Sub clinical? Confused!

[Jooju2004]

Hello again!

After my last blood tests my GP phoned me today and instead of telling me she thinks I’m over medicated, she actually asked how I’m feeling and said ‘because there are some signs you are subclinically hypothyroid’ - she wouldn’t tel me what signs, and she said my T4 and TSH were pretty much the same as they have been for some time (so normal for me) - so what on earth is she seeing to suggest this? I’m very confused (doesn’t take much🤦🏼‍♀️).

I know my TSH was 0.02, she didn’t tell me my T4 other than that it’s the same as usual, so I’m assuming it’s just over the top of the range.

Imagine if she’s tested T3? Surely not! I’m going to ask for a print out of my results because they seem to be shrouded in mystery - but has anyone else had this suggestion in this situation?

I’m wondering if perhaps she is a little bit psychic as I’ve started to experience a few hypothyroid symptoms again recently 🤔

[greygoose]

Are you sure she said 'hypOthyroid' and not 'hypERthyroid'? Because most doctors, on see such a low TSH - plus over-range FT4 - would immediately think subclinical hyperthyroid. I can't imagine why she would make such a mystery out of it.

[Jooju2004 in reply to greygoose]

No this is why I’m so confused - she asked me if I thought I needed to INCREASE my dose and whether I’ve been feeling more tired lately - and when trying to explain her reasoning said ‘it’s complicated’ 😃

I didn’t have the heart to say that I micro-analyse every aspect of this blooming journey and that I wasn’t wholly averse to complicated 😂

Thank you for your reply - I will get a print out of my results and report back to see if this sheds any light!

[greygoose in reply to Jooju2004]

I think that would be the best idea, yes.

[HashiFedUp]

Your TSH at 0.02 is a bit low but it would be good to test t3 as well for a complete picture. Dont forget vit D too. TSH ideally should be no lower than 0.4.

[Jooju2004 in reply to HashiFedUp]

Thank you for the reply 🙏🏻 I don’t think I’ve had my TSH higher than 0.2 for the last 3 years - I only seem to function when it is fully repressed - often it’s nearer 0.005 lol.

Last time I did a medichecks test my T3 was exactly mid range while my TSH was 0.005 and my FT4 was 25 (top of range being 21).

I think you’re right, I shall check my T3 again to hopefully shed a bit more light! Thanks again!

[diogenes Remembering in reply to Jooju2004]

Actually, the desired TSH range for someone with no thyroid and on T4 only is not the same as for complete health. The range for complete health is about 0.4-4.5, but for thyroidless patients on T4, 0.03-0.5. This is because if on T4 the production of T3 from it is not as efficient as in health, so you need more T4 to get an adequate T3 - a TSH of 0.02 is not drasically low in this regard.

[tattybogle]

I can't figure it how she's come to that conclusion either... It is possible that a TSH that low combined with an over range fT4 could trigger the lab to do an fT3. (Some use a cascade protocol where one out of range result leads to another test, and if that is out of range it leads to another) However, even if fT3 was to come back as UNDER RANGE i suspect the lab report would still come back with " !overmedicated , needs dose reduction !" plastered all over it due to low TSH /high fT4, or possibly "satisfactory" if the lab were used to you always having low TSH high fT4.

But i can't see any way to get to ' ?subclinical hypo' from there.... "Subclinical hypo" usually means "OVER-range TSH /In-range fT4 " or occasionally "In-range TSH /UNDER-range fT4 "

Unfortunately, it's not safe to assume the Doctor has not just had a confused moment about which is which, and which way to adjust Levo.

Why they are all so cagey about giving out the actual numbers has always seemed a bit daft to me.... it's like getting blood out of a stone.

But until you see the actual blood results you'll be none the wiser.

I've had a doctor tell me to my face while looking at the screen that "but that last one was 46"... when i got my historic record's there's no "46 "anywhere.... there was a 0.0046

It IS possible they have done fT3 ..... i've had 5 done without me knowing , between 2014 and 2018.

One, when BOTH fT4 /TSH were out of range ... Two, when EITHER TSH or fT4 were out of range.... One, when both were IN range ... and one, when TSH was 7..

All had OK/ no action / or normal printed on them by lab (apart from the TSH 7... they wrote 'abnormal, contact patient'.... but nobody ever did )

But there have been many other occasions when both results were out of range and an fT3 hasn't been done...

I get the impression that it was the Senior GP who asked for it to be done on a couple of these occasions.. but i'm not certain, and they weren't keen to say.

Long story short.... "get the numbers".... then we'll see.. until then don't waste too much energy trying to figure out what she means ! ... she might actually be looking at someone else's numbers