Confused

[Antibodie]

My free T4 level is 11.6 and TSH level is 4.66 my finger nails are splitting vertically and dentist told me to see GP as my teeth are getting loose I can't get appointment due to restrictions at surgery due to covid my thyroid antibodies are high 352

[SlowDragon Administrator]

Are you on levothyroxine or trying to get diagnosed?

Appointments are getting back to normal slowly

Email/phone surgery and request FULL thyroid and vitamin blood testing

TSH, Ft4 and Ft3, plus vitamin D, folate, ferritin and B12 and coeliac blood test

When was this previous thyroid test done

Please add ranges on these results (figures in brackets after results)

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

For full Thyroid evaluation you need TSH, FT4 and FT3 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

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 early morning, ideally before 9am ….if on levothyroxine last dose levothyroxine 24 hours before test

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 and money off codes

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...

[SlowDragon Administrator]

If trying to get diagnosed

You need 2 thyroid tests with TSH over 5

Or

Ft4 below bottom of range

To get highest TSH test early morning

Very important to test vitamin levels as low vitamins tend to lower TSH

Test and improve and Maintaining all four vitamins at GOOD Levels important

High thyroid antibodies and symptoms should get you starting on levothyroxine

Starting levothyroxine - see this flow chart

researchgate.net/figure/Flo...

If already on levothyroxine, dose should be increased by 25mcg and retest in 6-8 weeks.

[Antibodie in reply to SlowDragon]

I'm on 50gm levothyroxine from August 2021

[SlowDragon Administrator in reply to Antibodie]

50mcg is only the standard STARTER dose

On levothyroxine the aim is to increase the dose slowly upwards in 25mcg steps until TSH is around one, all symptoms gone

Typically Ft3 at least 50-60% through range and Ft4 usually a little higher

Make appointment with GP and request/politely insist on 25mcg dose increase in levothyroxine up to 75mcg

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

Likely to need further increase in levothyroxine after next test or over coming months

Which brand of levothyroxine are you currently taking

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

Persevere - have all guidelines printed and be ready to quote them

healthunlocked.com/thyroidu...

[SeasideSusie Remembering]

Antibodie

Has your dentist not discussed any possibility of why your teeth are getting loose? I would have thought that was their job.

At my surgery, and I don't know if this is now the norm, if you have anything wrong with your mouth/teeth they say you must see your dentist, and if there's anything wrong with your eyes they say you must see your optician, they wont entertain looking at these problems.

[Sparklingsunshine in reply to SeasideSusie]

Hi

It's the norm, if you're very lucky you might be able to get emergency antibiotics from a GP for a dental abscess or infected tooth, my so had this during the first lockdown and dentists weren't seeing anyone. My son was in agony and painkillers just weren't helping.

The GP prescribed him some amoxicillin to get him through and fortunately they did the trick and the pain went away until the dentists reopened. But anything eye related, unless it's an infection or an emergency, you are told to go to the opticians. It's been like that for a while.

Similarly many GPs are no longer treating earwax, you now have to pay to get it removed. Around £50. The list of conditions the NHS no longer treats is getting longer by the day.

[SeasideSusie Remembering in reply to Sparklingsunshine]

Ah yes, I'd forgotten about the ear wax!

[Sparklingsunshine in reply to SeasideSusie]

Podiatry is another victim to cuts. Unless you are diabetic or have joint problems like arthritis, you have to go private. I'm lucky in a way, I've got a long history of foot problems like plantar fasciitis and because I have Ehlers Danlos, I can still get NHS treatment.

But they've moved the dept that does any surgical procedures over 20 miles away and when I developed a lump on the tendon which needed removing I had to turn it down. I dont drive, we don't own a car and I didn't have anyone I could ask. And hopping on public transport after an operation didn't appeal.

[Antibodie in reply to SeasideSusie]

Dentist said oral hygiene good loose teeth down to thyroid see GP

[greygoose in reply to Antibodie]

Yes, you need an increase in your dose of levo. 50 mcg is only a starter dose, and with a TSH of over 4 you are still hypo. Your doctor is being negligent! Low levels of thyroid hormone can wreak havoc on your teeth. Your dentist is right, you should see your doctor and insist on an increase in dose - and keep increasing until your TSH comes down to about 1, and your FT4 is at least over mid-range.

[SeasideSusie Remembering in reply to Antibodie]

Antibodie

Dentist said oral hygiene good loose teeth down to thyroid see GP

Well you'll just have to keep badgering the surgery, make a nuisance of yourself, ring every day, ask to speak to the practice manager and explain you have seen the dentist and the dentist insists it's a GP job not theirs. My surgery is seeing patients face to face now, precautions in place but been seeing them for about 3 months and been doing routine blood tests even longer. Even if you have a telephone appointment it's a start. If GP says it's your dentist's job then invite GP to argue that out with your dentist.

[SlowDragon Administrator]

Also request/insist on testing vitamin D, folate, ferritin and B12 if not been tested in last 6 months

High thyroid antibodies confirms autoimmune thyroid disease (hashimoto’s)

Low vitamin levels and gluten intolerance are common with autoimmune thyroid disease

Have you had vitamin levels tested at all

What vitamin supplements are you currently taking

If not had coeliac blood test done, GP should also do this

5% of Hashimoto’s patients are coeliac, further 80% find strictly gluten free diet helps or is essential

GP should test for coeliac

nice.org.uk/guidance/ng20/c...

1.1.1 Offer serological testing for coeliac disease to:

people with any of the following:

persistent unexplained abdominal or gastrointestinal symptoms

faltering growth

prolonged fatigue

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes, at diagnosis

autoimmune thyroid disease, at diagnosis

irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease.