Subclinical hypothyroidism : Hello everyone, just... - Thyroid UK

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Subclinical hypothyroidism

jm2450 profile image

Hello everyone, just need some help/advice as I’m feeling quite worried and anxious.

Yesterday I was told I have subclinical hypothyroidism and told to start taking 50 of levothyroxine. My tsh results were 18.1 so she said I am literally heading fast towards full blown hypothyroidism.

I do get a lot of muscle pain/strains and fatigue but I had a thyroid test in 2018 which was perfect.

I’ve recently been told I’m deficient in B12 and B6 so been supplementing with them (spray and drops) and also a gut phytobiotic. Could those have pushed my TSH levels up to look this abnormal? I’m also scared that as I’ve only had one blood test with this level it could be a mistake or a fluke? As I have always had normal thyroid tests come back before. Should I start the levothyroxine or should I insist that I have another test in 6-8 weeks? I am confused and feel overwhelmed with all the information and what I should do. Also seeing other people’s results which are so low and subclinical I feel like why are mine so high and subclinical apparently?

Can anybody help me?

Thank you.

30 Replies

A TSH over 10 is considered OVERT hypothyroidism, not subclinical.

Your GP has misunderstood the guidelines.

I'm glad you've been started on levo. It would be very unlikely, I'd have thought, to have a fluke TSH of 18!

Did you have T4 and/or T3 tested?

jm2450 profile image
jm2450 in reply to plant_lady

I’ve only got serum free T4 it say which was normal. That’s what I don’t understand. Is from what I’ve been reading my level is considered high so why has she said subclinical? Is it reversible? If I start taking Levothyroxine is it possible to reverse it or is it something I will likely have to live with and take for the rest of my life?

RoboTh profile image
RoboTh in reply to jm2450

I'm still classified as subclinical with a TSH over 10 but T4 within range. I suppose it doesn't really matter what they classify you as long as treatment has started. Good luck 🤞 I started to feel an improvement almost immediately after starting levothyroxine.

plant_lady profile image
plant_lady in reply to jm2450

The guidelines the medics work from class a TSH below 10 and in-range T4 & T3 as 'subclinical' which loosely translates to them as 'doesn't cause symptoms' which is nonsense. I was symptomatic with a TSH of 4 and many on here never had a TSH over 10 but were symptomatic.

Now you have your diagnosis, TSH can be a helpful guide but for health, the most important results are T4 and T3. If your T3 is low that is what will be causing symptoms.

"normal" isn't a result. It's an opinion. Do you have the actual result and range? (I've just seen your result further down the thread. It is very low! and if T4 is that low, T3 will be very low too in all likelihood.)

Did you have antibodies tested? Most hypothyroidism is caused by autoimmune disease and unfortunately, is not reversible and will require hormone replacement for life. Personally, I struggled with that. I was so grateful to finally be medicated but had to go through a grieving process for my lost health and thyroid.

There are things you can do to help the healing process though, which I found empowering. Giving up gluten is the first thing. It can be overwhelming to start with, just go at your own pace and you'll get there.

Look after yourself.

jm2450 profile image
jm2450 in reply to plant_lady

Thank you for your response, I appreciate it. I am just scared at the moment for my health and what it means I guess.

SlowDragon profile image
SlowDragonAdministrator

Your results are not sub clinical

TSH over 10 is clinical hypothyroidism

See flow charts on here

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

GP was correct to start you on levothyroxine

Standard starter dose of levothyroxine is 50mcg

Bloods should be retested 6-8 weeks later

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Important to also test vitamin D and ferritin and thyroid antibodies if not been tested yet

jm2450 profile image
jm2450 in reply to SlowDragon

I’m really terrified is taking anything, does Levo tend to have any side effects?

SlowDragon profile image
SlowDragonAdministrator in reply to jm2450

Are you male or female…approx age ?

Levothyroxine is replacement hormone, not a medication

Your thyroid is struggling to make enough thyroid hormones.

Most common reason is autoimmune thyroid disease also called Hashimoto’s

Have you collected your prescription yet

Many people find different brands of levothyroxine are not interchangeable

Best to avoid Teva brand, unless lactose intolerant.

Low vitamin levels are common when hypothyroid

Important to regularly retest vitamin D, folate, ferritin and B12

Exactly what vitamin supplements are you currently taking

jm2450 profile image
jm2450 in reply to SlowDragon

I am female age 35. I am currently taking a spray B12, a gut phytobiotic called bio.me essential and a multivitamin tea which does have a small amount of biotin in (17% nrv). Before my thyroid test I didn’t stop any of these as I didn’t know/wasn’t told. I also had my thyroid test at about 2pm after lunch and eating normally all day. I didn’t know if any of these things have an effect!

SlowDragon profile image
SlowDragonAdministrator in reply to jm2450

TSH would perhaps have been higher if tested early morning

Stop any supplements that contain biotin 5-7 days before all blood tests

You could ask GP to retest after week without biotin if that would reassure you that you need levothyroxine

I think that they’ve named it subclinical because my T4 is normal. But she obviously has suggested I start levothyroxine because of my high TSH levels, she said to put the brakes on it so to speak.

SlowDragon profile image
SlowDragonAdministrator in reply to jm2450

Please add Ft4 and ft3 results and ranges (figures in brackets after each result)

jm2450 profile image
jm2450 in reply to SlowDragon

My results for T4 is 10.3 (9-19) So that result is within normal range. T3 wasn’t tested! And thank you for your responses, I suppose yes you’re right it isn’t a medication it is a replacement hormone. I have been getting lots of muscle problems like soreness/stiffness and aching and fatigue so I guess hopefully levothyroxine will actually help those things. How long before I should see any effects or things being better?

I am picking up my levothyroxine this morning so not sure what I have been given yet! I will update when I’ve got it.

SlowDragon profile image
SlowDragonAdministrator in reply to jm2450

If they try to give you Teva brand,request different one ….Mercury Pharma (Advanz) or Accord (boxed as Almus via Boots or Northstar via Lloyds)

Ft4 is right at bottom of range shows thyroid output is low

jm2450 profile image
jm2450 in reply to SlowDragon

Thank you for your help. It’s much appreciated. I feel quite overwhelmed with it all. I’m away for the next three days. Are any side effects usually mild enough to manage at the start or should I wait until I’m back in my own home to start?

RoboTh profile image
RoboTh in reply to jm2450

I was hyper for first five days but enjoyed the sensation after being so low for so long. Headaches for first 2 weeks that's all. X

jm2450 profile image
jm2450 in reply to RoboTh

Thank you Rob that’s reassuring. I’m already pretty hyper sometimes (or go through phases of it) so I’m not particularly looking forward to it if it does that but I know it’s for the best long term x

jm2450 profile image
jm2450 in reply to SlowDragon

They have given me Teva, is it best to try and request a different one or give it a try and see?

SlowDragon profile image
SlowDragonAdministrator in reply to jm2450

Up to you

Perhaps try it and see….you might be fine

Always check the bag before leaving the pharmacy, if you don’t want to accept a particular brand in future

jm2450 profile image
jm2450 in reply to SlowDragon

If I don’t get along with Teva I can always request a different brand next time. My body is quite sensitive to anything going in it so I am nervous but I don’t know what the best thing to do is!

RoboTh profile image
RoboTh in reply to jm2450

Yellow card any adverse Symptoms

SlowDragon profile image
SlowDragonAdministrator in reply to jm2450

Yes, some people never notice any difference between brands

Levothyroxine should always be taken on empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Teva poll shows many people love it

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

50mcg is only a starter dose. Bloods should be retested 6-8 weeks time and dose is likely increased to 75mcg ….retested 6-8 weeks later etc

BethH77 profile image
BethH77 in reply to jm2450

I am in the same position and feel very anxious as try to avoid medication but this is a pure hormone. I am concerned about cancer too.....xx

jm2450 profile image
jm2450 in reply to BethH77

That’s how I feel too Beth. Sorry to hear you’re also feeling this way. Sending hugs xx

BethH77 profile image
BethH77 in reply to jm2450

Thank you, and to you. Hopefully we both start feeling much better once we get the medication going xx

SlowDragon profile image
SlowDragonAdministrator in reply to jm2450

Actually, yes looking at flow chart, if Ft4 is within range it’s classed as “sub clinical “ even if TSH is over 10

But with TSH over 10 levothyroxine is always started

Just to reassure you, there are many of us on here who take a tablet of Levothyroxine every day and have no side effects and continue to feel good. Thyroid issues are extremely common.

I had a mild panic once when I was given a different brand to usual and thought I’d better check. It turns out I’d been using Teva brand all along, so not all of us have a problem with it. Brands seem to make no difference to me, nor taking my medication with a meal.

I was borderline when I was first diagnosed many years ago, but my GP decided to start treatment because I had antibodies. Within days I was feeling like I had more energy when I hadn’t realised I was sub par.

Good luck on your journey.

jm2450 profile image
jm2450 in reply to Ruby1

Thank you Ruby!

You might find this thread of interest :

healthunlocked.com/thyroidu...

Lots of people are afraid of taking thyroid hormones. But having levels of thyroid hormones that are too low for you will be bad for your health. Your Free T4 is only 13% of the way through the range. Most of us on this forum need our Free T4 to be at least half way through the range up to as high as 80% of the way through the range, with the average being (I'm guessing) perhaps 70% of the way through the range.

Whenever you read something along the same lines as I've just written don't get hung up on the percentages. Your level is right for you whenever you feel well, wherever that happens to be in percentage terms. There are no hard and fast "rules" - it's how you feel that counts.

Always keep good records of your results and doses of Levo. Keep records of your symptoms. If you start to feel better or worse you want to know what results and doses you were taking at the time you felt better/worse. It will help you in future to avoid feeling bad and increase your chances of feeling well.

jm2450 profile image
jm2450 in reply to humanbean

Thank you your comment is definitely appreciated!

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