For years I have been told I have a borderline underactive thyroid but never been given any medication for it. In February last year my tsh levels were 5.5. In June last year they were 3.8. I am visiting the doctor tomorrow and just wondering what questions I should ask.
Following a miscarriage a number of years ago I have been trying (unsuccessfully) to conceive. My skin is dry, hair is brittle, I've low energy and mood and despite every effort I keep gaining weight. My periods are regular, but extremely heavy and painful and I have experienced incidents of flooding over the past few months and just been told to take ponstan. I'm tired of being fobbed off, the doctor keeps telling my my thyroid is in normal range. Am I right in saying my tsh should be below 2.5 especially when trying to conceive?
Thanks all
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T683
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I am visiting the doctor tomorrow and just wondering what questions I should ask.
As for a full thyroid panel to include:
TSH
FT4
FT3
Thyroid antibodies
Also ask for key nutrients to be tested:
Vit D
B12
Folate
Ferritin
As you will need the highest possible TSH to help with diagnosis then make a future appointment for your blood test no later than 9am.
This is what we advise for thyroid blood tests:
* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.
In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:
If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.
* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.
[* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.]
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
Get a print out of your results and any past results, it is our legal right in the UK to have a copy of our test results so ask the receptionist (not the doctor) a couple of days after your blood test, the results should be back then. Your GP will have to see your results befor they are passed on to you. Or if your surgery offers online access to results then find them there. Once you have the results then post them, along with their reference ranges (ranges vary from lab to lab so we must have the ranges your lab uses to be able to interpret you results).
Once we have this information we can help you with the way forward.
Your TSH may be within-range, but it is too high in-range. It's the ranges that are wrong. A euthyroid TSH (normal) would never be above 2.
Do you always have your blood draw at the same time of day? Because TSH is highest before 9 am, then drops to its lowest point around midday, before starting to rise again to its highest around midnight. So, even though doctors say it doesn't, it does matter what time of day you have the blood draw.
Is TSH all they test? If so, that is totally inadequate and cannot always rule out hypothyroidism. You need full testing:
For years I have been told I have a borderline underactive thyroid but never been given any medication for it.
I was told that my thyroid was "borderline underactive" by an IVF Clinic back in the early 1990s. But they also said I didn't need treatment. I didn't get my first prescription for Levothyroxine until 2013, when I was still considered to be only suffering from subclinical hypothyroidism (my TSH has never reached 6), and my doctor was angry with me for pleading for treatment for my thyroid. My hypothyroidism hadn't progressed at all in 23 years as far as my TSH was concerned (although I don't know what my TSH was in the early 90s - I wasn't given any numbers, I just knew it was "borderline underactive"). My Free T3 in 2013 was 8% of the way through the reference range, and my Free T4 was not much higher in terms of percentage.
Back in the 90s I did IVF five times, got pregnant three times, and lost all of them in the first trimester. I've never had children.
I would suggest that you might have central hypothyroidism but without results it is impossible to say. This is where the problem would be caused by a poorly functioning pituitary (which produces TSH) rather than your thyroid. Without sufficient TSH your thyroid can't do its job properly even if it is healthy.
Since central hypothyroidism leads to low thyroid hormone levels (just like primary hypothyroidism) you are likely to be suffering from all the same effects as anyone else who is hypothyroid for other reasons.
One of the main effects of low thyroid hormones is low stomach acid. This leads to all sorts of gut problems, and low nutrient levels.
If you want to have children I would suggest that (temporarily) you forget about it, and start looking after yourself. Get private tests of what your thyroid hormone levels are, and what your nutrient levels are. The nutrients most often discussed on this forum are vitamin B12, folate, vitamin D, ferritin (iron stores). They are important for converting T4 (a storage hormone) to T3 (the active thyroid hormone).
Vitamins and minerals can be bought to improve your nutrient levels, you don't need to beg from a doctor. But you need to know the best forms to buy - not all supplements are the same.
Once you have found out what your TSH, Free T4 and Free T3 are you might be able to convince a doctor to treat you. Or if the worst comes to the worst you could buy thyroid hormone online. But hopefully it won't come to that.
Once your thyroid hormone levels are better, and your nutrients are optimal you will dramatically increase your chances of becoming and staying pregnant, and maintaining a pregnancy until birth. You will also improve the health of any offspring you have. Note that nutrients and thyroid hormones, once optimised, must be maintained, you can't just stop taking them all after reaching optimal.
Before spending money on private testing write another post and tell us what you want to test and we can direct you to the tests that are best value for money, and in some cases can point you to useful discount codes.
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