Hypothyroid : Hello folks please to meet you but... - Thyroid UK

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Hypothyroid

PeterpPiper profile image

Hello folks please to meet you but not so please to have to be here :) I’m sure we all the same.

Im just trying to get my head around my readings and how hypo I am .. my readings are as follows any advice is mist welcome thankyou

Serum free T4 = 15 pmol/L

Serum TSH = 4.99 mIU/L

35 Replies
RedApple profile image
RedAppleAdministrator

Welcome to the forum PeterpPiper

Are you taking any thyroid medication?

PeterpPiper profile image
PeterpPiper in reply to RedApple

Thanks for your reply RedApple I’ve just been prescribed 50mcg of thyroxine start it tomorrow but I’m trying to work out how much under the norm my readings are as I’m getting conflicting into off google The readings I list are without any meds

RedApple profile image
RedAppleAdministrator in reply to PeterpPiper

You need to obtain the actual reference ranges for your test results from your GP. This is the most accurate way to read your own results because the labs that process our tests can have varying equipment and reference ranges. So you can't compare your results with the ranges you might find on google. Also, ranges will vary according to country, and you might see ranges from e.g USA :)

PeterpPiper profile image
PeterpPiper in reply to RedApple

Thanks . It does refer to a reference range on my report of 0.27 - 4.20 IU/L and 11.00 - 22 pmoI/L Whatever that’s all about :) my doc says I’m hypo but I got confused looking at ranges online which made my readings look normal .. thanks again for your reply

Serum free T4 = 15 pmol/L (11-22) 36.36%

Serum TSH = 4.99 mIU/L (0.27-4.2)

As you can see, your TSH is above range. A euthyroid (normal) TSH would be around 1.

Your FT4 is very low. A euthyroid FT4 would be around mid-range. (Handy percentage calculator here: thyroid.dopiaza.org/ )

So, yes, you are pretty hypo. :)

Thanks for that and the calculator. I feel totally fine, the result just came up in my annual test .. just hope I don’t start walking up the walls and dancing on the ceiling when I take the meds .. thanks for the info greygoose

No, I really don't think you'll do that. lol Thyroid hormone is not a stimulant.

Thanks for the reassurance:)

You're welcome. :)

Welcome!

50mcg levothyroxine is the starter dose to treat hypothyroidismYou need to have a further test after 6/8 weeks

The results (and further test results following increases) will determine the need for further increase(s)

More than 50mcg is usually required

FT4 should approach 75% through the reference range

Your result is only 36.4% so you will need to raise this with replacement T4/ levothyroxine

When medicated TSH should be 1 or less.

The result may sit within the reference range but that does not mean it is "normal" or right for you.

For good health the result needs to sit at a point within the range where you feel well.

Tests should be done around 8am and away from food and drinks

Important to remember that levothyroxine is not a drug per se but a replacement thyroid hormone.

Thanks for that Dippy I appreciate your explanation. Worth mentioning I feel just fine which is odd .. the result just came up on an annual health blood test .

The bottom line is that we are all different individuals with different treatment needs.but time and further testing will tell...

It is worth noting that high cholesterol is/can be a hypo symptom and that a healthy heart needs a decent level of thyroid hormone/T3 ( the active thyroid hormone)

You really need to have a full thyroid test ddone to get the full picture..

TSH, FT4, FT3, vit D, vit B12, folate, ferritin and thyroid antibodies TPO and TG

Instead of trawling the net for information this might help

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

Thanks Dippy much appreciated.

On this forum people often report being unwell when their lab work is good and we, rightly, argue that symptoms are the true diagnostic not the lab work. So here we have the converse, someone with pretty bad lab results but feeling fine. Should we not suggest caution to PeterpPiper in medicating if they truly don't have hypo symptoms?

Partner20 profile image
Partner20 in reply to Cornwaller

Absolutely. At the very least these tests should be repeated prior to any treatment to see if the results are replicated. Antibody testing should also be done. The results currently posted might not be optimal for anyone diagnosed with hypothyroidism and receiving treatment, but they are by no means awful! We are all different, and sit at different points within any range, and yes, symptoms should be taken into account too. There are several reasons why tsh can be elevated, and, if not by hypothyroidism, replacement hormones should not be given. The need for them should be unquestionably established in the first instance.

Usually doctors wait for two consecutive over-range TSH results 3 months apart before starting Levothyroxine treatment. TSH can be raised by other things sometimes like a recent infection. Many doctors in the UK won't start treatment until TSH gets nearer 10. If you have no symptoms it might be worth waiting for a second abnormal test result.

Currently you are what is classed as 'subclinical' hypothyroid.

Subclinical = TSH over range /fT4 still within range

This means your TSH is a little bit raised , and has gone over the limit's of the levels found in 95% of the healthy population.

While your fT4 is still comfortably within the range of what 95% of healthy people will have.

Some people have symptoms at this point and some don't.

1) Before considering treatment for subclinical cases, they first need to repeat the tests after about 3 months to rule out a 'one off' raised TSH that could have been seen for several other temporary reasons

2) After that , the decision to 'treat now' or 'wait and see' is based on :

~ Symptoms.

~ Whether they find raised antibodies (TPOab Thyroid Peroxidase antibodies).

If they find raised TPOab then this shows them a clear cause for the hypothroidism, and so they know there is a much higher chance that it will eventually get worse and fT4 will end up under range at some point, once more thyroid tissue has been damaged by the immune system .

So raised antibodies will mean they are more confident about treating when TSH is only slightly raised, and fT4 is still in range.

As to how 'bad' yours is :

See this graph healthunlocked.com/thyroidu... it show the % of healthy people with various levels of TSH... most people are usually about 1 ish , 3 pretty unusual. and over 4 is highly unlikely when healthy

The fact that your fT4 is 15 pmol/L (11-22) 36.36% might be perfectly normal , (plenty of healthy people have their fT4 at that level), but the fact that your TSH is 4.99 shows that your thyroid hormone regulating system thinks you need more thyroid hormone.

TSH (Thyroid Stimulating Hormone) is a signal from the pituitary to your thyroid gland asking for more or less thyroid hormone (T4/T3).

When T4/3 are low, the TSH goes up.

When T4/3 are high , the TSH goes down.

Personally, if i had your results and i felt absolutely fine, i would not start Levo unless/until i had symptoms that were casing me a problem.

Not because Levo causes any harm , but because if i've learned one thing about replacing thyroid hormones, it is . "if you feel well ~ don't mess with anything " .

Thyroid hormones are controlled by an extremely complex regulating system and adding some T4 in the form of Levo inevitably affects the balance of how it works. and it can take a long time (months at least) to find the right dose that replaces your levels correctly,

Also while you are using added T4 you will not get the same levels of T3 as the system makes on it's own. and T3 is the one that actually does anything ., (T4 is a kind of inactive /storage/ transport form of the active T3 )

So there is a risk that if starting Levo when you feel well , you may then feel less well .

However . statistically , there are some slight increased long term risks associated with untreated subclinical hypothyroidism,

But if you do try Levo and it makes you worse , there is nothing stopping you coming off it , and after a month or so your thyroid should then go back to making however much T4/3 it is capable of .

Assuming this is your second over range TSH test ? (If not, it needs confirming in 3 months time before considering Levo ).......

.... You now have two options :

you can wait and see if you get any problems with symptoms before adding T4 from Levo,

or you can try it now .

Thankyou for this information. Most appreciated. My doc seemed keen to start it. This is my first test so nothing to compare it with . I do have a heart condition as well and am on statins and blood pressure tabs etc so she may have been concerned about that. I do feel just fine on all these meds .. so I am a bit concerned about any messing with thyroid . I took my first 50mcg tablet today .. I now feel a bit concerned about it all but guess I will follow docs orders … from what I read above her treatment seems a bit hasty

Ah ..... 'heart condition' might put a different spin on it. Not something i understand much about, but some of those 'statistical risks of untreated subclinical hypothyroidism' i mentioned, are to do with the heart.

And untreated hypothyroidism can cause raised cholesterol, which goes down once hypothyroidism is treated .

So i guess it's possible her hastyness might make more sense in your case, but i don't know enough about hearts to be sure of that.

This post healthunlocked.com/thyroidu.... might come in useful to you one day.

It has a link to an article written for GP's by a cardiology registrar, and an endocrinologist, explaining effects of low / high thyroid hormones on heart/ cardiovascular system.

I've often read that people with heart conditions ( i don't know which 'heart conditions' ) are only given 25mcg Levo to start with, so that any effects of increasing their thyroid hormone level are more gradual than starting with 50mcg in one go . But i really don't know if this is an issue that concerns your situation or not .

Yes the heart side of it probably plays a part especially as my cholesterol was very high before statins (but now fine) I still think your suggestion of taking a second reading in 3 weeks before going on meds would be sensible but hey, I suppose we have to trust in these experts .even if they only go from textbook references and phone calls with the patient . I will read the article you linked and thanks again for taking the trouble to write ..

You're Welcome :)

3 months . (not 3 weeks ) that's the NHS guideline for a repeat TSH test when first one was over range. It is very unusual to be started with just one. I suppose you could ask for a call back from the GP who prescribed it to clarify why she wants to start with only one over range Test ..... might put your mind at rest.

There are lots of people on here with heart conditions and hypothyroid, but more of them will notice and respond if you wrote a new post with 'heart' in the title.

I’m getting a blood check in 6 weeks after starting meds … I’m just going to run with it but will certainly be on to the doc if I start to feel bad in the meantime … Before my heart issue just over a year ago I never took any meds not even parasitomol but I’m sure making up for lost time now.. Good Health to you :)

OK, hopefully you'll have no problems, lot's of people don't ... (the ones who do are on here ) All being well, GP can handle it without any problems , but if you get stuck , you know where we are :)

Thanks it’s a comfort to find folks with experience.

Lulu2607 profile image
Lulu2607 in reply to tattybogle

I totally agree with tattybogle. The NHS website even advises not to medicate in circumstances like yours so maybe your Dr is being a bit hasty. I hope you manage to sort it out PeterPiper.

Your heart problem might be caused by the thyroid, so it's possible that you had raised levels before. High cholesterol in particular could be a low T3. I'm totally against statins, if you research them there's very little evidence in favour.

mistydog profile image
mistydog in reply to mistydog

I'd get copies of all previous tests and take a look at the pattern.

PeterpPiper profile image
PeterpPiper in reply to mistydog

Thanks it’s a sensible idea but I don’t have any other thryroid results

mistydog profile image
mistydog in reply to PeterpPiper

Have you got access to them all? Because you may have been checked and not told

PeterpPiper profile image
PeterpPiper in reply to mistydog

I wasn’t one for going to the docs over the decades so there is limited history .. I did have blood tests after my heart issue but the nurse last week said she could see no previous thyroid readings .. I did have a parotid (saliver) gland removed over 20 years ago and I might do some research to see if that might have any connection with reduced thyroid hormone … one thing leads to another doesn’t it, your knee bone is connect to your thigh bone in other words :))

mistydog profile image
mistydog in reply to PeterpPiper

Absolutely, was it just the one? Were you told to take calcium?

PeterpPiper profile image
PeterpPiper in reply to mistydog

Just the one parotid gland yes. I’ve not taken or been advised to take calcium

PurpleNails profile image
PurpleNails in reply to mistydog

Why would removal of parotid need calcium? Just wondering is you are confusing with parathyroid which control calcium. Parotid one of the salivary glands. Being hypothyroid can cause swelling. What was the reason for removal?

mistydog profile image
mistydog in reply to PurpleNails

Ah yes sorry was confusing the two. As you were.

PeterpPiper profile image
PeterpPiper in reply to mistydog

Good point it might be

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