Advice when TSH is over range but not reaching the magic number 10

[NWA6]

The picture shows my cousins recent thyroid results. She is in her 50’s and has had a diagnosis of Fibromyalgia for the last 10yrs. She has been in steady decline over these 10yrs to the point now that she’s usually housebound because she has so many ‘Hypo’ symptoms. Finally after my successful treatment she has come to me for advice. Hence the Medichecks tests as her own GP only does TSH and FT4, both of which are in range but at the top end and bottom end respectively.

Does someone have the link to the NHS guidelines which state that it is possible to start Levothyroxine despite her TSH not reaching that magic number 10. I’m desperate to help her. I wish her TPO was higher as that would have left no doubt about Hashi’s.

[MaisieGray]

To be accurate, it is the NICE/Clinical Knowledge Summary that currently applies. The relevant section is:

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.

-In older people (especially those aged over 80 years), follow a 'watch and wait' strategy, generally avoiding hormonal treatment. If a decision is made to treat, prescribe LT4 and recheck TSH two months after starting and adjust the dose accordingly.

-In asymptomatic people, observe and repeat thyroid function tests (TFTs) in 6 months.

The link to the document is cks.nice.org.uk/hypothyroid...

[NWA6 in reply to MaisieGray]

Thanks MaisieGray 🤗 I doubt it will help when GP’s are so resistant but she has to at least try before she starts self medicating.

[NWA6]

Will a private Endo start treatment with these results? I’m worried about wasting money and time. Does anyone think I should just recommend that my cousin just start self medicating? Her GP’s will absolutely NOT start Levo.