Supposedly subclinical hypothyroidism but feeling horrendous and have all the symptoms online....

[MrsRich]

My most recent bloods came back as TSH 5.87 and Free T4 10.2 so I know both are outside optimal range....my GP is refusing to treat me even though I struggle to get out of bed sometimes (not ideal with a 14 month old baby and a job!). Feeling stuck...should I go private??

[Nanaedake]

Can you add the lab ranges please?

NICE guidance summaries for thyroid conditions here.

nice.org.uk/guidance/ng145

You could ask GP to retest in 6 to 8 weeks time and refer to the NICE guidance if your FT4 is below lab range and TSH above. Ideally you should have FT3 tested too.

You also need TPO antibodies and ideally TgAb testing although NHS rarely does TgAb. You could ask GP to run a full set of blood tests, full blood count, to check you do not have an infection that could be reducing thyroid function. This would include CRP that would indicate an infection.

At the same time, ask for vitamin B12, folate, ferritin and vitamin D to be checked. If any of these are low it will compound symptoms. Once you have results then post here. Don't accept GP saying they are all fine. Coasting also g the bottom is not the same as optimal. Someone here will help once you've got results.

Read Slowdragon's replies to posts for advice on reliable online labs if GP won't do the tests you need.

[DippyDame]

Looks like you have another medic with limited thyroid knowledge!

For a thorough thyroid evaluation you need to test

TSH

FT4

FT3

Folate

Ferritin

Vit D

Vit B12

Antibodies

thyroiduk.org/getting-a-dia...

Many of us here have private tests because the NHS consider TSH the gold standard test....which research has proved is not the case.

With a TSH of 5.87 you should be medicated...no wonder you feel unwell. A healthy person should have a TSH of close to 1

thyroiduk.org/getting-a-dia...

Post any test results you might have, including reference ranges, and members will advise

In the meantime I suggest you ask your GP to give you a trial of levothyroxine with a starting dose of 50mcg because you are hardly able to function!

You might find it helpful to read and use this paper to support your request.

The authors are all eminent in the thyroid field

bmcendocrdisord.biomedcentr...

Your GP is nothing short of cruel to leave you with such a low quality of life, the result of his/her incompitence.

Good luck

DD

[JAmanda]

Yes probably. But guidelines do allow doc to treat you with those results and where you have continuing symptoms. I would ask doc for a trial of t4 - saying I hear it’s cheap and fairly benign and can I please just try it just to see if I feel better? Then impress on doc your struggling with new baby etc.

[HashiFedUp]

Hi. Did your symptoms come on after you had your baby?

Postnatal hypothyroidism is very common. I was probably subclinical before I had my son (although he was a low birth weight baby pointing to undiagnosed hypothyroidism) And it got MUCH worse after having him. Doc palmed me off for months saying “you’re tired because you’ve had a baby” but I knew this wasn’t right.

I demanded treatment in the end by refusing to leave the surgery!

Assuming your TSH range is 0.2-4.2 you are not subclinical, you are hypothyroid!!

Be assertive, do your research before you go, and state what you want. T4 to begin with. Good luck.

[Hillwoman]

Even without the lab ranges available, with TSH at 5.87, you do not have subclinical hypothyroidism, it is overt.

FT4 of 10.2 would be at or below the bottom of most current lab ranges.

In the bizarre world of NHS England NICE guidelines, this probably does count as subclinical hypothyroidism, because no attention is now paid to the whole clinical picture. Symptoms and signs have been deemed irrelevant, regardless of the consequences to patients. It's barbaric.

If your GP cannot be persuaded to do the decent thing by doing a full thyroid panel, and giving you a trial of 50 mcg levothyroxine (the adult starting dose) for six weeks, you will be better off taking guidance from this forum about self-treatment.

[SlowDragon Administrator]

See GP again...or different GP and request that vitamin D, folate, ferritin and B12 are tested

Plus thyroid antibodies

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Insist GP 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 .

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

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin (doesn’t include folate)

medichecks.com/products/thy...

Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

[MrsRich]

Thanks all, here is the full set of results from the NHS tests on 9th July, and a Medicheck set of results from 13th February 2020.

NHS results 9th JULY 2020 (most recent results) -

B12 - 725ng/L Range 120 - 900

Cholesterol - 5.2mmol/L

Full blood count:

- Haemoglobin - 143g/L Range 115-165

- White Cell Count - 7.3 Range 4.0 - 11.0

- Platelet Count - 365 Range 150 - 400

- HCT - 0.42 Range 0.37 - 0.46

- RCC - 4.54 Range 3.8 - 5.8

- RDW - 12.6 Range 11.0 - 14.8

- MCV - 91.5 Range 80-100

- MCH - 31.5 Range 27.0 - 32

- Neutrophil Count - 4.47 Range 1.7 - 7.5

- Lymphocyte Count - 1.98 - Range 1.0 - 4.5

- Monocyte Count - 0.74 Range 0.2 - 0.8

- Eosinophils 0.07 Range 0.0 - 0.4

- Basophils 0.04 Range 0.0 - 0.1

Plasma Glucose - 4.9 Range <11.1

Liver Function Test

- Total protein - 69 Range 60 - 80

- Albumin - 47 Range 35 - 50

- Globulin - 22 Range 20 - 35

- Alkaline phosphatase - 68 Range 30 - 130

- Total bilirubin - 6 Range 0 - 21

- ALT - 13 Range <35

Thyroid Function

- TSH - 5.87 Range 0.3 - 5.0

- Free T4 - 10.2 Range 7.9 - 16

Urea & Electrolytes

- Sodium - 142 Range 133 - 146

- Potassium - 4.0 Range 3.5 - 5.3

- Urea - 3.4 Range 2.5 - 7.8

- Creatine - 63 Range 45 - 95

Total Vitamin D - 68 nmol/L

CKD-EPI eGRF >90

MEDICHECKS Results 13th February 2020

Ferritin - 81.4 Range 13 - 150

Folate Serum - 8.84 Range >3.89

Vitamin B12 Active - >150 Range >37.5

Vitamin D - 33.9 Range 50 - 175

TSH - 5.6 Range 0.27 - 4.2

Free T3 - 3.61 Range 3.1 - 6.8

Free Thyroxine - 11.3 Range 12 - 22

Thyroglubin Antibodies - 16.4 Range <115

Thyroid Peroxidase Antibodies - 10.6 < 34

[DippyDame in reply to MrsRich]

Oh dear that GP needs to go back to med school.......with these results how can he have missed that you are hypothyroid

Your TSH is too high

FT4 is 28.4% through it's range

FT3 is 13.42% through it's range

Both Free should be close to 75% through their respective ranges so you can see that you need to be medicated with replacement hormone! No ifs, no buts!

As usual FT3 wasn't tested (NHS labs) This is perhaps the most important result.

Your nutrients also need attention....they support thyroid function.

Go back to your GP, now with more knowledge, and tell him how you feel and that your quality life is more important than numbers that he doesn't seem to understand! (Well maybe not that last bit.....you want him on side!)You need a thorough clinical evaluation......and a starting dose of 50mcg levo which he can monitor and adjust after 6 weeks.

If he refuses see another GP or self medicate.......members will guide you, as they did me!

[tattybogle]

If Gp will accept your medichecks result from Feb, with TSH 5.6 as evidence, then you have already fulfilled the criteria in NHS NICE guidelines to be offered a trial of Levothyroxine, see below; (if Gp will not accept it , then make sure they do one of their own that is 3 months after your latest one, or check if they have a previous one for you that shows over-range TSH ) Emphasise that your symptoms are having a material effect on your daily functioning.

nice.org.uk/guidance/ng145/...

PAGE 13.

TREATING SUBCLINICAL HYPOTHYROIDISM

1.5.4 Consider a 6-month trial of levothyroxine for adults under 65 with subclinical

hypothyroidism who have:

• a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions

3 months apart, and

• symptoms of hypothyroidism.

If symptoms do not improve after starting levothyroxine, re-measure TSH and if the

level remains raised, adjust the dose. If symptoms persist when serum TSH is within

the reference range, consider stopping levothyroxine and follow the recommendations

on monitoring untreated subclinical hypothyroidism and monitoring after stopping

treatment.

[tattybogle in reply to tattybogle]

Just to add . Post Partum Thyroiditis is sometimes self resolving, but it is expected to have done so within a year from birth, so don't get fobbed off with that as an excuse.

[kmf0503]

I will just add my DIL was diagnosed with hypo while pregnant. 24 months later she was put on levothyroxine, so it did not resolve. I was left a decade at the high end of the TSH scale and I feel it did untold damage to my weight, my skin, my hair, my gut and my quality of life. I kept being told I was normal and yet having most of the symptoms in the book. Get another Dr if this one will not help you.

[Nanaedake]

Your vitamin D was very low back in Feb via medichecks 33.9 nmol. Have you been supplementing since then?

You should be able to get retested for thyroid function as TSH is elevated above the NHS lab range. Your FT4 is in range in the NHS test so you need to find out whether thyroid function is improving or not by retesting . You don't have thyroid antibodies so it's possible thyroid function will improve. An ultrasound would rule out thyroid problems not picked up by antibodies tests.

Vitamin D levels are still on the low side so it's likely that if they continue to improve it will help to alleviate symptoms. You need to keep an eye on thyroid function though to make sure it improves. Don't leave it and suffer, get retested and see if GP will start treatment if you have no improvement. GPs will take notice of NICE guidelines so worth reading them.

[MrsRich]

I’ve had some more tests done through a private endocrinologist and I’d appreciate any thoughts on the results. He’s prescribed 50mg/day of levothyroxine but he doesn’t think it’ll have much effect!

Cortisol - 200 nmol/L (185-624)

TSH - 5.79 mU/L (0.3-5.0)

Free T4 - 10.6 pmol/L (7.9-16)

Total Testosterone - 1.1 nmol/L (<2.4)

Free T3 - 4.7 pmol/L (3.8-6.0)

Thanks x

[SlowDragon Administrator in reply to MrsRich]

You need to click reply for anyone to get notification of a post (easy mistake to make)

Good that you are started on 50mcg levothyroxine

Bloods should be retested 6-8 weeks after each dose increase in levothyroxine

Dose is increased slowly upwards until on full replacement dose for almost all patients....that’s 1.6mcg levothyroxine per kilo of your weight

Make sure to get blood test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...