When should I take medication for under active thyroid

[Labby1955]

I am on the under active thyroid chart but not lower enough to take medication. I have had my bloods taken yearly for the passed three years. Some doctors say take a low does and another said you are only border so to wait Advice wanted on this issue

[fuchsia-pink]

Welcome to the forum.

Do you have any blood results to share, so we can see how "borderline" you are? In many countries you would be treated when TSH is 3 or more, but in the UK they will often wait until it gets to an astonishing 10 - even though the lab range usually has a maximum of around 4 (lab ranges vary from lab to lab, so we always need the lab range as well as the blood result) - and a euthyroid person (ie one with no thyroid issues) won't have a TSH of more than 2.

TSH is a message from the pituitary to the thyroid, basically telling it to work harder if it doesn't produce enough hormone, so that the higher TSH, the worse your thyroid is doing.

But TSH can't tell you if the message is getting through to the thyroid, or being acted on. For that, you need to test your actual thyroid hormones. Free T4 will measure the inactive hormone your body produces, and isn't usually that controversial to get tested, You really want this nice and high - at least 2/3 through the lab range; and ideally also want to have free T3 tested - this is the active thyroid hormone, needed in every cell in your body. Your T4 converts into T3 and some people (like me) are "poor converters" so that a good free T4 result doesn't always translate into a decent free T3 result. This is harder to get tested.

It's also worth having your thyroid antibodies tested. Around 90% of people with an under-active thyroid have raised antibodies, indicating Hashimoto's (or Hashi's). This in itself isn't a worry and can't be cured - but DOES mean that your thyroid is likely to struggle in the future if it isn't now. Your antibodies will jump about as they see fit, so you only need one over-range result (ie it's not worth testing again and again). If you do get re-tests and they are lower than before, it doesn't mean that it's "getting better" - they're just low on that occasion and will bounce back later.

SO you can usually get thyroid meds prescribed even if TSH is less than the "magic" 10 if you have two over-range results AND either antibodies are high OR free T4 is under-range.

You are legally entitled to your blood results. You don't need to give a reason, but it's usually easiest to say you want them "for my records" or register for on-line access. Good luck x

[Labby1955 in reply to fuchsia-pink]

Great knowledge and explanation. I am in the uk and have never seen my results. I will try and ask to see my results on line.

Thank you so much with your response

[shaws Administrator in reply to Labby1955]

You may already be aware of how to get the best results when having a blood test for thyroid hormones:-

Always book the earliest blood draw - even if you make it weeks ahead, It is a fasting test (you can drink water) and don't take thyroid hormone replacement before blood draw but afterwards. We take thyroid hormones with one glass of water and wait an hour before we eat (food can affect the uptake of hormones).

Always request a print-out of your blood test results for your own records and post if you have any queries.

When your next blood test is due also request a check for B12, Vit D, iron, ferritin and folate .

Put your results on a new post for comments.

[SlowDragon Administrator]

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

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

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.

In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)

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

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). Ord’s is autoimmune without goitre.

About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s.

Gluten intolerance is often a hidden issue too. Request coeliac blood test BEFORE considering trial on strictly gluten free diet

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

List of hypothyroid symptoms

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

See flow charts on here re starting levothyroxine

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

Once we start on levothyroxine, almost everyone will eventually end up on full replacement dose. Feedback mechanism means that levothyroxine doesn’t “top up” failing thyroid, it replaces it

[Labby1955 in reply to SlowDragon]

Thanks, all of this is extremely helpful. I will be requesting my copies. Just had my appointments cancelled due to the boosters being given so will update when I have any results.

Once again thank you