Advice on subclinical hypothyroidism

[Curiousegg]

HiIn 2014 I had hyperthyroidism diagnosed. Medicated & levels reduced and then went too low - hypo symptoms until I came off. Through levels have remained in normal range since then.

My recent thyroid tests were:

TSH 4.89 (Range 0.2-4.5)

Serum Free T4 10.5 (Range 7-17)

Blood taken midday. No other tests done

My TSH levels have been gradually rising over the past few years

I had been feeling healthy and well and increasing fitness levels but most recently I have been suffering from lots of cramps, tight muscles & tendonitis together with significant fatigue & low mood.

A Locum GP is speaking to me on Tuesday about my most recent test results. I am not sure if I should be aiming for more thyroid tests, antibody tests, or a low dosage of medication.

Other factors - I'm on HRT, have high blood pressure which is medicated to normal levels & Dr has raised some concerns over cholesterol levels though no statins prescribed.

Feel a little bit at sea and want to have a clear idea of what a good outcome would be for my discussion with the GP.

[Jaydee1507 Administrator]

Welcome to the group.

When you were treated for hyperthyroidism did they check your antibodies to give you a specific diagnosis? It's just that from your description of what has happened it sounds like you more likely have Hashimoto's, an autoimmune thyroid condition where your thyroid is slowly destroyed. This is quite different to Graves disease where your thyroid puts out too much thyroid hormone. Hashimoto's can begin with a period of excessive thyroid hormone output and look a bit like Graves until antibodies are checked.

You really need antibodies for Hashimoto's and Graves disease tested - TPOab and TRab.

So now it looks like you have developed hypothyroidism and your TSH has risen above range. We recommend blood tests at or as close as possible to 9am when TSH is highest. Always test fasting before the test for consistency.

The NICE guidelines suggest that you need 2 consecutive TSH results above range or 1 above 10 for diagnosis and to begin treatment. I'm not sure how previous history might affect this but likely doctor will want to retest in a few months time to be sure that it isnt a one off raised result.

Many people find taking it at bedtime works well for them.

When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins. Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...

There is also a new company offering walk in & mail order blood tests in Crawley, Hove and Reigate areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...

If your GP offers treatment then thats great and usual starting dose would be 50mcgs. If not then go for further testing.

Testing you need: TPOab and TRab, ferritin, folate, B12 & D3. A repeat thyroid function test in a few months time.

Raised cholesterol is often normalised by treatment for hypothyroidism. nhs.uk/conditions/statins/c...

[Curiousegg in reply to Jaydee1507]

Thank you for such a helpful and comprehensive answer. I have wondered about Hashimotos and thought that the tests for that would be helpful.

I haven't had any of the other tests done except B12 & Ferratin in 2021 when results showed to be normal.

Really appreciate your help.

[Jaydee1507 Administrator in reply to Curiousegg]

If you have any other questions or when you get new blood results then start a new post.

[SlowDragon Administrator in reply to Curiousegg]

I haven't had any of the other tests done except B12 & Ferratin in 2021 when results showed to be normal

What were these results and ranges

And definitely time to get retested and test folate and vitamin D as well as test thyroid antibodies

Test thyroid early morning around 9am

TSH, Ft4 and Ft3

[greygoose]

Definitely push for antibody testing. This sounds very much like Hashi's - aka Autoimmune Thyroiditis.

Next time you have a test, make sure it is early morning, and before breakfast. If your TSH was that high at midday, when TSH is at its lowest, it will be even higher before 9 am. And doctors only tend to look at TSH.

Don't be alarmed by your doctor's 'concern' over cholesterol levels. They know nothing about it. High cholesterol is not really a 'concerning' thing, and is usually caused by low T3. If he suggests statins, best to refuse.