How can I persuade the consultant that I need treatment for my Hashimotos?

[DraigGoch]

A scan of my thyroid (small thyroid, U3 nodule) and the antibodies on an old blood test persuaded my consultant to agree with his colleague, at last, that I have Hashimotos. However, he's holding off on treatment - TSH was only 'slightly high' and he intends to scan my thyroid again in 12 months. I have an online consultation on Tuesday next with him. I feel very unwell all the time and hope I can persuade him to give me treatment. In preparation, I have done a Medichecks blood test for thyroid and associated vitamins (precisely following the instructions about stopping supplements, timing of test etc that appear in response to many posts). I am hoping that you will be able to tell me, from the results, what I should be asking/saying to the consultant in order to get the treatment I need. Many thanks in advance. These are the results:

CRP HS 3.14 mg/L (Range: < 5)

Ferritin 129.00 ug/L (Range: 13 - 150)

Folate - Serum 16.59 ug/L (Range: > 3.89)

Vitamin B12 - Active >150 pmol/L (Range: > 37.5)

Vitamin D 61.10 nmol/L (Range: 50 - 175)

TSH X 4.76 mIU/L (Range: 0.27 - 4.2)

Free T3 4.21 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 12.100 pmol/L (Range: 12 - 22)

Thyroglobulin Antibodies X 479.000 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies X 157.00 kIU/L (Range: < 34)

[Lalatoot]

Over range TSH and bottom of range FT4 are what you need to keep telling him.

[DraigGoch in reply to Lalatoot]

Thank you, Lalatoot

[SeasideSusie Remembering]

DraigGoch

Over range TSH (plus bottom of range FT4) plus raised antibodies suggest you should be started on Levo according to the following:

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):

Question 2:

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 two or three months in case the abormality represents a resolving thyroiditisis.

But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune 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 be come 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 restore serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.

If there are no thyroid peroxidase antibodies, levothyroxine should not be started unless serum TSH is consistently greater than 10mU/l. A serum TSh of less than 10mU/l in the absence of antithyroid peroxidase antibodies may simply be that patient's normal TSH concentration.

Vit D is recommended to be between 100-150nmol/L so you could do with improving your level. Are you currently supplementing?

[DraigGoch in reply to SeasideSusie]

Thank you, SeasideSusie, that is very useful. I think the pragmatic approach would be good with this consultant. Fingers crossed! I had been supplementing Vit D up until a week before the blood test, and was surprised to see how low the level was. I do have the genetic mutations that affect the levels of Vit D, and may need to take a lot more, I guess. I'm always worried about overdosing on vitamins.

[SlowDragon Administrator]

Vitamin D needs improving to at least around 80nmol and around 100nmol maybe better

Are you on strictly gluten free diet. If not request coeliac blood test done BEFORE trialing strictly gluten free

[DraigGoch in reply to SlowDragon]

Thank you, SlowDragon. I was surprised at how low the Vit D was, as I had been supplementing until a week before the blood test. I have genetic mutations that affect my level of Vit D, so maybe I need to take a much higher dose.I have been on a strict gluten free diet for some years - I don't know whether my thyroid problem would be worse if I was not, but I do know that some tummy problems have completely disappeared.

[serenfach]

Bore da DraigGoch. From your name I am am guessing you are in Wales. Your thyroid is obviously struggling, and I believe they start treatment in the USA if your TSH is above 3. Tell him you are feeling really ill and would like a "trial" of Levo to halt the decline in your thyroid. Why wait until you are really ill? pob lwc! Cwtsh.

[DraigGoch in reply to serenfach]

Diolch o galon, serenfach, byddaf angen y lwc! After receiving SeasideSusie's response I decided the pragmatic response would be the best way, but if he were to still be reluctant suggesting a 'trial' would be a good idea. He might go along with something that sounds less permament!

[helvella]

I take a somewhat simplistic view of this.

Does your consultant expect your thyroid to make a full recovery, to stop being destroyed by macrophages, and to re-commence making the right amounts of thyroid hormones?

If not, and I really don't think that he does, then what on earth is the point of waiting? Of delaying treatment? Of guaranteeing that you will suffer from now until some arbitrary future point?

Starting treatment would always be somewhat arbitrary. Let it be done in the interests of the patient rather than a consultant more or less flicking a coin.

[DraigGoch]

Thank you, helvella. I fail to understand the reluctance among people who are supposed to be specialists to diagnose, let alone treat, something which is the most common of the thyroid disorders. I am well armed for my appointment now after reading the replies here.

[helvella in reply to DraigGoch]

Quite!

(By the way, you replied to the thread - that is, your own post - so I did not realise you had replied until just now.You need to click on the blue Reply button. )