High TSH with Low T3 & T4

[Thyroidconfusion]

I hope you are well? I hope you can help? 6 years ago I was diagnosed with inoperable throat cancer with a large lump at the base of my tongue. After a lot of chemo and radiotherapy I have been given the all clear of the cancer. My Gp has been concerned with my high TSH since April 2019. With the highest being 9.81 in June 2019 with Range (.27-4.4) and the lowest of 3.89 in Dec 2020. I have had constant low T3 and T4 during this time. My latest tests are below. I have mild hypothyroid symptoms, weight gain, regular but mild headaches, difficulting concentrating, brain fog. Nothing life changing and certainly no where near as severe as a lot of the contributors to this site. I believe that I have subclinical, hypothyroidism but would welcome feedback from you and advise on whether with mild symptoms I should consider introducing medication. Thanks.

TSH (mlu/L) 7.17 (.27-4.4)

Free T4 (pmol/L)12.4 (12.0-22)

T4 (nmol/L) 70 (66-181)

Thyroglobulin Antibodies14.4 (0-115)

Free T3 (pmol/L)3.4(3.1-6.8)

Thyroid Peroxidase Anti (kIU/L)9.8 (0-34)

Vitamin D (nmol/L)116 (50-200)

Active B12 (pmol/L)150 (37.5-150)

Vitamin B9 (nmol/L)8.8 (8.83-45)

HBA1C (mmol/mol)35 (20-42)

Triglycerides (mmol/L)1.07 (0-1.7)

LDL (mmol/l)6.4 (0-34)

HDL (mmol/L)1.9 (1-3.88)

Tri/HDL 0.563 (0-1.75)

[greygoose]

'Subclinical' is just a red herring doctors use to get out of diagnosing people. But, hypothyroidism is like pregnancy: either you are or you aren't. And, you most definitely are. So, yes, start the treatment, I would say. I certainly would. Doesn't matter about other people's symptoms, what's important to you are your symptoms. And, you probably have a lot more that you don't even associate with thyroid - there are, after all, over 300 known symptoms of hypo. So, yes, take the treatment.

[Thyroidconfusion in reply to greygoose]

Thank you for your response. Looks like another trip to the GP. I have plenty of info to make my case. It really helps to get experienced feedback. I was concerned I was just making a fuss

[greygoose in reply to Thyroidconfusion]

Oh, no! You're not just making a fuss. Hypothyroidism is something to be taken very, very seriously.

[fuchsia-pink]

Definitely definitely take the treatment and kiss the ground that you have a supportive GP. You should be started on 50 mcg or 1 mcg per kg of body weight and then re-tested 8 weeks later and the dose increased until TSH is less than 2 - probably less than 1; free T4 and free T3 are a good 2/3 through range rather than crawling along the bottom and (most important) you feel properly well

For a lot of us going hypo is a bit like going deaf - it creeps up on you slowly and insidiously so you don't realise how bad thing have got until you start to get better. You will have to be patient, as it can take time to get onto the right doseage.

Going forwards, always have an early morning, fasting blood test (no later than 9am) when TSH is highest, and leave 24 hours from your previous dose of levo. And if you currently pay for prescriptions, don't forget to get the GP to sign a form giving you exemption (from all prescription charges, not just levo)

Good luck x

[Thyroidconfusion in reply to fuchsia-pink]

Thank you your feedback is much appreciated

[SeasideSusie Remembering]

Thyroidconfusion

Vitamin B9 (nmol/L)8.8 (8.83-45)

Did your GP say anything about this slightly below range folate level? It is too low. See cks.nice.org.uk/anaemia-b12...

Folate level

◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.

◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.

Your GP should look into this as it comes into the "suggestive of deficiency and not diagnostic" category.

Active B12 (pmol/L)150 (37.5-150)

Do you supplement with B12?

[Thyroidconfusion in reply to SeasideSusie]

Thanks for the response. I noticed the low Folate and have started to introduce more liver into my diet which hopefully will raise the levels. Yes I do supplement with B12 but I eat a lot of red meat so suspect a supplement is not really necessary. Haven't seen my GP yet for comment. The test where from Thriva as i can't get the GP to test FT3 which for me is crucial to understanding what is happening. Can't get an appointment until 28/03. Thanks

[SeasideSusie Remembering in reply to Thyroidconfusion]

Thyroidconfusion

Yes I do supplement with B12 but I eat a lot of red meat so suspect a supplement is not really necessary.

When we supplement with B12 we should always take a B Complex as well as this helps keep all the B vits balanced.

You no longer need a B12 so I'd suggest you take a good quality, bioavailable B Complex which will maintain your B12 level and help raise your folate level.

I have used Thorne Basic B for a long time and always been happy. However, it's quite expensive so I have bought some of this one to try when I've finished the last of my Thorne. The amounts of the vitamins are very similar, it's liposomal which is said to absorb better, there are no unnecessary added ingredients and better priced:

amazon.co.uk/Liposomal-Vita...

If you look at different brands then look for the words "bioavailable" or "bioactive" and ensure they contain methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid). Avoid any that contain Vit C as this stops the body from using the B12. Vit C and B12 need to be taken 2 hours apart.

When taking a B Complex we should leave this off for 3-7 days before any blood test because it contains biotin and this gives false results when biotin is used in the testing procedure (which most labs do).

[Thyroidconfusion in reply to SeasideSusie]

Thanks I will look a B complex

[SlowDragon Administrator]

Approx 50% of patients become hypothyroid after head or neck cancer treatment

ahns.info/survivorship_intr...

[Thyroidconfusion in reply to SlowDragon]

That's what I understood too. My main concern is that if it is not treated things will get worse. Thanks

[SlowDragon Administrator in reply to Thyroidconfusion]

Be aware….levothyroxine doesn’t top up failing thyroid…..dose levothyroxine is slowly increased until on full replacement

Standard starter dose of levothyroxine is 50mcg, unless over 65 years old

If over 65, then start on 25mcg …..but will still need to increase

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

[Thyroidconfusion in reply to SlowDragon]

Thank you slow Dragon, that was one of my concerns. Once you start, you are on T4 for live, although I know that there is no chance that my thyroid will suddenly spring back to full functionality.

[Thyroidconfusion in reply to Thyroidconfusion]

I hope you are well? I was unable to get a GP appointment for a few weeks so used my work BUPA cover to get a referral to an endocrinologist which is on the way. I understand that you won't be able to respond directly on this forum but can you recommend an endocrinologist in the Bath/Bristol area please? Thanks for all your help. Much appreciated.