I’m new here. I’ve had blood test done this week which have flagged as abnormal so I have a telephone appointment with the GP on Wednesday and I want to be prepared before I speak to her as she has sometimes not been that helpful in the past. I have a family history of hypothyroidism (mum and maternal aunt both diagnosed around age 50). I was tested a couple of years ago and told thyroid function fine but I did have antibodies. When I pushed for help for fatigue and pain I was referred to a rheumatologist who diagnosed Fibromyalgia. I’ve been taking amitripyline and max dose of ibuprofen but feeling more tired than ever, I’m still in pain, my weight is increasing and my mood is low etc...
These are my results:
TPO antibodies 1374.4 iu/mL [0.0 - 35.0]
Plasma free T4 level: 12.9 pmol/L [6.3 - 14.0]
Plasma TSH level 7.45 mu/L [0.3 - 5.6]
Any ideas what the GP is likely (or should) say?
Thank you for any help you can give.
Written by
Lonnex
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If there's any justice in this world, and if she has the slightest idea what she's doing, she should put you on 50 mcg levothyroxine. Your antibodies are very high, which means you have Hashi's, so things are going to get worse, not better. And, your TSH is well over the top of the range. You are pretty hypo.
Your FT4 isn't too bad at the moment, at 85.71% through the range. But, that won't last. To have antibodies that high more than likely means that your thyroid has recently been under attack from the immune system, and your FT4 is high due to the dying cells in the thyroid dumping their stock of hormone into the blood. It won't last. It will probably go down quite quickly.
So, don't let her get away with any old nonsense about oh, the antibodies just mean that you might eventually go hypo - you are hypo! And, the sooner it is treated, the better.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in an article he wrote 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.
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.
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 as you have 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 .
If you have high antibodies this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
I'm assuming this latest thyroid test was done by the GP, rather than privately ?
NHS guidelines on diagnosing and treating 'sub-clinical hypothyroidism' say they should repeat an over range TSH test 3 months apart .
So you may get told to wait 3 months and retest to make sure it's not a 'one off' out off range TSH result.
However the level of TPOab antibodies, is pretty high , and you have history of them , so there should not really be any doubt about the cause of your current 'sub-clinical' hypothyroid results .
(as far as NHS is concerned , 'TSH over range while fT4 is still within range' is called 'sub-clinical'... which is silly , because if it was really 'subclinical', you would have TSH a bit overrange , but you wouldn't be experiencing any hypothyroid symptoms. )
If you're lucky they might start Levo on these results , or at least shorten the wait for a 2nd test , but they could stick rigidly to guidelines and make you wait 3 months to repeat the TSH test.
So be sure to ask if they have ever had a previously over range TSH test on record. If you have, then maybe you can insist they stick to guidelines and start Levo now.
Yes, test down by GP. They did test vitamin D and B12, both ok. I was severely vitamin D deficient 3 years ago which is when they did first thyroid test which showed antibodies. I’m not sure what the TSH was or if it was even tested.
If you were previously told 'thyroid function fine' and they did antibodies , then that test will have definitely included TSH. I Suggest you ask what the result of that test was ie TSH 0.0[?-?] Lab range in brackets.
Or at least ask "has my TSH previously been over the lab range ?"
They wouldn't usually bother to test for antibodies unless the TSH was over range ,(but i suppose they may have done if you'd pushed them to look because of family history ?)
Just because they told you ' fine ' it doesn't mean it wasn't a little over range.
also, on the subject of your Vit D and B12 being 'Ok' . you might want to get hold of the actual results, as 'OK' usually just means 'the bare minimum has been achieved.'
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