Thyroid Results help please!

[Emmie323]

I'm 47 with underactive thyroid and take 50mcg Levothyroxine per day. GP says all results "in normal range" however I am feeling worse and worse all the time - croaky voice, weight gain, excessively tired, headaches, joint pains, burning eyes, unable to focus - just generally rubbish!

Since January I have overhauled my diet to cut out all processed sugars, processed foods, caffeine, white bread & pasta etc and now eat all fresh prepared meals, loads of fruit, veg, oats, wholemeal bread, rice, pasta etc. I've felt no better at all and not lost any weight. I've also had GP tests for peri- menopause but again all results in normal range!

I've just had a Thyroid Ultra Vit Test done privately after reading posts on here and I'm slightly confused by my results when compared to others I've seen on these posts, so wondered if anyone can help me interpret them please? I think they suggest my dose is too low but GP says not?

My iron is low at 19.4ug/l (range 13-150) and Vit D low at 61.1nmol/L

TSH is 5.39 (range 0.27 - 4.2)

Free T3 is 4.06 (range 3.1 - 6.8)

Free Thyroxine is 12.9 (range 12 - 22)

Thyroglobulin Antibodies are 399 and Thyroid Peroxidase Antibodies are 409 - results say this suggests an autoimmune cause for thyroid disease but I'm not sure what this means? Plus to combat this the report suggests eliminating eggs, legumes, dairy, bread, pasta, fruits, rice .... surely that doesn't leave much to eat?!

Can anyone offer any further advice and how to approach this with GP please?

[Lalatoot]

Put it to the GP that your FT4 was 12 it would be normal; if it was 22 it would be normal. There is a big difference and you don't feel well enough for your normal to be 12.9. You would like a higher level of normal.

Your TSH is over range and needs to be brought down to the low end of normal.

You need an increase of 25mcg at the mo.

[Hoxo]

You are clearly still hypothyroid and not getting enough thyroid hormone. 75mcg is a low dose. Your TSH is above range showing your thyroid is struggling and your T4 is very low in range. You have hypothyroid symptoms still. On treatment in order to feel well usually people’s TSH needs to be 1 or lower and free T4 and free T3 in the upper part of the reference ranges. Your autoimmune antibodies are high indicating you have Hashimotos thyroid disease. The antibodies tested are ones which your body’s immune system produces ‘by mistake’ and attacks its own thyroid gland tissue. It’s called autoimmune disease. Gradually the body’s immune system attacks its own thyroid gland thinking it is foreign material in the body and slowly destroys it until the gland cannot produce enough thyroid hormones to maintain healthy metabolism and other processes leading to all the unpleasant symptoms.

You need an increase in thyroid hormone dose until you feel better. If your GP says that your bloods are OK together with your symptoms list then they are not treating you properly and you may need to find another doctor that is knowledgeable about treating thyroid disease.

You could start by taking these blood results and a list of symptoms to your current GP and state you want to increase your Levothyroxine dosage ASAP. Say you cannot carry on being under treated and living with these symptoms. As long as free T3 is not way over range there’s no reason not to increase your dose. Also don’t let them scare you with talk of bone thinning and heart problems (atrial fibrillation) as a risk of over treatment. Under treatment carries the same risks of bone thinning heart disease high cholesterol and more.

[greygoose]

Autoimmune Thyroiditis - commonly known as Hashi's - is a condition where your immune system slowly destroys your thyroid, with the result that you become more and more hypo. Therefore, you are going to need six weekly increase of 25 mcg for the foreseeable future. Whether your doctor likes it or not. Until you reach a dose that gets rid of your symptoms and makes you feel well.

Your GP, like most doctors, is under-educated in thyroid. So, we as patients, need to learn all we can about our disease and try to 'gently guide' or medical practitioners. Or, put our foot down firmly and insist on the right treatment!

50 mcg is just a starter dose. You cannot expect to feel better on that. And, how you feel is far more important than your blood test results. Even so, it's obvious that no-one is going to feel well - or hardly anyone - with such a high TSH. When on thyroid hormone replacement - levo - it should come down to 1 or under. And your FT4/3 should be at least over mid-range, or wherever you need them to be well. Try asking your doctor what the point is of having ranges, if he totally ignores them.

[shaws]

So many doctors diagnose by the TSH alone (and if it is 'somewhere' in the range think patient is on a sufficient dose). However, if you've already been diagnosed the aim is increases in levo until your TSH is 1 or lower (not somewhere in range). 50mcg of levo is a 'starting dose' with 25mcg increases every six weeks until TSH is 1 or lower.

Your results are:-

TSH is 5.39 (range 0.27 - 4.2) - too high - the aim is 1 or lower

Free T3 is 4.06 (range 3.1 - 6.8) - too low, should be nearer 6.

Free Thyroxine is 12.9 (range 12 - 22) - too low - should be nearer the upper part of the range.

If you're in the UK, I think that doctors somehow have an idea that if TSH is 'somewhere' in the range that we're on a sufficient dose of levo. That's not the case. The aim is a TSH of 1 or lower with FT4 and FT3 in the upper part of the ranges.

Ask GP to test Vit B12, Vit D, iron, ferritin and folate. Everything has to be optimal.

[Emmie323 in reply to shaws]

Thanks so much for all the responses - I went back to GP yesterday armed with my results and various printouts from here and Thyroid UK regarding them He actually rolled his eyes at me that I'd been researching myself!

He still said my TSH was within range but then proceeded to say that ideally it should be in the lower third of the range! So why have you been happy to keep me at the upper limit for years whilst complaining how bad I felt?! I was fuming.

He was horrified that I had paid for the blood tests and said "we would have done them all for you here" - yes, and then said they were all "in the normal range"!! He said "we" knew it was Hashimoto's but I had never heard that before.

Anyway, end result is he has doubled my dose from 50mcg/day to 100/day - am I right in thinking that I should increase this dose gradually over a few weeks rather than in one go? I have some 50/25's left over that I can use to do this.

Thanks for all the useful info - this site is amazing!

[shaws in reply to Emmie323]

Usually we go up in increases of 25mcg increments every six weeks. You can halve the 50mcg if need be.

The main aim is that symptoms resolve and also notice how you 'feel'. You can then around 6 weeks add the other half. The priority is that our symptoms are resolved and I'm glad you shocked your doctor into (I believe) realising he knows little except about the TSH and T4.

His following phrase :-

"in the normal range"!"

just goes to show how ignorant many doctors are. For instance he still thinks that 10 is the number before diagnosing instead of realising that the aim of the TSH number, once diagnosed, is 1 or lower. He believe that a TSH somewhere in the lower part of range is fine.

The aim for FT4 and FT3 is to be in the upper part of the ranges but I think the NHS wont test the 'frees'. If, however, you're feeling much better and symptoms resolving I wouldn't bother.

When NDT was first introduced in 1892 (and before that people just died). Doctors gave small increases of NDT until symptoms were resolved and all of the concentration was relief of them - no blood tests were available, just doctors' expertise.

[Buddy195 Administrator]

Hi, just to add that I had very similar symptoms & feel much better now my TSH is under one and key vitamins are optimal. Keep following the advice of knowledgable forum members (as I did) and I’m sure your symptoms will improve! 👍

[Snowowl46788]

My Gp fobbed me off for years your TSH needs to be brought down

From Bristol NHS

Reference Range: TSH: 0.27 - 4.2 mU/L, Free T4 12 - 22 pmol/L, Free T3: 3.1 - 6.8 pmol/L.

Your TSH is too high and needs to be brought down you need a higher dose of levothyroxine then you need to get tested again in 1 months time.

Your thyroid antibodies mean that your body is attacking your thyroid. I had extremely high antibody levels and was diagnosed with Hashimoto. Gps are useless and don’t understand this condition. You need to be referred to an endocrinologist. I felt extremely tired and only now feel ok when my TSH is below 3. The UK has a higher acceptable maximum 4.2 than a lot of other countries which means people suffer more than they should do. Keep pursuing this and complain to the practice manager if they don’t listen. Unregulated TSH levels can affect your heart etc.