NHS Test Results Sub Clinical Hypothyroidism

[jamjar67]

My friends mother has just had the following test results from an NHS Dr.

Her results have gotten worse since her test results in 2021 so have her symptoms and they have now recognised Subclinical Hypothyroidism. (I’ve put the 2021 results in the comments)

Therefore should she be able to ask for a trial on Levo before things get any worse?

Is there any help anyone can offer to persuade the GP to give her a trial?

I have advised to get a private test to show her T3.

Thanks

[SeasideSusie Remembering]

jamjar67

I think you'll find that there needs to be 2 x raised TSH results 3 months apart, the 2021 results will probably not be taken into account. See:

nice.org.uk/guidance/ng145/...

1.5.4 Consider 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.

Obviously that only applies if she is below 65 years of age.

Also consider Central Hypothyroidism which is where the problem lies with the pituitary or the hypothalamus rather than the thyroid. With Central Hypothyroidism the TSH can be low, normal or slightly raised, and the FT4 will be low.

GP can look at BMJ Best Practice for information - here is something you can read without needing to be subscribed:

bestpractice.bmj.com/topics...

and another article which explains it:

ncbi.nlm.nih.gov/pmc/articl...

and another here:

endocrinologyadvisor.com/ho...

and another one:

academic.oup.com/jcem/artic...

A long read which might find useful:

thyroidpatients.ca/2020/01/...

A referral to an endo may be required if Central Hypothyroidism is suspected, many GPs haven't heard of it.

[jamjar67 in reply to SeasideSusie]

Thanks Susie, she’s around 75/80yrs do you think that makes a difference re having to wait another 3 months?

[SeasideSusie Remembering in reply to jamjar67]

To be honest I doubt it but can't say for sure. Also, they say TSH is higher in older people anyway so may not even be bothered about her TSH level.

[jamjar67 in reply to SeasideSusie]

The thing is she’s always been very fit and well but tiredness and dizziness have been getting worse over the years and her labs have declined a bit so to me indicates it probably is her thyroid.

I noticed her raised HbA1c higher (which happened to me when my thyroid was off)

Cholesterol starting to raise (mine did)

B12 is low (mine was)

And obvs the raised TSH and FT4 just in range

I know with myself I had symptoms with similar readings but a year later I had horrendous symptoms when diagnosed…

I would just hope she wouldn’t have to leave things until it’s gotten really bad before being treated.

Also if she was in the USA she’d no doubt be treated…

I guess she’ll just need to keep monitoring symptoms and keep going back 🤷‍♀️🤔

[humanbean in reply to jamjar67]

Cholesterol starting to raise (mine did)

Please don't worry about cholesterol. The liver makes it because it is essential, plus there is some in food. The more you eat the less the liver makes, and the less you eat the more the liver makes.

These links should be of interest.

drmalcolmkendrick.org/2012/...

Notice the graphs in the above link. For women in particular, the higher the cholesterol the lower the risk of death.

I like this link, particularly fact number 17.

spacedoc.com/articles/50-fa...

Even taking the best possible figures, from selected trials, and painting them in the best possible light…if you took a statin for thirty years, you could expect five to six months of increased life and that is only for men with pre-existing heart disease. For women it is pointless and cannot extend your life by even one day.

On this link about statins from the NHS :

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

[SlowDragon Administrator]

First thing is to improve low B12 by supplementing

What vitamin supplements is she currently taking

Vitamin D good

Folate high …..presumably supplementing?

test BOTH TPO and TG thyroid antibodies via Medichecks or BH in 2-3 months

[humanbean]

B12 is low (mine was)

I'm assuming in this post that the patient doesn't have Pernicious Anaemia because that requires more complicated testing and treatment than straightforward low B12.

This link is worth reading, particularly the section entitled "The New Normal Vitamin B12 Levels Chart" :

perniciousanemia.org/b12/le...

When supplementing B12 it is important to know that there are four different kinds of B12 supplement which come in oral form. Many of us take methylcobalamin (aka methyl-B12) and sometimes adenosylcobalamin (aka adenosyl-B12) as well. (The body uses more methyl-B12 than adenosyl-B12, I think.)

perniciousanemia.org/b12/fo...

Vitamin B12 isn't poisonous or toxic. However if someone with low levels takes a massive dose there is a chance they could temporarily run low in potassium.

The reason for this :

If someone is low in B12 it will reduce their ability to create red blood cells (RBCs). If they then start supplementing with high doses of B12 it makes the body go into a frenzy of making RBCs. There are multiple ingredients required to make RBCs, not just B12, and potassium is one of them. If the body suddenly requires lots of potassium to make RBCs and it runs low then people will get some unpleasant symptoms.

en.wikipedia.org/wiki/Hypok...

If you ever need to increase your potassium levels then this link is helpful. The article and the comments are worth reading.

drmalcolmkendrick.org/2013/...

[Bearo]

I noticed her raised HbA1c higher (which happened to me when my thyroid was off)

Did your HbA1c improve with thyroid treatment ?

Mine has been 40-43 for the past few years/since starting Levo. I don’t think i had any blood tests before this so I can’t compare

[Esmielola]

I am by no means an expert in this, but have some personal experience only. How old is your mother? Older people's results can seem a bit high but are reasonable for people over 60. Is she feeling well? ( see below for GFR which needs more testing)

I hope I'm not intruding but it looks like your mother should be offered more tests for the GFR result. This is important I think.

Also a question about the folate result which is very high. Is there a known medical reason for this? or has she been taking folate supplements eg some tablets . If she is taking supplemtents she potentially could stop for a while and retest. You need to run this by the GP I think though first before taking any action. Good luck!