Blood Test

[ScottyLottie]

Hi everyone. I have post operative hypothyroidism, but my partner has recently had blood tests done and we were wondering if anyone could help us understand his thyroid test results? Any comments on these results, particularly in relation to male diffuse hair thinning would be greatly appreciated.

[SlowDragon Administrator]

Welcome to the forum

So was test done via GP

TSH over 10 = overt hypothyroidism

GP should start your partner on levothyroxine

Standard STARTER dose is 50mcg

Bloods retested in 6-8 weeks

ALWAYS test thyroid levels early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

Request GP test thyroid antibodies for autoimmune thyroid disease at next test

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

Request vitamin D, folate, B12 and full iron panel test including ferritin tested now

Hairloss often linked to low iron/ferritin

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)

[SlowDragon Administrator]

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

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

NICE guidelines on full replacement dose

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

1.3.6

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.

Also here

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

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.

[tattybogle]

an over-range TSH with T4 still in-range is termed 'sub clinical' hypothyroidism.

(your partners fT4 is 'only just' in range ~ if it was 11.999 they would be classed as 'overt' hypothyroidism, when Levothyroxine treatment should always be started)

If this is their first 'over range' TSH , then a repeat thyroid blood test should be done to make sure it's not just a one off high TSH due to some other temporary cause .... if TSH is still over range at repeat test , then levothyroxine should be started.

(the timescale for the repeat test is usually 3 months, but when TSH is over 10 already that is likely to be shortened ).

Thyroid auto-antibodies should be tested to see if there is an autoimmmune cause for hypothyroidism.

When TSH is over 10 , NHS guidelines recommend that levothyroxine should be given even if the patient has NO symptoms (because long term risks for lots of other things increase once TSH is over range eg. cardiovascular issues/ high cholesterol/ bone problems)

However , hair loss is a classic symptom of hypothyroidism.

nice.org.uk/guidance/ng145

"Treating subclinical hypothyroidism

1.5.2 When 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

1.5.3 Consider 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.

1.5.4 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.

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."