Not so subclinical hypothyroidism

[mrskiki]

As per great advice on here, I'm taking vitamin D3 spray and also did my own results to include T3 and to baseline before I start on any medication. At 8:30am before eating.

My TSH did indeed go up to over 10 as was suggested may happen.

FT4 similar but I was previously told -ve for antibodies, as only TPO tested but the other antibodies they tested are positive so not so good ....

This test included cortisol which is also high, but I guess could be stress of trying to do the blood test, or work? I don't take any steroid/asthma medication.

Magnesium H 1.02 0.7 - 1.0 mmol/L

Cortisol (Random) 627 6am - 10am 166 - 507 nmol/L

4pm - 8pm 73.8 - 291

TSH H 14.20. 0.27 - 4.20 mU/L (8.9 GP)

T4 Total 103.0 66 - 181 nmol/L

Free T4 15.1 12.0 - 22.0 pmol/L (14.5 GP)

Free T3 5.04 3.1 - 6.8 pmol/

Anti-TPO 11 <34 IU/mL (9 GP)

Anti-Thyroglobulin Abs H 645 <115

[SlowDragon Administrator]

Looking at previous post

healthunlocked.com/thyroidu...

Has GP started you on 50mcg levothyroxine

Email/post copy of these results to GP

With TSH over 10 you must be started on levothyroxine

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

Standard STARTER dose levothyroxine is 50mcg

But dose will be increased slowly upwards in 25mcg steps until TSH is ALWAYS under 2

Most people when adequately treated will have TSH around or under one

Cortisol is often high when hypothyroid as adrenals try to compensate for lack of thyroid hormones

What were vitamin results and ranges

What vitamin supplements are you currently taking

Remember to stop taking any supplements that contain biotin a week before all blood tests

Multivitamins are never recommended on here

[mrskiki in reply to SlowDragon]

Thankyou slowdragon, I didn't retest vits, as only D3 was low so I'm taking the D3/K spray at moment instead of multivit. B was actually over range and Fe ok.I was going to ask whether to share the results, as they can get a bit tetchy but I'll do that, if they don't like self test results i'd happy do another GP test to save my fingers .....

[SlowDragon Administrator]

High TG antibodies can cause significant symptoms

pubmed.ncbi.nlm.nih.gov/303...

Should reduce as TSH lowers

[mrskiki in reply to SlowDragon]

Thanks, helps explain why I feel so odd with only marginally off numbers from the GP tests. Shows why it's so important to understand the tests you don't get from your gp as well as the exact numbers for the ones you do!

[SlowDragon Administrator in reply to mrskiki]

Have you been prescribed levothyroxine yet?

[mrskiki]

When I got the prescription from the chemist it was 25mg as warned with a recommendation to retest in 3 months and increase dose if needed. Now I've got my self test results, I realise my slight hope of not needing medication is firmly on my 'who are you kidding' list now. I was also worried about having to travel last weekend - starting new meds whilst away, with travel insurance and all, but those plans were thankfully put on hold end of last week due to Omicron so I was able to do the self test when it arrived.

[SlowDragon Administrator in reply to mrskiki]

Which brand is 25mcg

Teva brand upsets many people

25mcg is for over 65 year olds or patients with heart conditions

Can make you feel worse initially starting on too low a dose

Getting next blood test at 6-8 weeks so can get next dose increase asap up to 50mcg

[JAmanda in reply to SlowDragon]

Agree please don’t start on 25. Call Doc and say I’ve read 50 is starter dose and that 25 can make people feel worse not better.

[mrskiki in reply to JAmanda]

Thanks, I am trying for another telephone appointment, don't know what Is do without all of the experience on here!

[mrskiki]

The brand was wockhardt and I checked it doesn't have that mannitol filler mentioned on here as I'm fine with Lactose. I didn't realise quite how difficult brand and dosage could be until reading around here. I didn't know you could feel worse on low dose, just thought it might do nothing. i think she was uncertain because tsh < 10 but didn't want to leave me untreated for 3 months because of my tiredness, these latest results will hopefully make it easier.

[SlowDragon Administrator in reply to mrskiki]

Standard starter dose of levothyroxine is 50mcg Bloods should be retested 6-8 weeks after each dose change and dose is increased slowly upwards in 25mcg steps until TSH is ALWAYS under 2

You can say you have read NICE guidelines and advice from Thyroid U.K. support group (don’t mention online forum )

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

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

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

With TSH over 10 you are clinically hypothyroid (not sub clinical)

[mrskiki in reply to SlowDragon]

Thank you SlowDragon, yes I was a bit confused whether I was sub or not as my T4 is still in range but low, but now know my antibodies are positive and I have those symptoms in the paper you linked to and badly swollen up eyes. I was surprised tbh when TPO was negative but I guess it's Ords now, guess the treatment the same so they don't put much emphasis on the antibodies but it's do useful to help with understanding. This has all really convinced me I need to start treatment and on dose of 50 especially with my weight gain 🙄

[SlowDragon Administrator in reply to mrskiki]

Come back with new post once you get results 6-8 weeks after starting on 50mcg

You can start on 25mcg now and meanwhile push GP to increase levothyroxine dose to 50mcg