Do I have underactive thyroid?

[jenniferhunter094]

Hi,

Please cna someone confirm if I have an underactive thyroid or not as one doctor says I do and one says no. They keep taking me off and putting me on the medication.

Aug 18

Serum free T4 level – 15.8 pmol/L

Serum TSH level - 2.6 miu/L

Feb 19

Serum free T4 level – 16.4 pmol/L

Serum TSH level - 5.7 miu/L

Thank-you

[SeasideSusie Remembering]

jenniferhunter094

Can you please clarify what were your results when you were originally prescribed Levo?

When your Levo was deprescribed, what were the results that prompted this?

Was it the same doctor?

Please add the reference ranges for your results, as ranges vary from lab to lab then we need to see your lab's ranges to be able to interpret your results and see if they are in range or over/under range.

Are TSH and FT4 the only tests carried out? Have you ever had thyroid antibodies tested?

[jenniferhunter094 in reply to SeasideSusie]

Serum TSH level (XaELV) 5.7 miu/L [0.27 - 4.2]

Serum free T4 level (XaERr) 16.4 pmol/L [12 - 22]

[jenniferhunter094 in reply to SeasideSusie]

I've only had bloods done for thyroid. I've had numerous doctors as my actually doctor is on a sabbatical for a year so have locums

[SeasideSusie Remembering in reply to jenniferhunter094]

Feb 19

Serum TSH level (XaELV) 5.7 miu/L [0.27 - 4.2]

Serum free T4 level (XaERr) 16.4 pmol/L [12 - 22]

Are these the results that gave you the diagnosis of hypothyroidism and prescription for Levo? So you had your diagnosis last month?

If so, can you clarify

They keep taking me off and putting me on the medication.

Or were you put on Levo before February and have had your Levo taken away and given back?

Can you give the results that prompted the taking away of Levo and putting you back on Levo, and the dates.

[jenniferhunter094 in reply to SeasideSusie]

Hi.

Sorry that's the results they gave me and decided to put me back on levothyroxine. Yes I had results in August which prompted the medication but then I saw a new doctor who said you don't need it. The symptoms didnt improve so I went back and a new doctor took bloods again as above and said i needed levothyroxine. I've just had a call from another doctor saying I shouldn't be on it.

[SeasideSusie Remembering in reply to jenniferhunter094]

OK. So these results, assuming reference ranges are the same as the other tests:

Aug 18

Serum TSH level - 2.6 miu/L [0.27 - 4.2]

Serum free T4 level – 15.8 pmol/L [12 - 22]

don't show hypothyroidsm. Your TSH is slightly higher than one might expect to see in a normal healthy person (one would expect it to be no higher than 2-ish)

and your FT4 is slightly lower than one might expect to see (normally around mid-range). It's very surprising that any doctor actually prescribed Levo with these results.

Your new results:

Feb 19

Serum TSH level (XaELV) 5.7 miu/L [0.27 - 4.2]

Serum free T4 level (XaERr) 16.4 pmol/L [12 - 22]

show an over range TSH which does suggest hypothyroidism, but most doctors would wait until TSH reaches 10 before prescribing Levo when FT4 is in range.

I've just had a call from another doctor saying I shouldn't be on it.

What I would do in your position is make an appointment with the doctor who prescribed the Levo. Tell him what's been happening and ask that they make up their mind and stop messing you about.

Check for signs and symptoms of hypothyroidism here

thyroiduk.org/tuk/about_the...

If you have any, print it and tick them off. Use this to support your diagnosis of hypothyroidism.

When booking thyroid tests, we advise:

* Book the first appointment of the morning. This is because TSH is highest early morning and lowers throughout the day. If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Fast overnight - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Eating may lower TSH, caffeine containing drinks affect TSH.

* Leave off Levo for 24 hours before blood draw, if taking NDT or T3 then leave that off for 8-12 hours. Take after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

These are patient to patient tips which we don't discuss with doctors or phlebotomists.

Were your tests done like this? This is the only way you can compare results accurately. So if you are tested again, make sure you follow this advice to give you the highest possible TSH.

If your tests were done under these conditions, and your results show fluctuation, then ask for thyroid antibodies to be tested.

[jenniferhunter094 in reply to SeasideSusie]

Thank you so much. I have an appointment booked for Tuesday to get to the bottom of this.

[serenfach]

Also ask for the GPs notes for the dates in question. Put it in writing to the Practice Manager. They cannot refuse or charge you anything. Sometimes these notes are quite revealing!