Daughters GP is not acknowledging any need for levo treatment from these blood results. Your advice & support is so appreciated.
July 2021
TSH. 7.18 (0.27-4.2)
FT4 13.6 (12-22)
Dec 2022
TSH 7.3 (0.35-4.9)
FT4 11.1 (9.1-17.6)
Vit B12 396 ng/L (187.0-883.0)
Ferritin 108 ug/L (5.0-204.0)
Folate 5.5 ug/L (3.1-20.0)
CRP 3.9 (0-10.0)
Serum total protein level : 82g/L ( 60.0-80.0)
HbA1c 69 mmol/mol ((20.0-41.0)
Has type 2 diabetes taking metforman. Been very poorly with bronchitis for last 8 weeks, had antibiotics & steroids but still unwell. GP says wait 3 months for next HbA1c check because she’s had x2 steroid treatments 4 weeks ago
PH of mental health problems, GP tends to refer to this quite frequently!!!
Daughters GP’s reply to these blood results:
“Your bloods are all fine apart from the subclinical Hyperthyroidism which is stable and you’re low on Vit D Please take supplements 800-1000 units per day. kind regards Dr “
The Gp’s are still not offering any Levo treatment. There was no Vit D result from labs!! Please help, how do I get my daughter well, she permanent struggles with what I feel are hypothyroid symptoms.
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JAE69
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NHS guidelines for treatment of subclinical hypothyroidism say that treatment 'can be considered' when they have 2 over range TSH results (taken 3 months apart) AND symptoms of hypothyroidism . (Sub-clnical hypothyroidism is defined as 'TSH over range while fT4 still in range')
Thyroid antibodies TPOab (Thyroid peroxidase antibodies) should be tested once there have been 2 over range TSH results .. If TPOab are over range (indicating autoimmune cause for hypothyroidism) , this should also be taken into account when deciding whether to start Levothyroxine .
*Note - TPOab 'in range' does not exclude prescribing Levo fwhile still 'subclinical' , but if over range then GP's feel more confident to medicate sucb-clinical hypo as there is an increased probability that overt hypothyroidism (TSH over range + fT4 under range) will eventual occur.
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."
(Guidelines for children are shown elsewhere in the same document if she is not yet adult )
Discus these NHS guidelines with your GP and ask for TPOab to be tested if they haven't already done so ... They may have some legitimate grounds to wait for another TSH in 2/3 months test due to her recent illness /steroids etc , as thyroid bloods can be misleading if done too soon after an illness.... but once this issue is clarified , then if this GP is still unwilling to consider a trial of Levo , see a different GP .
Starting Levo when TSH is under 10 is up to the discretion of the GP ..and another one may well be willing to trial your daughter on Levo ~ I was started on Levo after TSH 5.7 then 6.8 (my T4 was still in-range ..but i did have extremely high TPOab)
Just because hypothyroidism is 'sub clinical' and is 'stable' that doesn't mean it isn't causing debilitating symptoms already .. and it doesn't mean it's ok not to treat it if symptoms are causing problems ....i was really struggling to function at home and at work before i was treated.
There are also all sorts of increased long term risks once TSH goes above 4. ...i will look up some references for this and add it later if i can find it ... or someone else may have something to hand. eg. academic.oup.com/jcem/artic... ~This is perhaps not the best one as it is looking at patients already taking Levo .. but does show increased risks when TSH is over 4.
Thank you so much for your super quick response. My daughter is 43 years old. May I ask would it be ok to approach the GP with the two sets of Thyroid bloods taken in July 2021 and Dec 2022 or would you suggest just using the Dec 2022 blood results and repeat them in 2 or 3 months and then revisit the GP.
Another consideration is that both my mum , myself and twin sister were all diagnosed with hypothyroidism from 40 years and treated with Levo.
~the July 21 ones are very good supporting evidence that the current TSH is not a one off.
~ but also . it would probably be a good idea to have another set at least ? 6 weeks after she has been unwell / taken steroids .,as this will stop them saying the illness/steroids have compromised Dec 22 results .
(i'm guessing about the 6 weeks.. as i can't remember what affect( if any) steroids may have on thyroid results . but it is good practice to never rely on any thyroid bloods that were done during/ shortly after a serious illness... due to something called 'Non Thyroidal Illness Syndrome' .. which makes TSH /T4/T3 levels go all over the place for a while as HPT axis alters functional thyroid levels to compensate ,during acute illness and recovery .
other family members definitely makes it more likely that the cause of her hypo is autoimmune .. so yes mention that to GP.
* note ... it is possible to have autoimmune hypothyroidism and never find raised TPOab .... some people only have raised TGab (thyroglobulin antibodies ~ which NHS rarely test) .. and there is evidence that some people don't seem to have either TPOab or TGab.. but still have typical autoimmune damage found in ultrasound ..
Thanks tattybogle, your reply makes good sense. I’ll advise my daughter to wait another 6 weeks. Is it alright using Medichecks advanced thyroid blood tests ( I used them myself). Just checking incase daughters GP won’t dispute these because the July 2021 bloods were requested from GP’s I think & not private.
i would use "Monitor My Health" .. it is an NHS Lab in Exeter that runs that service.. which makes it hard for GP to say it's unreliable .. also its cheapest for TSH/ fT4/ fT3 under £30 .... plus there is a TUK 10% discount code somewhere ....have a look on ThyroidUK charity webpages.
unfortunately i don't think they do the other ones , vit D etc.
GP's will always have to do their own to confirm anyway , so doesn't really matter which lab you use .. they are basically not allowed to diagnose from private tests regardless of which lab did them ...as for all they know you could have sent your uncle's blood off.
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.
once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)
Thorne currently difficult to find at reasonable price, should be around £20
If she wants to try a different brand in the meantime, one with virtually identical doses of the ingredients, and bioavailable too, then take a look at Vitablossom Liposomal B Complex. Amazon sometimes has it branded Vitablossom but it's also available there branded as Yipmai, it's the same supplement
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
In week before blood test, when stop vitamin B complex, she might want to consider taking a separate methyl folate supplement and continue separate B12
Note that improving folate when B12 is very low is not a good idea. Taking folate before B12 is good enough can lead to severe neurological problems.
I wanted to pick up on the term your daughter's GP as said ,which was subclinical hyperthyroidism firstly your daughter's bloods don't show hyper they show hypo TSH above range, T4 low ,if she had hyperthyroidism the TSH would be below range and the T4 would be higher.
I was first diagnosis with subclinical HYPERthyroidism in 2014 my GP did nothing, I suffered greatly going back and forth to my GP with awful hyper symptoms, eventually I collapsed in 2018 was taking to my surgery where a completely different GP diagnosed me as hyperthyroid bloods later confirmed this.
So the years from late 2014 to 2018 I was having hyper swings turns out I had graves disease, unfortunately my GP did not follow the endos advice in the report, she asked for regular blood tests to be performed as my TSH was suppressed.
I went on to loose my thyroid to my incompetent GP😠
So I feel your daughter's GP is doing the same, ignoring the fact her TSH is over range, by waiting the 3 months your daughter's GP is hoping her bloods will come back normal so no Futher action required, but this is incorrect as it was in my case, insist if you can that your daughter has regular thyroid blood's done at least 3...if all 3 blood tests come back what the NHS considered normal still question them especially if your daughter as no improvement in her symptoms, if she as an autoimmune thyroid condition she could periodically attack her thyroid giving the over range TSH results or indeed she could also have hashis a swing from hyper to hypo bug her GP for answers 👍 good luck💓💓
Since JAE69's daughter has been seriously ill with bronchitis for 8 weeks and taken antibiotics and steroids for it ,it does make sense to wait a little while for a repeat test. ( due to non thyroidal illness syndrome and steroid use potentially showing altered TFT's) .
i agree, 3 months does seem a bit long though , given they have a previously recorded over range TSH .
Hi tattybogle❤️Yeah though it may be a type o 👍.. Its the 3 months wait for further testing I have a problem with, as with me, my gp never acted on my TSH being suppressed and the endo requesting regular thyroid blood tests because of subclinical hyperthyroidism plus an episode of thyroiditis.
Insted my gp just ignored all blood work focusing on my menupausal state as the cause of my symptoms, as your probably aware through my posts I lost my thyroid, and completely blame my gp for his failure to diagnose me, my actual diagnosis was through another gp at my surgery in 2018 no thyroid bloods were ever done after 2014 I've checked my records it makes my blood boil tattybogle😠
yes not following up when specifically requested and then lazily blaming menopause for symptoms was a big 'fail' .... not sure if finding it any sooner would have saved your thyroid though .....i got impression from your previous posts that your inability to tolerate taking Carbimazole to control it was why it had to be removed.. not how long you had been undiagnosed for . If you'd been able to tolerate Carbimazole or PTU , then you may have gone into remission and kept it but without taking either of those it was inevitably go totally bonkers and have to be removed..... you would have had to take one or other of them to control it even if you had been diagnosed promptly .
Still suck's though ..... not surprised your p***d off with them .
Well, I thought if I could have tolerated the AT meds I could have been OK.. But when I was in thyroid storm, the Dr on the ward got me a uptake scan and an appointment with the endo who told me no amount of AT drug would have helped, he just said that needs to come out your thyrotoxic in essence your thyroid is poisoning your system, the ward gp agreed, to be honest they way I felt they could have removed my head and I would have felt way better 😂.. But from 2014 with the subclinical hyperthyroidism and thyroiditis diagnosis my thyroid was definitely playing up as I had all the hyper symptoms, I think that's why I get a bit mad my gp didn't follow up on the endos advice, but hey its thyroid hormones under the bridge now tattyboogle😂 hope you have a lovely Christmas and a happy new year 🎉🎄🎄
.. right i'm going to have a slow gin mince pie with stilton... , i've deserved it ... i've been up since 6 am and i've hoovered the lounge, changed the cushion covers and wrapped up a hippopotomus .....
Hope you enjoyed your wonderful concoction of mince pie with stilton & sloe gin. It sounds delicious. A very worthy delight for a well deserved lady. like everyone on this forum. The untimely care and support from all of you and the rest of the forum is overwhelming. Thank you so much and have a very enjoyable Christmas everyone. X
Thank you for your advice birkie. This is the second GP in the practice who has ignored my daughters blood results. You may think I’m being paranoid but I’m sure they chose to focus more on her previous mental health problem and ignore the current thyroid situation. When the next bloods are to be requested we shall try seeing another GP in the hope that we get a positive outcome if they still indicate signs of hypothyroidism. If not we’ll have to request an Endocrinology referral and if refused get a private Endo consultation ourselves.
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Any help with results much appreciated 
Latest results, confused again, 
Thyroid Blood Results
Granddaughter with anxiety- blood results
Latest Blood Results
