - Ref range 12 - 22

Free T3 Result 4.1 - Ref range 4.0 - 6.8

Antithyroid Microsomal Positive Titre 1:6400 - Less than 1:100 = Negative More than 1:10 = positive

Antithyroidthyroglobin Negative- Less than 1:10 = negativeMore than 1:10 = Positive

I had a message from the Dr, he said to make an appointment only of I wanted to discuss it further or had any questions. I am happy to go in and see him, but he is on the lazy side and it's good to go in with as much knowledge as possible.

many thanks to everyone who answers

[jimh111]

You have a slightly elevated TSH and marginal fT3, fT4. Usually as a patient's fT4 falls TSH shoots up and this stimulates more conversion of T4 to T3 thus maintaining fT3 levels. This enables hypothyroidism to be detected at an early stage, TSH becomes elevated, usually well above 10.0. This is not happening in your case. With an fT4 of 12.0 and fT3 of 4.1 we would expect a very high TSH. Thus, it is likely you are considerably hypothyroid. Your doctor cannot rely on TSH for diagnosis or treatment because the pituitary is not responding appropriately to your low thyroid hormone levels. Although both fT3 and fT4 are just within their reference intervals the combined effect of both of them being low will render you hypothyroid. fT3 and fT4 tend to see-saw in healthy people, it's not normal for both to be low.

I'm afraid I don't understand your antibody results, they are not in a form I've seen before. In any event they don't matter, your hormone levels are low, that is the cruical point.

When fT3, fT4 are low and TSH is low it's called 'central hypothryoidism' and a pituitary problem is suspected. This is not so in your case, it's very unlikely anything is wrong with your pituitary. Cases like yours are sometimes called 'isolated thyrotropin deficiency', thyrotropin is another name for TSH. Your doctor should prescribe levothyroxine and monitor your response. Since your TSH is not responding appropriately they should not rely on TSH to titrate your treatment, they should instead look at your signs and symptoms and fT3 / fT4 levels. For techinical reasons I suspect you may eventually need some liothyronine (L-T3) also but do not mention this for now as it will cause great resistance to treating you. Please note I am a patient not a doctor.

[Goforitmum in reply to jimh111]

Thank you so very much. You have given me the confidence to go to the Dr.

[Andyb1205 in reply to jimh111]

Just wanted to add, as it’s a subject I’ve explored considering my similar labs, though never such low FT4/FT3.

Firstly, it is possible that it’s a case of antibodies negative Hashimotos which can only be diagnosed by an ultrasound. The only slightly elevated TSH can be explained by individual biological variation, where the set point is far lower and narrower than what is common.

Secondly, as in my case where the ultrasound was also negative. It is possible to have central hypothyroidism with a low, normal, or even slightly elevated TSH. Distinction from subclinical primary hypothyroidism is based on negative for Hashimotos.

academic.oup.com/jcem/artic...

The elevated TSH hence would be biologically inactive, which is more common with problems with the hypothalamus though it doesn’t matter if it’s the hypothalamus or pituitary, it’s still Central Hypothyroidism.

Another good read.

“Moreover, serum levels of TSH are usually low to normal, or even slightly elevated, in patients with tertiary (hypothalamic) hypothyroidism. Tertiary hypothyroidism can be misdiagnosed as a con- dition of primary hypothyroidism12. Therefore, meas- urement of circulating anti-thyroid autoantibodies and thyroid ultrasonography should be carried out in every patient with central hypothyroidism.”

qbpatologica.files.wordpres...

Whatever the cause of your hypothyroidism, the treatment is the same. Supplementation with T4/T3 with the thyroid hormone levels as a guide to supplement clinical symptoms.

[Goforitmum in reply to Andyb1205]

Thank you very much, I will read the attachments later.

[SlowDragon Administrator]

Request that vitamin D, folate, ferritin and B12 are tested too when you see GP

With autoimmune thyroid disease low vitamin levels are very common

Often need to supplement to improve

[Goforitmum in reply to SlowDragon]

Thank you