is this sub clinical or hypo

[Daisywhoopsa]

the above are my daughter’s result. Usual protocols for testing followed. She’s unmedicated, 24 yrs old. She does take Propanalol for anxiety. Symptoms are constipation, fatigue, hair loss, outer third of brows have disappeared, headaches. I appreciate there’s no B12 vit D or ferritin results. It was a starting point to see if there was an issue. My gut feeling is to speak to GP with a view to retesting (with B12 vit D and ferritin) in 6 weeks. Advice please. For info I have Hashimotos and other daughter and also her half sister had Graves, daughter had RAI step daughter had thyroid surgery and are now hypo.

[HealthStarDust]

No. An above 10 TSH is just Hypothyrodism.

Go to GP to have full thyroid panel tests, once she has 2 TSH’s they’ll likely diagnose and treat especially with those TPOs.

[seveneleven]

Goodness, she is hypo there - no 'subclinical' about it. She's both symptomatic and levels are way off. TSH is very high, T4 bottom of range. Antibodies are through the roof, so she absolutely has Hashimoto's. Not surprised at all that she feels rubbish, and very likely the anxiety is caused by being hypo, and probably that would ease with treatment, which would be important because long-term propranolol use can have negative effects on thyroid. Has she not been tested by the GP before? I'd take these results to GP and ask for her to be tested on the NHS now - no need to wait 6 weeks, because she needs an above-range NHS test to get treatment. Good thing is that her TSH is high enough that there should hopefully be no argument from the GP that she meets the criteria for starting levothyroxine - guidelines, if I remember correctly, say that 1 test with TSH above 10 is sufficient or two tests where it's above range but below 10. Her T3 isn't too bad, so she may be someone who would do very well on levothyroxine alone and see some good improvements.

[Daisywhoopsa in reply to seveneleven]

Thanks - my thoughts are the same. It was the comment from the lab Doctor that made me question myself. I do wonder how many people see the comments and take them as gospel!

[tattybogle]

Technically the NHS define 'sub clinical' hypothyroidism as "TSH over range while fT4 is still within range" .. so by NHS definition these results are subclinical.

However their guidelines tell them to consider treating subclinical hypo once TSH is over 10 ...... EVEN IF THERE ARE NO SYMPTOMS. ( it does need to be confirmed by a repeat high TSH to rule out a one off from some other cause)

( When symptoms ARE causing a problem, their guideline tells them to consider treating when TSH is "over range but under 10". (on 2 occasions, 3 mths apart)

So yes it's still technically 'subclinical' , but there should be no problem whatsoever with getting treatment once it's confirmed to be over 10 .

Subclinical is a rather stupid term in this case .... her classic symptoms of hypo (and the TSH over 10) , clearly mean it is in effect 'clinical'. They are using 'subclinical' only in the sense of the (clinical) fT4 blood result is still in 'normal' range .. subclinical doesn't mean there are no symptoms.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

NHS guidelines :

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

"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."

[Daisywhoopsa in reply to tattybogle]

As per usual a really detailed reply - thank you. I’ll no doubt encourage her to join the forum and then she can gen up before the doctors appointment she’s trying to book this morning - here’s hoping she can actually get one!

[tattybogle in reply to Daisywhoopsa]

yes get her to join ... tell her spending a few wks reading facts on here will be very good for her confidence when she does get to see a Gp ..... if it's anything like my doctors surgery , she'll probably have at least 4/5 wks to do plenty of reading up before she see's a Doctor ( 'seeing' is probably optimistic lol)

[SlowDragon Administrator]

how much propranolol is she taking

Propranolol slows uptake and conversion of levothyroxine

Anxiety is common hypothyroid symptom

She should be able to ween SLOWLY off propranolol as levothyroxine dose is increased over coming months

Propranolol lower Magnesium levels too

Essential she has vitamin D, folate, B12 and ferritin levels tested

Plus coeliac blood test