Thyroid test result / menopause help.

[Hux71]

I've been feeling averagely rubbish for the last 18 months or so; zero energy, low mood, irritable, tearful, unable to focus, steadily gaining weight, dry, thinning hair, dry skin - the list goes on.I requested a blood test a year ago, and mentioned at the time that I wondered if my symptoms were thyroid related (there is family history of hypothyroidism) Following the test I heard nothing from my GP and so rang the surgery to query the results and was simply told everything was "normal".

Fast forward a year, with ever worsening symptoms I returned to the GP and requested HRT, which she duly prescribed. At this point I hadn't had a period in approximately 12 months.

After 6 weeks on Evorel Conti I had a period reminiscent of The Texas Chainsaw Massacre, and my hair loss drastically increased. Alarmed and distraught I endeavoured to make a doctor's appointment but have been unable to do so. I've subsequently stopped using the Everol.

In sheer desperation I turned to Dr Google, and realised I could request the results of my previous blood test.

According to the results my folate levels were (are?) low and there was a recommendation (of which I was never informed) to take folic acid. Moreover my TSH level was elevated, but T4 within range. My (admittedly limited!) understanding is that high TSH and low folate levels can indeed be indicative of a thyroid issue, and there's some evidence to suggest low folate levels alone can contribute to hair loss?

I've also just received test results from Medicheck, and my TSH level has gone from 4.35 a year ago to 7.75, but free T3 and thyroxine still at normal levels - 3.93 and 13.2 respectively.

I'd be hugely grateful if anyone could cast any light on any of this. After my having raised a complaint with the surgery, my doctor is supposed to be calling me tomorrow and it would be really helpful to have some idea of what tests or other intervention I should be requesting as I'm still unclear as to whether my issues are thyroid or menopause related, or a combination of the two!

Thanks for reading.

[SlowDragon Administrator]

TSH 7.75

free T3 3.93 (3.1-6.8)

Ft4 13.2 (12-22)

Was test done early morning

Did you also test thyroid antibodies, folate, ferritin, B12 and vitamin D?

GP will want to retest thyroid levels via NHS

Request/insist they also test thyroid antibodies, and definitely retest folate, ferritin, B12 and vitamin D NOW

Starting levothyroxine - flow chart 

gps.northcentrallondonccg.n...

[Hux71 in reply to SlowDragon]

Thanks for your reply SlowDragon.

Yes, I tested at 7am, so first thing. I'll request the tests you suggest when I speak to my GP tomorrow. In fairness to her she's generally been stellar. The previous test was arranged by a different doctor and the results were apparently sent through to him, though I'm not sure if that's at all relevant.

[Buddy195 Administrator]

I’m not surprised you are feeling rubbish as raised TSH shows your thyroid is struggling. However, many GPS will not consider Levothyroxine until levels are raised in a follow up blood test. Having key vitamins optimal supports thyroid health, so do check these as advised by  SlowDragon

Regarding menopause, it may be useful to have a look at Dr Louise Newson’s free Balance App, as I find it really useful for comparing HRT medications & having up to date research articles. There is also an ability to post questions.healthunlocked.com/redirect... 

[HeartWoman]

It is so hard teasing out what is what, especially when you feel so bad. I entered surgical menopause many years ago and then a few years later my thyroid showed issues in my bloodwork, butbi suspect I probably had a thyroid issue even as a child. I have started over with thyroid treatment and still have a ways to go. The moodvstuff being the worse symptom.

Your test results definitely indicate hypothyroidism. I would address that thyroid first and then decide if you need HRT.

[tattybogle]

Hi Hux71.

over range TSH (Thyroid Stimulating Hormone) while Thyroid hormone ( fT4) is still in range , is classed as 'sub clinical hypothyroidism .

NHS guidelines for treating hypothyroidism say that GP's 'can consider' treating subclinical hypothyroidism if there are symptoms of hypothyroidism .

The fact that the previous results went to a different gp is not relevent.. the previous over range 4. 35 [? -?] will be on your record for any GP to refer back to , so your TSH should really have been re tested at the time you went in to ask for HRT .

NHS guidleines below :

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. (TPOAb's)

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."

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~ You should inform GP that your TSH has now risen to 7 ~they should retest for themselves to confirm.. and also test thyroid antibodies (Thyroid Peroxidase antibodies~ TPOab ) to see if there is any evidence of autoimmune hypothyroidism... if there is, it helps convince them to start Levo before waiting until TSH is over 10.

To get the highest TSH of the daytime, make sure you get an early a.m appointment for the NHS blood draw even if it means waiting a few weeks for the appointment .. (they won't agree early am is necessary for TSH testing and will say they must save their early appts for fasting tests ~ rather than argue with receptionist it's easer to just be "unable to attend after 9.30 am due to work/ other commitments" .... medichecks test was done a bit early at 7 am .. you can expect TSH to be a little bit lower than that at 9 am ~ TSH is highest around the middle of the night and falls gradually until it's lowest around 1-3pm , then gradually rises again .

[Hux71]

Thank you all so much for taking the time to reply - knowledge, as they say, is power - and I feel better even just in knowing what tests I should be requesting. Feeling crap for over a year seems quite long enough!