Good morning. I am just looking for some advice regarding my 25 year old son's test results. He's been suffering from many symptoms over the past 8-10 years including extreme anxiety, depression and fatigue. I usually speak on his behalf with the GP and they have said, on the phone, that he's borderline hypothyroid and needs to retest in 3 months or so. I questioned this decision, considering the number of symptoms he has, and she suggested a face to face appointment with a different GP (she didn't have any free appointments) to discuss... this is happening at 10am this morning.
Having been through this whole process myself, I know it's going to be a battle to get them to prescribe medication but I'd be very grateful for your thoughts with regard to the raised antibodies as this is new to me. The first GP said they consider medicating once TSH is over 10... personally I only feel "well" if mine is <0.1. TIA.
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Beany101
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Those results indicate Hashimoto's, an autoimmune disease that causes hypothyroidism. His TSH is elevated and his T4 is quite low in the range, and there are elevated thyroid peroxidase antibodies. Has your doctor told you any of this?
The GP has not mentioned Hashimoto's at all. The first GP said he is borderline and will most likely develop Hypothyroidism in the future.
At the bottom of his NHS blood results it says "Subclinical hypothyroidism with positive TPO antibodies. Patient is at risk of developing overt hypothyroidism. Advise yearly monitoring and consider starting thyroxine if TSH >10 mU/L".
It's Hashimoto's if your TPO antibodies are positive/elevated, and doctors will say it's subclinical hypothyroidism if your TSH is high but below 10, however, if there are symptoms it's not subclinical. I never saw my TSH higher than about 6 and I could barely function when I was finally diagnosed.
The GP has not mentioned Hashimoto's at all. The first GP said he is borderline and will most likely develop Hypothyroidism in the future.
U.K. medics rarely call autoimmune thyroid disease Hashimoto’s…..they tend to completely ignore the autoimmune aspect…..and only treat subsequent hypothyroidism …with a fixation on test results…not symptoms
Similarly NHS only tests and treats vitamin deficiencies
If results are within range, even if right at bottom GP is likely to dismiss the possibility that vitamin levels are too low
Down to us to test and maintain OPTIMAL vitamin levels
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
He will need to start on at least 50mcg levothyroxine
Meanwhile look at increasing iron rich foods in his diet
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
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 you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
There are 2 ways to get diagnosed. One is with a TSH over 10, the other is with 2 consecutive NHS tests with TSH over range.
When your son retests be sure that he books the test for as close to 9am as possible and also fasts before it that day. This gives highest TSH result.
Are Medichecks going to rerun the folate & vit D?
His B12 is on the low side and I'd recommend him starting a good methyl/active B complex to help keep the B's in balance. This B complex has all the right vitamins at a not unreasonable cost for 90 days supply. amazon.co.uk/Liposomal-Soft...
As he has positive antibodies he has Hashimoto's and may well benefit from a trial of strictly gluten free diet. You will need to be reading labels carefully to ensure no gluten is consumed. Some Hashi people also need to remove dairy from their diet.
Thank you. I've been trying to find where it says about 2 consecutive NHS tests with TSH over range... I can't find it in the links or the NICE guidelines. Any ideas where it may be?
He does have a lot of gastro symptoms... I asked my son to mention this to the GP and request a coeliac test but it fell on deaf ears!
( 'sub clinical hypothyroidism' means ~ over range TSH while fT4 is still in range)
"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."
We often have to become our own health advocates where doctors are concerned. Try and find a helpful open minded GP at the practice where your son is, print off the information tattybogle has given you and stand firm in your conviction that the 2 test above range is also in the NICE guidelines as criteria for treatment.
Thank you all for your replies... I'm familiar with some of the advice and working my way through the rest.
Just got back from GP and I'm absolutely fuming. Despite my warnings of being fobbed off... my son insisted on seeing the GP on his own. He came out saying what a waste of time... the doc was an idiot and spoke to him as if he was stupid. He was told that he's not hypothyroid, they would only prescribe medication with a TSH over 10, his iron levels are good and he should try aerobics to lift his mood.
My son's so deflated and disappointed... he's decided to walk home. We were both pinning our hopes on him starting medication and looking forward to a better quality of life for him. I'm not sure whether to ring to speak to the same GP or ask to speak to someone else, who is likely to be a nurse practitioner.
In my experience, in the past, I have asked my NHS GP and he has referred me to an endocrinologist - but i agree many GPs are not great when it comes to thyroid issues.
There is an email here (in this forum) that can be used to find a good endocrinologist. Do people have this email address?
I have experienced hypothyroidism for 28 years and in my opinion, it is possible to feel well, so there is hope.
All the best & fingers crossed he feels better soon.
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