TSH - 9.17
Free T3 - 4.55
Freethyroxine - 10.5
As of May 2022
Hi all. Is anyone familiar with the thresholds that UK doctors use to begin treating patients for hypo? The reason I ask is because, a few years ago, I was considered borderline, with levels of around TSH 6. I took a hike blood test this month by Medichecks and it came back with TSH 9 and Free thyroxine of 10. Would 9 still be considered borderline in the UK?
WelcomeI’m quite new to this myself but there are many on here that will come along with great advice.
Firstly, it will help if you post your blood test results with ranges in brackets after.
TSH
FT4
FT3
And any other results vitamin tests.
It will help us look at an overall picture.
Keep reading posts from others here and you will learn a great deal to help you decide your next steps
Sarah
i got treated on NHS by GP with TSH 6.8 (and my T4 was still in range), because i had very high thyroid antibodies showing autoimmune disease , and severe symptoms . NHS guidelines (N.I.C.E ) for Thyroid Disease say ~ GP's 'may consider' treating 'sub clinical' hypothyroidism with levo once you have "two, over-range ( but <10) TSH tests taken 3 months apart ..... and symptoms of hypothyroidism ."
They are told to take raised thyroid antibodies into account, because this shows progression to overt hypothyroidism is more likely due t autoimmune disease.
When TSH is over range but under 10 .... if fT4 is still in range [? range should be after the result in brackets ] ......then you are classed as 'sub clinical' hypothyroid .
Once TSH goes over 10 and / or fT4 goes below range , then you are classed as 'overt' hypothyroid.
Your fT4 of 10 looks likely to be below the lab range ?, which would make you 'overt' hypothyroid...a common lab range for fT4 is [12 -22] ish , but some tests are different and use [7.9-14] ish .
But if you TSH is now 9 and you have symptoms of hypothyroidism , you should be treated now with no argument , regardless of whether fT4 has fallen below range yet or not .
Ask GP to test your thyroid antibodies ~ TPOab (Thyroid Peroxidase antibodies ) to find the cause of your hypothyroidism .
nice.org.uk/guidance/ng145/...
"1.5 Managing and monitoring subclinical hypothyroidism
Tests for people with confirmed subclinical hypothyroidism
Adults
1.5.1Consider measuring TPOAbs for adults with TSH levels above the reference range, but do not repeat TPOAbs testing.
Treating subclinical hypothyroidism
1.5.2When discussing whether or not to start treatment for subclinical hypothyroidism, take into account features that might suggest underlying thyroid disease, such as symptoms of hypothyroidism, previous radioactive iodine treatment or thyroid surgery, or raised levels of thyroid autoantibodies.
Adults
1.5.3Consider levothyroxine for adults with subclinical hypothyroidism who have a TSH of 10 mlU/litre or higher on 2 separate occasions 3 months apart. Follow the recommendations in section 1.4 on follow-up and monitoring of hypothyroidism.
1.5.4Consider a 6-month trial of levothyroxine for adults under 65 with subclinical hypothyroidism who have:
a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions 3 months apart, and
symptoms of hypothyroidism.
If symptoms do not improve after starting levothyroxine, re-measure TSH and if the level remains raised, adjust the dose. If symptoms persist when serum TSH is within the reference range, consider stopping levothyroxine and follow the recommendations on monitoring untreated subclinical hypothyroidism and monitoring after stopping treatment."
I do wonder whether the gp would take the results seriously I.e. would they insist on having blood tests done every 3 months only at their surgery?
Also, in the past, the gp’s attitude has always been that it’s not my thyroid that’s making me feel the way I do. I was given anti depressants which worked for years but then have become ineffective now. I’m also now anaemic, so they will probably suggest my symptoms are down to that as opposed to thyroid issues.
ok so since they already know you have positive autoimmune antibodies that doesn't need doing again , so you should let GP know you have now had a TSH of 9.
What is the lab range for that fT4 test ? .. if 10 is 'under range' tell GP that too.
They will need to do their own NHS tests to confirm these results ... they may or may not want to make you wait 3 months to repeat, but if fT4 is under range on their test they should treat now .. and since they already know you are likely to end up overt eventually anyway (due to autoimmune thyroid disease) .. they may not make you wait the full *3 edit * months .. they might hurry it up a bit to 6 weeks.
The retest is needed to rule out a temporary rise in TSH for 'other reasons' eg, nonthyroidal illness .. they don't want to start people on lifelong levo when it's not going to be needed for life ..... but with positive thyroid antibodies , and TSH 9 this 'wait to be sure' is less necessary.
It's all the other way round .. depression is a symptom of hypothyroidism... if they'd treated your thyroid earlier you would probably not have needed the antidepressants.
hypothyroidism causes difficulty in absorbing some nutrients properly .... like iron ... so again .. if they'd treated your hypothyroidism earlier , you may not have become so anaemic.
I'm past my best at this time of night so can't remember the details about iron .. but check back in the morning when everyone is awake .. there is lots of evidence/ guidelines people can give you to help your confidence (and put under your GP's nose) to help you make sure GP doesn't just keep fobbing you off for any longer than they obviously have been.
Thank you, that is helpful. I did feel that too re the cause and effect of depression. The free t4 is under the range on medichecks which I think is between 12-22, so that came back abnormal also. I will be speaking to them tomorrow about it!
ok ,be prepared for the inevitable "well, of course private blood tests are unreliable , why have you done them ? " etc ... it is the truth that they can't accept private results .... so they will have to do their own anyway .... .... stay very calm ,and don't ever say the words 'internet' or ''forum' .......( other wise they might just decide you've got 'health anxiety' next ).
If necessary , just say you have 'looked up the NICE guidelines for thyroid ' or "spoken to ThyroidUK charity" .....
Say ThroidUk recommend you ask for tests for Ferritin / Folate / Vit b12 /Vit D ...... see if you can get GP to order them at same time as ordering your thyroid blood tests,
Good luck tomorrow ... once you've successfully remained calm and unruffled at the GP's .. you are then allowed to go 'anywhere else' and act like a demented seagull because you're so furious about how long they've not been treating you properly for .
........... I only say this because, of course, i can't manage it myself .... and the last time i went to the GP, i ended up sqwawking like a demented seagull in front of the GP ..... oh well .. but hey, do your best. Never give them any excuses to say it's in your head . They seem to prefer prescribing antidepressants to thyroid hormones ...as you've already discovered.
i forgot to mention. for when you have blood tests with the GP:TSH has a circadian rhythm.. it's highest middle of the night . gradually falling to it's lowest at about 1-3pm every day .. you want the highest TSH you can get, so book your blood tests preferably before 9 am ,,and have all future blood at similar time so they are comparable.
Easiest way to get appointments at this time is to say you are unable to get to appointments later in the day due to work commitments .... they will not accept that the time of day matters for TSH tests ( their ladybird book of instructions tells them it doesn't matter,, but time of day does make a difference ) ..... if you go at 2 pm your TSH will be lower than it would be first thing in the morning.. leaving them the opportunity to say .. "look ,it's got better than it was on your private tests"
it is the truth that they can't accept private results
I know this is what doctors tell their patients in the UK. But I've never seen any evidence that this "rule" is actually true.
I always imagine the super-wealthy Lord Muck going off to see his doctor in Harley Street getting tested by private companies. Would a GP refuse to accept those blood test results or is it only the plebs who are told they've spent their money to no purpose?
just the plebs.
Starting levothyroxine - flow chart
researchgate.net/figure/Flo...
With TSH over range, but under 10 and BELOW RANGE Ft4 your GP must start you on levothyroxine
They may wish to repeat the test themselves
Make sure you always get thyroid tested early morning, ideally before 9am
Meanwhile if you have low vitamin levels GP should be treating these too
What were actual results and ranges of
Vitamin D
Folate
B12
Ferritin
Low vitamin levels are directly linked to being hypothyroid
When hypothyroid we frequently develop low stomach acid levels this leads to poor nutrient absorption and low vitamin levels as direct result
Depression is extremely common symptom of hypothyroidism
List of hypothyroid symptoms
Tick all that apply
thyroiduk.org/if-you-are-un...
Standard starter dose of levothyroxine is 50mcg
Bloods should be retested 6-8 weeks after each dose increase
Retest thyroid levels early morning and last dose levothyroxine 24 hours before test
Likely to need several further increases in levothyroxine over coming months. Dose is increased slowly upwards in 25mcg steps retesting 6-8 weeks after each dose change or brand change in levothyroxine
I'm in the U.S, but in 2015, my TSH was 8 something and it wasn't until this year when I found a new doctor that would actually listen to me after my kidneys began to fail, rapid weight loss, loss of vision, severe lightheadedness and a host of other issues. He ran my TSH and it was almost 14 "overt hypo". He immediately put me on Levothyroxine and I am feeling good since starting on it 4 weeks ago. I too developed anemia from being hypo. My advice is to find another doctor if your current one won't help you.
Okay, thank you. I had my antibody levels taken back in 2018 and I was told they were ‘slightly elevated’ . However at the same time that test was taken, I think my TSH level was down to 3 which is the lowest it has ever been so they didn’t take any action.
It doesn't matter by how much TPO antibodies are elevated. If they are over-range you have Hashi's, if they are within range, the jury is still out. So, if you once had over-range antibodies you have Hashi's.
Thank you. I hope they will take it seriously
My sister has been hypo for 19 years her tpo is in range but her tg antibodies are 1490. She is getting more tests today by her GP but they only test tpo. Has she got hashimotos?
Hoop1888 I was in a similar situation with results, also similar to Tattybogle - High TPO antibodies and TSHs over range (but below 10) on several repeated blood tests.
I spoke to my GP armed with all the information from the amazing people here and used phrases like "from my research, the guidance seems to suggest that........" and "I've read the NICE guidelines and they say that.......".
The GP agreed to a trial of Levo without much of a fight to be honest. At one point he did ask me if I worked in the industry (which I thought was hilarious). I just said no but I like to know what's going on with my body and I can read. 😉
Hope you get a good outcome.
Mx
Hi, mine was a TSH of 12 before my GP gave me levo.
I was seeing a endo privately and he was doing all sorts of tests, which discovered I had Hashimoto’s and a TSH of 6.
. However when he did everything that confirmed I needed thyroid medication told me it wouldn’t help.
It was only when my husband had to physically dress me, and take me to my doctors looking like a zombie, they took notice.
Prior to that visit we saw another GP in the same surgery and was told it was depression and in my head.
If your struggling to get levo then lots do self medicate. I know you would probably prefer having guidance, but lots are forced too because GP stick to the thyroid guidelines. You maybe lucky and find a GP within your practice that does have experience in thyroid and listens to patients.
Best wishes
Peanut31
Hi Hoop. I've been reading the threads here and the content is mostly about results, ranges and treatment, but I was wondering what symptoms you have? If you have symptoms that make you feel ill, that would be a strong indicator that you would benefit from treatment. Symptoms would be the first thing I'd discuss with the Dr, adding in your results alongside. The Dr may then prescribe levo but he might also want to investigate other causes of your symptoms too. I was found to have antibodies in 2014 and had borderline TSH/T4 for years until becoming very hypo in 2021 when I started treatment. Starting levo may sort out a lot of problems, but as you can tell from this forum, it's not always the end of the matter I'm afraid.
My TSH was ignored for several years at 5.They finally took notice when it was just under 10 and FT4 at bottom of range. I couldn’t get up early at that point, so this test was done after lunch - I wonder what it would have been at 8.30am? My GP put me on thyroxine and then sent me to an nhs endo.
Maybe see a different doctor if you can, and follow the great advice as above. Hope you get taken seriously soon 🤗
My TSH was described as borderline by GP when it was 4.9. My FT4 was two points below the range but I don’t think GP was concerned about that,and, of course, FT3 has never been tested.When I discovered I’d been ‘borderline’ for several years I pushed for further tests (at least more than once a year) and I was given Levo, “why don’t you try a bit”, rather than offer me more tests. I was then left on 50mcg Levo for about nine months.
Should I accept GP advice for dose reduction?
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