Hi, I’m new 😊 I’ll try and keep this as short as I can.
Saw my GP at the beginning of the year complaining of hormone changes i.e fatigue, increase in migraines, irregular and heavy periods. I also had been suffering with chronic pelvic pain. He thought I might be going through early menopause. I’m 38. After a lot of messing around, losing my notes etc I finally got a blood test and a new doctor. 😐
25/06/19
TSH 4.93 mU/L (0.27-4.20)
T4 14.1 pmol/L (11.0-25.0)
Told that I would be retested in 2 months.
At the end of July I ended up having excruciating pelvic pain with constipation and diarrhoea. I was diagnosed as having Diverticulitis. I was put on antibiotics and it cleared up. I still suffer with intermittent pelvic/abdominal pains.
When it came to be retested I asked to have my antibodies tested to check for Hashimoto’s. Blood retested on 17/09/19.
TSH 3.95
TPO 89.2 U/ml (< 34.0)
T4 14.2 pmol/L
He told me that I needed to have another blood test in 6-12 months despite the fact that when I last saw him I told him that I’m constantly tired, I can’t concentrate on anything and my memory is terrible, my hair is dry and falling out. I’m always cold etc etc. But because my TSH is in range it’s not a concern.
So, what I want to know thyroid warriors, is do I keep pushing the GP’s for a confirmed diagnosis and medication or do I want to attempt to control it myself with diet?
Written by
Samd39
To view profiles and participate in discussions please or .
With your first test your TSH was over range. However, in the UK we have to wait until TSH reaches 10 for a diagnosis of hypothyroidism, whereas in some countries it is diagnosed when TSH reaches 3.
Your second test shows over range TPO antibodies which suggests autoimmune thyroid disease aka Hashimoto's which is where the immune system attacks and gradually destroys the thyroid.
What you need is an over range TSH and positive antibodies from the same test, then an enlightened doctor should start you on Levo if they are willing to follow the guidance of Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist, who stated in an article in Pulse magazine (the magazine for doctors):
Question 2 asks:
I often see patients who have an elevated TSH but normal T4. How should I be managing them?
Answer:
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 thyroid function tests in 2 or 3 months in case the abnormality represents a resolving thyroiditis.
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.
Treatment should be started with levothyroxine in a dose sufficient to restored serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 2 to show your doctor.
When doing thyroid tests, we advise:
* Book the first appointment of the morning, or with private tests at home no later than 9am. 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.
[* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds 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.]
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (both Medichecks and Blue Horizon advise to leave Biotin/B Complex off).
These are patient to patient tips which we don't discuss with doctors or phlebotomists.
With Hashi's, test results and symptoms fluctuate with the Hashi's activity. So you need to book a thyroid test to include TSH, FT4, (FT3 is possible), plus Thyroid Antibodies, when you feel at your worst to try and get the highest possible TSH and positive antibodies.
With Hashi's, some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Thank you SeasideSusie that’s really helpful. I’ve emailed Dionne and will take it to my doctor. I didn’t know about fasting before a blood test so I’ll definitely be doing that from now on. 😊
Hope your GP decides to treat you or refers you to an NHS endocrinologist (although they're not always keen to treat either). Sometimes people see an endocrinologist privately and then get the GP to take on the prescribing (thats what i did). Good luck and let us know how you get on 🙂
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
next step?
Next step?
Advice on next steps & Professor Chatterjee 
Next steps!
