Do I need a medication?

[Lellu]

I have suspected having a under active thyroid but my GP has years just been monitoring it.

I have all the symptoms for under active thyroid and my recent test results were Serum THS 6.33 my/L and Serum free T4 10.4 pmol/L. What are these levels indicate?

Thank you for any advice.

Lellu 😊

[greygoose]

Well, we really need the range for that FT4 before we could say anything for sure, because ranges vary from lab to lab. But, that TSH is most definitely saying that you are hypo - is it always that high?

A 'normal' TSH (euthyroid) is around 1, never over 2, and you are hypo when it gets to 3. But, the NHS likes it to get to 10 before they will diagnose. I'm pretty sure that at 6.33, your TSH is over-range. So, ask your doctor what the point is of having a range if they totally ignore it?!?

[Lellu in reply to greygoose]

thank you for your reply

TSH was 3.11 in Aug 2021 and 3.04 Jul 2022 when previous bloods were taken. Before that it has been 1.46

I will ask the doctor on my next wisit after new bloods are taken next week

[greygoose in reply to Lellu]

You're welcome.

But, be warned, doctors know next to nothing about thyroid.

[SlowDragon Administrator]

welcome to the forum

Please add ranges on these results (figures in brackets after each result )

Was test done early morning, this gives highest TSH

Request new test including thyroid antibodies, vitamin D, folate, ferritin and B12

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/wp-content/up...

Tips on how to do DIY finger prick test

healthunlocked.com/thyroidu...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

[Lellu in reply to SlowDragon]

many thanks for very comprehensive reply

My bloods were tested mid day and I did had breakfast as was not told to fast

Next bloods will be taken at 11 am so I will fast for that one

I also need to mention to the doc about the other tests or I will do them privately

You mention I deffo have hypo, does this mean overactive as GP mention under active?

Thx Lellu

[SlowDragon Administrator in reply to Lellu]

Hypothyroid = under active

Too little thyroid hormone

TSH = Thyroid Stimulating Hormone.

The message from pituitary telling thyroid to work harder

TSH is higher when hypothyroid

Thyroid hormones

Ft4 = Free (available) storage version of thyroid hormone

Has 4 atoms of iodine

Ft4 is low when hypothyroid

Ft3 = Free (available) active version of thyroid hormone

FT3 is low when hypothyroid

Every single cell in your body needs Ft3 to make the cell work.

Thyroid hormones run your metabolism

For good conversion of Ft4 to Ft3 we need good vitamin levels

[SlowDragon Administrator in reply to Lellu]

Next bloods will be taken at 11 am so I will fast for that one

Can you change to 9am if possible…..TSH would be higher

(Patient to patient tip - medics deny it’s relevant.)

My bloods were tested mid day and I did had breakfast as was not told to fast

TSH at 9am, and no breakfast before test…..TSH result would probably have been between 8-9

[SlowDragon Administrator]

Helpful Flow chart

gps.northcentrallondon.icb....

With 2 thyroid tests with TSH over 5 and symptoms GP could start you on levothyroxine …..especially if antibodies are high

[Lellu in reply to SlowDragon]

many thanks for your reply I will check the flow chart

[Bearo]

When you have a TSH result over the range the GP should test again three months later. If still over range, and if you have symptoms, GP should consider treatment. If FT4 is below range they should start treatment.

You may have to remind them to do a repeat blood test.

[Lellu in reply to Bearo]

Thank you, I will have blood test next week

[helvella Administrator]

I think you are realising that "monitoring" is a way of saying "do occasional tests and watch as the patient deteriorates but don't actually do anything".

Long-term rising TSH is a clear indication of hypothyroidism that needs treatment.

It obviously isn't what we sometimes see, a one-off result.

This failure to act completely undermines any claim to be moving to preventative medicine, to be putting patients' interests first, etc.

Just what does the doctor expect at the next test? I predict continuing rise in TSH (and fall in FT4) and worsening of symptoms. Why should you go through that?

[Bearo in reply to helvella]

As you know, if the TSH is above the range but below 10, a second blood test is often required in case the high result was a one-off. But ‘just monitoring it’ does imply the result has already been over range more than once, so yes, it does beg the question.