sisters results: High TPO (200+) elevated TSH 4.91 & T4 lower end of normal. Should she request thyroxine given family history.

[ML44]

Hi everyone,

My sister is always fatigued and has put this down to low iron.

I advised her to get her thyroid checked on the back of my problems. She has results as followed:

TSH 4.91 (0.35-5.00)

T4 13.3 (11.00-23.00)

I’m afraid these are the only results I’ve got but her TPO results were over 200.

Should she request thyroxine? Is the TPO result indicative of hashimotos?

I know she needs more bloods to provide accurate information but just wondering what’s what.

Many thanks

[fuchsia-pink]

As you suspect, this is a high TSH reading and low fT4 such that yes, I'd say she should start medicating - aiming for fT4 in the top third of the range and TSH to go to 1 or lower. And ideally test free T4, ferritin, folate, B12 and vitamin D.

And yes, the high TPO suggests Hashis.

Once she gets her levo, she should take it on an empty stomach and not eat or drink (except water) for at least an hour.

And future blood tests should be as early in the morning as she can get, with no food or drink and 24 hours from taking the previous levo [this may entail splitting tablets if she decided to take her meds at night rather than in the morning]

[SlowDragon Administrator]

For full Thyroid evaluation your sister really needs vitamin D, folate, ferritin and B12 tested too

Low vitamin levels are extremely common, especially as she has autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

[Musicmonkey]

Perhaps your sister could check for Secondary/Central Hypothyroidism. Do the symptoms fit with the rest of the family? When TSH is low/normal and T4 is low it is suggestive of Secondary, rather than Primary Hypothyroidism. In cases like this, patients should be referred to an Endocrinologist to investigate further before medication is started.