First Time Thyroid Problems

[sparky82]

Hi All,

I'm after some advice, please.

back in July, I went for some routine blood tests as I hadn't been feeling myself recently.

All came back fine, but there was a note to advise that they wanted to repeat my thyroid in 6 months' time, and said there was nothing to worry about.

The last few weeks I have started feeling very fatigued to the point where I could literally sleep all day, and have no energy to do anything else, this is strange to me as i have never felt like this before.

I spoke to the GP about it this morning, and explained how i was feeling and that could it be related to the note she put on my letter about repeating thyroid in 6 months, she explained that no it shouldn't be causing that as my levels weren't elevated enough to cause those sort of symptons.

She has brought forward my repeat blood to next month to review, as she explained there had to be a min of 3 months between the blood tests

I did ask what the levels were, she explained TSH 11.0 and T4 7.0.

Can anyone advise their thoughts, as this is all new to me, and i don't have the foggiest if what she is saying is correct?

Thanks

[SeasideSusie Remembering]

Sparky82

A normal healthy person would have a TSH of no more than 2, often around 1, with FT4 in the middle of it's range (always get a print out of your results, the reference range will be on there). Your TSH is high and although we don't have the range (they vary from lab to lab) your FT4 is either at the very bottom of the range or below range. My lab's range is 7-17 so you would be right at the bottom, but if the range is, say, 12-22, then you would be well below range.

It's usual to repeat the test if the first one comes back abnormal, because non-thyroidal illness can elevate TSH, so they have to eliminate that first. If your second test comes back with similar results there will be no question, it will be hypothyroidism and you will be given a prescription for Levothyroxine.

With your symptoms and those results I would guess that it is hypothyroidism so get that second test as soon as possible.

You are welcome to come back with new results for further guidance (post results plus reference ranges), and see if your GP will also test thyroid antibodies (this will tell you if the cause of hypothyroidism is autoimmune) and ask for nutrients to be tested - Vit D, B12, Folate and Ferritin - as these are often low in Hypo patients.

[SlowDragon Administrator]

No wonder you’re feeling terrible

With TSH over 10 you should be starting on levothyroxine ASAP

TSH over 10 is clinical hypothyroidism

See flow charts on here

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

Make sure next blood test is as early as possible in morning (ideally before eating or drinking anything other water)

This gives highest TSH

Request GP also test thyroid antibodies to see if cause of your hypothyroidism is autoimmune thyroid disease.

About 90% of primary hypothyroidism is autoimmune thyroid disease so it’s likely

Essential to also test vitamin D, folate, ferritin and B12

When hypothyroid we frequently have LOW stomach acid, this leads to poor nutrient absorption and low vitamin levels

Common to need to supplement to improve low vitamin levels

Come back with new post once you get results

Standard starter dose of levothyroxine is 50mcg

Unless lactose intolerant, best to avoid Teva brand levothyroxine.

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

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

Dose is increased slowly upwards in 25mcg steps until on something around 1.6mcg levothyroxine per kilo of your weight

[SlowDragon Administrator]

TSH 11.0 and T4 7.0.

You need to know the ranges on these results (figures in brackets after each result)

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

Keep good records of how you feel at each dose of levothyroxine

Which brand of levothyroxine suits you best etc

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

[tattybogle]

Any GP telling you that "you couldn't feel symptoms with TSH of 11" has obviously never had a TSH of 11.True , some people wouldn't feel any symptoms at that level , but i suspect they would be in the minority , (and they wouldn't have gone to see the GP with symptoms in the first place , their high TSH would have only been found by accident when doing some routine tests)

BUT some people would be unable to form a sentence or cross the road safely with TSH of 11.. it's VERY individual, and the reasons why some people are more symptomatic than others at the same level of TSH/fT4 depends on much more than just the level of TSH... most of which is not yet properly understood by anybody .. let alone your average GP.

I KNOW it's possible to feel like death, and be barely able to get through the day , and need a hat and coat on (indoors) in July with a TSH of just 6.8, and T4 still in range.

Yes ... It IS sensible to do a repeat test a few months later before starting someone on lifelong Levothroxine to replace their low thyroid hormone .. Their TSH could be temporarily raised due to an unrelated illness.... so that's why the '3 month' wait to confirm is suggested in GP's guidelines . ... But the original suggestion for you to wait '6 months' was a bit sadistic if you already told them you felt bad.

strictly speaking , according to NICE guidelines , once TSH is over 10 it is classed as 'clinical/overt hypothyroidism' , and they then don't have to wait for the 3 months confirmation .. they can start Levo straight away.

With "TSH 'over range' but under10" and if T4 is still in range ,then it's classed as 'subclinical hypothyroidism' , and then the 3 month repeat is needed before treatment can start.

It's not the TSH that makes you feel bad ,, it's the lack of T4 (and therefore T3)

Low T4 is directly replaced by an identical synthetic version Levothyroxine (LT4) .

So welcome to the world where you realise GP's aren't taught very much about thyroid symptoms or treatment.

If it's all too confusing ....

TSH (Thyroid Stimulating Hormone) is a message from the pituitary to the thyroid to ask it to make more (or less) thyroid hormones (T4 and T3)

If the T4 /3 go too low the pituitary notices and sends out more TSH to ask for more.

Easier to remember if you imagine a see-saw with TSH on one end and T4/3 on the other ,

If T4/3 get too low ,TSH rises.

If T4 /3 get to high, TSH falls to 0

(the majority of healthy people have TSH around 1 )