I had my TSH done last month and it was 4.5. This was repeated on Wednesday and my TSH is 4.3 and my FT4 is 19.8. I am due to have it checked again next month. As I have some symptoms of subclinical hypothyroidism I wonder whether I should agree to commencing the three months of treatment and re-test as suggested by my medical practitioner? Any advice would be welcome.
Subclinical hypothyroidism: I had my TSH done... - Thyroid UK
Subclinical hypothyroidism
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Jaydee1507Administrator
Welcome to the group. If you could complete your profile it helps members understand your thyroid journey so far and be able to advise you better. Click on your image icon to start.
Can you add the reference range for each test - numbers in brackets after your result. Ranges vary between labs so are important to quote.
If your doctor has recommended starting treatment then I would accept that offer.
It's ideal if you can always get the same brand of levo at every prescription. You can do this by getting GP to write the brand you prefer in the first line of the prescription. Many people find that different brands are not interchangeable.
Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.
When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins. Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...
There is also a new company offering walk in & mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...
Only do private tests on a Monday or Tuesday to avoid postal delays.
Do you know if you had positive thyroid antibodies? Many with autoimmune thyroid disease aka Hashimoto's benefit from a gluten free diet. A smaller percentage of those also need to remove dairy from their diet to feel well. These are intolerances and will not show up on any blood test.
Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw, last T3 dose 8-12 hours before blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process)? Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.
in reply to Jaydee1507
Thank you for your response and advice. My laboratory reference range is TSH (0.27 - 4.2). My August TSH was 4.5 and my September TSH was 4.3. Following the last test I understand that I continue to have subclinical hypothyroidism. I will accept the offer of the treatment from my doctor.
So you have 2 TSH results above range and the recommendation per NICE guidelines would be to begin treatment.
Next step would be to get vitamin levels tested as now you are hypo and may have been for a while, you won't be able to absorb vitamins well from your food.
Your FT4 looks high in range. I'm surprised that your doctor has suggested treatment because the treatment is taking T4 - i.e. thyroid hormone replacement. Personally, I cannot see how that would help your symptoms, and could possibly make them worse. It's not a 'treatment' in the sense that it would improve thyroid performance, or cure the hypothyroidism. I'm not convinced it's a good idea.
Admittedly, your TSH is too high. However, that is probably due to low FT3. Did he say why he suggested 'treatment'? Did he do any other tests at the same time?
in reply to greygoose
As the initial TSH was done as part of a pruritis screen no other tests were carried out. The repeat TSH was done with FT4 only. Unfortunately he did not request a FT3. So will the Levothyroxine reduce my FT4 levels then?
greygoose in reply to
It could well do, yes. Taking thyroid hormone replacement of any kind - T4, T3, T4+T3, NDT - reduces the TSH. Without the stimulation of the TSH, the thyroid can no-longer produce hormone. So it will stop what it's making and the the FT4 will drop. And it's doubtful he's giving you a high enough dose to fully replace it. Plus you will lose the T3 that the thyroid makes, and be totally reliant on conversion.
How much T4 is he giving you?
in reply to greygoose
He proposes to try me on Levothyroxine 25 micrograms daily for three months.
greygoose in reply to
Pretty certain that would have a negative effect. The dose is too low and for too long. If it were me, I would wait a while and see what happens.
in reply to greygoose
The NICE guidelines state a trial of six months. Not sure about the dose - do you think it is to long what he is proposing?
greygoose in reply to
Yes, I do. He's starting you on a very low dose - because of your age, I suppose - so you're going to need an increase long before that.
A 'trial' of levo is a nonsense, anyway. It can take over a year to find the right dose - sometimes several years. Nobody is going to get better on 25 mcg levo. In fact, it could make you feel worse. So, when you go back, after three months, feeling worse than you did before starting, what do you think is going to happen? The odds are he's going to say well, obviously, levo is not the right thing for you. A 'six months trial' is not a fair trial. But all the odds are stacked against the hypo getting the correct treatment, and endos collude with that. I don't know, I just don't understand their attitude. And they don't understand the thyroid!
in reply to greygoose
I agree 25 mcg is indeed a very low dose. As you say it could make me feel worse. I think as I have private health insurance I might get a referral to a consultant endocrinologist for specialist advice, investigations and appropriate treatment if this is gelt necessary. Thank you for your help and assistance.
greygoose in reply to
Good idea. But, chose your endo carefully. Make sure he knows about thyroid before committing to an appointment, because of them know nothing about it.
Any endo is likely to want to start you on 25 mcg, because of your age. I don't agree with that, but there you go. BUT, with such a low dose, you should be retested and the dose increased after about four weeks. The longer you're left on a low dose, the harder it becomes to find the right dose. Starting the elderly on low doses is just a precaution. I don't think there's any medical evidence that that is all they need, so if everything goes more or less well, no adverse reactions, then it should be increased quickly. That's the way I see it, anyway. I didn't actually have that particular battle because I was diagnosed at 55 and put straight on 50 mcg.
Wua13262348 in reply to
I could be well off target, but since it was an incidental finding on a pruritis screening, I wonder if the recent heatwave weather may be the reason you had the itching. Thyroid and tolerance to heat and sun directly link to thyroid. The past few years I haven't been able to stand being out in the sun at all. At one time, I used to love the sun.
I think the heatwave might be a possible factor for your incidental findings. Another possibility would be if you had something like a covid or pneumonoccal vaccination around that time, or even a new medication where fillers or excipients don't agree with you. A common problem at the moment for all types of medications, is brand switches when you have previously been settled on a particular brand. Also , new formulations to brands.
They do it with foods all the time- "new improved recipes". My heart sinks at the sight. You buy it because you liked it, or it didn't upset you, and they change it! They should leave well alone.
in reply to Wua13262348
I have had the generalised ideopathic pruritis for one year now - and the dermatologist asked my doctor to repeat the pruritis screen. Interesting when he did my TSH and FT4 last year they were both normal!
Wua13262348 in reply to
I think rashes and hives, so probably pruritis, can be indicative that the thyroid is problematic. This may be your first sign that your thyroid is starting to be problematic.
If you follow Slow Dragon's excellent advice to check your key vitamins you may well find that you are deficient in , for example, folate and B12. If you rectify any deficient or low findings, perhaps that would make all the difference in the world, as you had normal TSH and FT4. However, what were your TSH and FT4 last year? Often what you are told is normal really isn't, and this will be apparent to you as you read posts on the forum. You are told that you are normal if within the range, which is different from being optimal and you can be problematic when within the range.
SlowDragonAdministrator
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
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
Low vitamin levels much more common as we get older …..especially B12
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 and …..once you start on levothyroxine….last dose levothyroxine 24 hours before 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
in reply to SlowDragon
Thank you for your very comprehensive response.
Low vitamin levels affect thyroid…..and thyroid affects vitamin levels
Next step test Vitamin levels and thyroid antibodies
Come back with new post once you get results
Also worth testing testosterone and cholesterol levels
A trial is usually 6 months as stated by NICE Guidelines. During that time, the GP should work with you for the right dose for you. Worth having antibodies tested.
Edit: I’m not sure why your GP is testing TSH monthly, as for subclinical hypothyroidism according to NICE guidelines it ought to be tested again between 3/6months as TSH can rise temporarily.
in reply to HealthStarDust
I'll mention this when I meet with him next month.
HealthStarDust in reply to
Good idea.
With your FT4 pretty good I would stay away from treatment for now. It looks like the TSH could just be red herring. And there maybe something else wrong instead. May be worth asking GP to test other hormones.
in reply to HealthStarDust
Sounds like a good idea - thank you!
HealthStarDust in reply to
Your welcome. As others have mentioned, you need a full thyroid panel with TSH, FT4, and FT3 as well antibodies.
For you, I hope it is not hypothyroidism but the tests can tell a different story and are not a perfect science anyway.
Good luck 🤞🏽
in reply to HealthStarDust
I had difficulty in having him agreeing doing a FT4 with the TSH. I'm not sure what his response would be if I asked for the addtional tests.
HealthStarDust in reply to
There are private options as mentioned above.
in reply to HealthStarDust
I will check these out - thank you!
Well I saw my medical practitioner yesterday after having my bloods re-checked and thinking I was going to have to start treatment and was surprised to learn the following results:- TSH 3.5, FT4 16.0, FT3 4.5 and TgAB 7. He says these results are all normal and that I am euthyroid and there is no indication of thyroid gland disorder - so I do not need to start any treatment. We will check the TSH again in three months.
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