The receptionist at my gp surgery told me that my blood tests showed that I had an under active thyroid and vitamin b12 deficiency. I have an appointment tomorrow morning and I wondered if anyone had any advice on what to ask. I thought that I was experiencing symptoms of the menopause and have not felt myself for months. From what I have read most of my symptoms could be related to the two conditions listed above. I am pretty desperate to start feeling better so I am hoping that I can start treatment. Is it likely that I would be started on treatment straight away ?
Any advice or help would be greatly appreciated
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Mst27
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Is it likely that I would be started on treatment straight away ?
For underactive thyroid (hypothyroidism ) that would depend on the actual numbers on this blood test.
TSH.. this is a message from the pituitary to the thyroid, to ask for more (or less) thyroid hormone (T4) to be produced .. so TSH goes up when we are hypothyroid (not enough T4) and it goes down when we have enough/too much T4.
When we are producing the right amount of T4 , TSH stays around 1 for most people .. but the range is usually 0.4 to 4.5 (ish) (You must have gone over range for them to mention underactive thyroid to you ).
* If it's your first over range TSH result ...
if it is over range but still under 10.... they will want to repeat it in about 3 months (to see if it gets better on it's own ) before prescribing Levothyroxine .
If it is already higher than 10 .. they are more likely to start you on Levo straight away.
* fT4 (free T4) this is the actual thyroid hormone .. (T4 gets turned into T3 which works in your cells .. if T4 / T3 is low TSH rises.
If TSH is over range, then the lab will usually test fT4 too (to see why TSH is high)
If TSH is over range(but under 10) and fT4 is still in range .. then they will retest after about 3 months.. sometimes earlier.
If TSH is over range AND fT4 is under range they may start you on Levo straight away.
Hypothyroid symptoms and the presence (or not) of thyroid antibodies (indicating autoimmune thyroid disease) will also play a part in the GP's decision to start Levothyroxine
About 99% of primary hypothyroidism is autoimmune thyroid disease diagnosed by high thyroid antibodies.
If GP hasn’t yet tested thyroid antibodies, request they test them
Also very important to test vitamin D, folate, ferritin and B12 as these are often low when hypothyroid
Starting levothyroxine
Standard starter dose of levothyroxine is 50mcg
Levothyroxine is an extremely fussy hormone and should always be taken on an 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
A lot depends on your results, if you can access them online you could post them with the reference ranges. You might be very hypo in which case you are likely to be offered Levothyroxine straight away or they might adopt a wait and see approach. It depends how high your TSH results were and if they measured FT4.
I first had blood tests in February 2020 for thyroid, mine came back borderline hypo. So had to wait 3 months and they retested again in June that year and I'd gone into the abnormal range with low FT4. So I got 50mcg of Levo and its increased steadily ever since. My results are far from optimal but I keep taking the tablets. They usually test every 6-8 weeks after a dose increase.
As regards B12 well again this depends on why you're deficient. If its diet related you're likely to be told to increase dietary sources of B12 or offered high strength supplements.
However if its Pernicious Anemia, like I have, then no amount of tablets will help because we can't absorb B12 because we lack an enzyme produced by the stomach called intrinsic factor. So in that case you are likely to be offered B12 injections which go into your upper arm.
Depending on how low your level is they give you a series of jabs called a loading dose. I think I had 5 every other day then it's a jab every 10-13 weeks. They sting a bit but they can really make a huge difference to how you feel. I know when I need one for sure.
B12 deficiency can be debilitating and untreated can cause permanent neurological damage so it needs sorting out. Hopefully you'll feel better soon.
It might be best if from now on you get a hold of your blood test results, to see exactly what has (& hasn’t) been tested as well as what the results are.
Its ideal to arrange online access, ask if your practice offer it. If not obtain copies via reception. Don’t ask Dr they don’t like it & don’t accept verbal or hand scribbled notes you need a printed copy with ranges (ranges vary between labs so essential). They shouldn’t ask why but if they do try to resist just say they are for your records. You are legally entitled to them.
For full thyroid function you need:
TSH
FT4
FT3
TPO & TG Antibodies
Folate
Ferritin
B12
Vitamin D
You know B12 is an issue, if you have an underactive thyroid other nutrients are often low & dr may not have tested them all. You need optimal levels. Especially if you need to begin replacement thyroxine (levothyroxine) if levels not optimal it won’t work well. Optimal is not same as in range which what doctors are satisfied with.
Hi my appointment went well I think. My test results were T4 11.5 (11.0-21.2)
TSH 6.94 (0.27-4.2)
Vitamin b12 195 (197-771)
Folate 2.8 (3.0-20.0)
I have been prescribed 25mg of levothyroxin once a day and supplements for 100mg b12 and 5mg folic acid. I have also been told to take 2000mg of vitamin d but this has not been prescribed. The supplements are for 2 months and I have been advised to try to increase these through my diet.
I know from reading on here to take the levothyroxin on an empty stomach and not to eat for an hour after but wondered if there are any rules about taking the supplements. I thought I had to wait for 2 hours after taking the levothyroxin which I did but not sure I have this right. Also wondered what people thought about my results are they pretty normal for people with an under active thyroid? If there is a normal!
Thanks again for any help understanding all of this it’s a lot to take in when your brain is full of fog .
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