Questions to ask GP on Brand New Diagnosis

[Cariboudle]

Hello all,

I have just had my first blood test since I was in my early 20s (I'm in my early 40s now) and it seems to suggest I am in the borderline hypothyroid area.

Serum free T4 level - 15.4 pmol/L - Normal

Serum TSH level - 5.63 mu/L - Abnormal

Note: The results are out but I have not yet discussed these with my GP. I have a telephone consult arranged for the 18th October and don't want to waste my 15 minutes being flustered or un-prepared.

I was hoping some of you might have suggestions on the types of questions I could ask, the information I need to walk away with, or could point me in the direction of some decent literature online to swot up on.

Not sure if it's relevant but I had a full blood count, liver and kidney function, diabetes and hormone tests at the same time. These revealed 'normal' or 'nothing significant' results.

Out of interest, would the above results lead to medication straight away or, since it's just 'borderline' would it be a case of monitoring?

Thoughts/comments/suggestions welcome.

[SlowDragon Administrator]

Welcome to the forum

First question is how do you feel

Was test done early morning, this gives highest TSH

Yes you will need a second blood test in 6-8 weeks ……and this should include testing thyroid antibodies for autoimmune thyroid disease

Also important to test vitamin D, folate, ferritin and B12

Have any of these been tested?

What was cholesterol result?

High cholesterol is often linked to being hypothyroid

Starting levothyroxine - flow chart 

gps.northcentrallondonccg.n...

[Cariboudle in reply to SlowDragon]

Hi SlowDragon thanks for responding so quickly!

My bloods were taken at about 11:30am - is that likely to still be very high?

I have been feeling tired, down, and gaining weight for the last few years but thought it was a mental health issue - the reason I asked for bloods was because I found out a lot of my family have thyroid issues and I began to wonder if it was that (they live in another country so I didn't know until I visited a few months ago).

I had:

Thyroid function test (high TSH, normal T4)

Full Blood Count (Mostly normal - high eosinophil, low basophil and low platelet volume - nothing significant)

FSH/LH (normal)

HbA1c level (Normal)

eGFRcreat (Normal)

Renal Profile (High serum potassium - nothing significant)

Liver Function (High Serum Alt level - nothing significant)

Serum Lipids (Normal)

They didn't test for VitD, B12, Folate or Ferritin. I will ask the GP about that.

[SlowDragon Administrator in reply to Cariboudle]

So TSH would have been higher if tested at 9am

Book next test for early morning

“Normal “ is not a result- you need actual results and ranges

Easiest option is to request online access to your medical records including blood test results

speak to receptionist to get that set up

[SlowDragon Administrator in reply to Cariboudle]

They didn't test for VitD, B12, Folate or Ferritin. I will ask the GP about that.

Also very important to test thyroid antibodies

As you have family members with thyroid disease, it’s more likely you have thyroid antibodies

Tiredness, anxiety and depression are all hypothyroid symptoms

[Cariboudle in reply to SlowDragon]

Apologies I have got the full results just didn't figure you'd need the actual readings of anything besides the Thyroid stuff. I used the words 'normal' and 'nothing significant' because these are the comments on the test results.

Serum cholesterol - 5.5 mmol/L

Serum HDL cholesterol level - 1.35 mmol/L

Serum triglycerides - 1.6 mmol/L

Serum cholesterol/HDL ratio - 4.1

Serum LDL cholesterol level - 3.4 mmol/L

Se non HDL cholesterol level - 4.15 mmol/L

[SlowDragon Administrator in reply to Cariboudle]

what’s the range on cholesterol

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

[Cariboudle in reply to SlowDragon]

For most of them, no range is given. Screenshot below. The comment on the report is 'normal'.

The only one with a range is serum triglycerides and I'm just within normal there.

Serum Lipids

[SlowDragon Administrator in reply to Cariboudle]

hopeless ….isn’t it

Ok

Never mind

[Cariboudle in reply to SlowDragon]

Thanks for your help, though, I'll ask about the vitamin tests and talk about cholesterol with the GP.

Edit: and thyroid antibodies

[Sparklingsunshine]

Hi

Its very likely theyll want to restest your thyroid in 3 months. If you have subclinical hypothyroid, basically TSH of under 10 then the usual protocol is another test in 3 months to see if TSH is still elevated. The first test can be a blip or a glitch so they like to make sure.

Even then GP's can be reluctant to prescribe Levothyroxine. My TSH was never above 7.1 but I had consistently below range FT4 and symptoms so got offered treatment. However if they test your antibodies and these are elevated, suggesting autoimmune hypothyroid, the most common reason for hypothyroid, then they may offer a trial of Levo.

[Cariboudle in reply to Sparklingsunshine]

While I want to feel better I also didn't enjoy the blood letting process - it took 3 nurses each trying various locations because they couldn't find a vein. I felt perforated by the end!

[Sparklingsunshine in reply to Cariboudle]

Hi

Try and drink plenty of water before the test, as this will make the draw much easier. And if you do get offered a future blood test try and arrange it for 9am as your TSH will be at its highest around then. And fast before hand, no food and nothing but water until after the blood draw. This gives the most reliable results.