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sub clinical hypothyroidism

Jeanette56 profile image
32 Replies

Hello everyone,

I was told by the lovely Julie at my occupation health to come on here for some advice and support.

Around two months ago I was completely exhausted struggled to get out of bed or he awake for log periods of time. I did have any energy whatsoever. I have been loosing weight gradually over 4-6 weeks over 6KG. I thought I might of picked up something or been abit run down. After two weeks I went to the doctors and got bloods done which revealed by TSH level at 6.7mu/L with Serum free T4 level at 17.9 pmol/L and had all other bloods done which was normal and within range, only very high vitamin b12. I was told this wasn't serious enough for any treatment. A week later I was feeling more fatigued , I normally go the gym 4-5 times a week and very active person, which I've not been able to do since, and become very anxious couldn't concentrate and all my body was aching. I rang up the doctors and got told I need medication for the anxiety I was experiencing after researching around the condition I then asked for thyroid antibioties blood test which resulted- thyroid peroxidase- 394 kIU/L. I was told this was slight raised but no need for concern. I have been back the doctors a number of times with my symptoms now am absolutely freezing can't get warm, have not been to work for over two months, my mood has really went down and my sex drive this is completely non existent whichever is staining my relationship. I have been the doctors 1 week ago with the right side of my neck being swollen which I am waiting for ultrasound now which has a few weeks wait, on this appointment I was prescribed anti-depressants to increase my energy levels. I just don't feel like I am getting listened too and I feel like I am getting made out to be a complete psychopath. I am 29 never had any other problems or needed to go the doctors and the minute I need some help I get treated like this.

I have now been told to wait until January for a repeat blood test, my mum, auntie and nan all had thyroid problems.

Any advice would be appreciated I feel like I am going insane.

Thank you

Jeanette

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Regenallotment profile image
RegenallotmentAmbassador

Push back at that GPof yours. You clearly have autoimmune hypothyroidism. It is cruel to make you wait any longer. I bet you feel dreadful. Use the info in the pinned posts to show your GP what the NICE guidelines are. Be kind to yourself while you wait and start treatment it’s a long road to feeling improvement and active again 🌱

Jeanette56 profile image
Jeanette56 in reply toRegenallotment

It really has been so hard and also have a child to look after with very little support. I did look through the NICE guidelines which does say repeat in 3 months but the symptoms I am having is just awful. Thank you I will have a look at the pinned post. Really appreciate your reply.

SlowDragon profile image
SlowDragonAdministrator

Welcome to the forum and well done lovely Julie at occupation health for recommending you come along here

Your high thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms (eg weight loss) as thyroid cells break down releasing excess thyroid hormones. It’s not true hyperthyroidism, and can rapidly swing to hypo

symptoms now am absolutely freezing can't get warm, have not been to work for over two months, my mood has really went down and my sex drive this is completely non existent

all hypo symptoms

Is your GP aware of close family members all having autoimmune thyroid disease?

Request another test NOW …..or test privately

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

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

NHS won’t treat until 2 blood tests with TSH over 5

(Over reliance on test results over symptoms)

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

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/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

See detailed reply by SeasideSusie

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

if GP hasn’t yet done coeliac blood test, get this done BEFORE trialing strictly gluten free diet

nice.org.uk/guidance/ng20/c...

1 Recognition of coeliac disease

1.1.1 Offer serological testing for coeliac disease to:

people with any of the following:

persistent unexplained abdominal or gastrointestinal symptoms

faltering growth

prolonged fatigue

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes, at diagnosis

autoimmune thyroid disease, at diagnosis

irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease.

Jeanette56 profile image
Jeanette56 in reply toSlowDragon

This blood test was done beginning of October and the DR told me yesterday that I have to wait for three months so beginning of January. I don't have the money to go private for the treatment I am single parent and now off sick with this.

I did get vitamin D I will ask for this.

Folate- 11.7 ug/L

Ferrin- 32 ug/L

Vb12-891 ng/L.

I have to wait now until 5th of December for my ultrasound.

Thank you so much for your reply!

Jeanette56 profile image
Jeanette56 in reply toJeanette56

I didn't get vitamin D I meant to say x

SlowDragon profile image
SlowDragonAdministrator in reply toJeanette56

DR told me yesterday that I have to wait for three months so beginning of January

They are being obtuse……6-8 weeks gap is plenty

Book next test for as early as possible…..9am latest

Only drink water between waking and test

Meanwhile make another appointment with GP

Request/politely insist on coeliac blood test

Ferritin is virtually deficient

So request GP do FULL iron panel test for anaemia

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

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

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

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

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

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

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Ferritin range on Medichecks

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes: 

Males 16-60: 30-400 ug/L

Female's: 16-60: 30-150

Both >60: 30-650 

The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. 

Vitamin D

Are you currently taking any vitamin D supplement?

If yes how much

Request GP test vitamin D as low vitamin D is strongly linked to autoimmune thyroid disease

pubmed.ncbi.nlm.nih.gov/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

pubmed.ncbi.nlm.nih.gov/273...

Vitamin D insufficiency was associated with AITD and HT, especially overt hypothyroidism. Low serum vitamin D levels were independently associated with high serum TSH levels.

pubmed.ncbi.nlm.nih.gov/300...

The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.

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

Our results indicated that patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia that is significantly associated with the degree and severity of the hypothyroidism. That encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency and serum calcium levels for all hypothyroid patients.

Jeanette56 profile image
Jeanette56 in reply toSlowDragon

thank you so much for all that information I will have a look through, I know I just feel like I am getting worse now and really feel down about it and don't have the funds to go private otherwise I would xx

Emaych61 profile image
Emaych61 in reply toSlowDragon

“NHS won’t treat until two blood tests with TSH over 5”

Huh? I wish! It’s 5.5 where I live. I had two come in over 5, one at a private clinic admittedly, and another two weeks later requested by my GP. The first one came back at 5.6 (upper normal limit 4.2) the second came back at 5.42 (upper normal limit 5.5) As everything else has come back in the “normal” range I got the distinct impression that was it as far as the NHS is concerned. Certainly it’s not been suggested that I should be retested in a few months time. This site (and you) have recommended that I should do that and I rather suspect I’ll be doing so privately.

SlowDragon profile image
SlowDragonAdministrator in reply toEmaych61

Emaych61

What were Ft4 and Ft3 results

Meanwhile get vitamins tested and improved to optimal

Insist politely that thyroid antibodies are included at next test and book test 9am or earlier. Only drink water between waking and test

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Emaych61 profile image
Emaych61 in reply toSlowDragon

T3 4.2pmol/L (3.1 - 6.8)

T4 14.8pmol/L (12 - 22)

SlowDragon profile image
SlowDragonAdministrator in reply toEmaych61

FT4: 14.8 pmol/l (Range 12 - 22)

Ft4 only 28.00% through range

FT3: 4.2 pmol/l (Range 3.1 - 6.8)

Ft3 similar at 29.73%

as discussed in your previous post 3 months ago TSH will quite likely be lower than should be for such low Ft4 and Ft3 due to long term steroid use in asthma inhaler

When were vitamin levels last tested

Emaych61 profile image
Emaych61 in reply toSlowDragon

Same time as the above, except for vitamin D which was last tested in April. All were in normal range but folate and vit D weren’t in by very much. Ferritin was on the low side, but not too bad, B12 looked OK. I’m working on improving all of them (mixture of supplements and diet - although the latter is really pretty good anyway and that’s not just my opinion:-)). I will certainly be asking for all of them to be rechecked come the New Year to see how things are going with them.

At the moment I’m awaiting testing for coeliac disease. Unfortunately I decided to come off gluten for a few days whilst away three weeks ago (I had been having a pretty difficult time with loose bowel motions - extremely unusual for me I might add; I have a very long history of constipation). I wondered whether gluten might be responsible after overindulging a bit on pastries and biscuits resulted in a rather bad bout of it. When I got back a GP agreed that testing for coeliac might be a good idea, but unfortunately because I had those few days off gluten I had to reset the gluten clock for six weeks of daily intake of the stuff. That blood test is now due to happen just before Christmas.

SlowDragon profile image
SlowDragonAdministrator

After two weeks I went to the doctors and got bloods done which revealed by TSH level at 6.7mu/L with Serum free T4 level at 17.9 pmol/L

How long ago was this test

What time of day

You should have 2nd test 6 weeks after first test

Please add actual results and ranges on

Vitamin D

Folate

Ferritin

B12

waiting for ultrasound now which has a few weeks wait,

Roughly where in U.K. are you

Private ultrasound scan about £100

thyroiduk.org/get-support/t...

Jeanette56 profile image
Jeanette56 in reply toSlowDragon

I thin it was around 2pm for my blood test too.

TiggerMe profile image
TiggerMeAmbassador in reply toJeanette56

Chances are if you get a 9am appointment for your next blood test it could well be that your TSH is already above the 'magic' 10 so they shouldn't mess you about any more and will get you started on Levothyroxine.... absolutely no reason you should have to go private at this stage and then at least you will qualify for medical exemption which means free prescriptions

Explain to them that you have been advised by Thyroid UK that 6 weeks is adequate between tests... you might have to puff yourself up have a little practice in the mirror.... be calm, polite but firm 🤗

You could put the request in via there website contact link if they have one?

Jeanette56 profile image
Jeanette56 in reply toTiggerMe

I will ring up again on Monday and will say that thank you very much. I know I am confident normally but it's hard when you're made to feel stupid so tend to go with what you're being told by the dr. I would need a telephone consultation for the bloods to be agreed I will ring on Monday and speak with them. Thank you so much for replying x

TiggerMe profile image
TiggerMeAmbassador in reply toJeanette56

Being Hypo really knock your confidence on top of everything else 😕 but once you realise that the Dr's really haven't much of a clue generally about thyroid issues you learn to guide them 😁

Jeanette56 profile image
Jeanette56 in reply toSlowDragon

I live in Merseyside x

SlowDragon profile image
SlowDragonAdministrator

Any obvious reason for low ferritin

Low iron/ferritin very common when hypothyroid

Are you vegetarian or vegan

Or heavy periods

Do you regularly eat red meat/liver

work on increasing iron levels by increasing iron rich foods in diet

Once you have had coeliac blood test via GP try gluten free diet

SlowDragon profile image
SlowDragonAdministrator

Folate- 11.7 ug/L

Vb12-891 ng/L.

What’s the range on folate

High B12

Are you currently taking any supplements that contain B12

High B12 can be deceiving

Paradoxical B12 deficiency

b12oils.com/paradoxical.htm...

1tuppence profile image
1tuppence

Hopefully by now you'll have been reassured that you are not going insane?

It's lonely being unwell, especially without support ...... so here are some hugs, as many as you need. xx

Polarbear54321 profile image
Polarbear54321

I was subclinical for years with terrible symptoms including history of vitamin deficiency and a parent with Graves’ disease. My periods stopped (I’m 37) and was on the cusp of starting hormone replacement. Despite my thyroid being subclinical through out they didn’t associate my problems with hormones to this. I had a feeling of needing to school myself up about thyroid (mostly because of my Mum’s condition) and came here. I paid for private blood tests which included TPO’s presented to docs with the symptom checker from this website. She immediately agreed to start me on thyroid replacement. (FYI my numbers weren’t as high as yours) Surprise surprise my periods have returned and my tsh hormone levels are in range now. I don’t feel like I am 💯 now and still have ‘bad’ days. Pretty sure I’m not on enough thyroxine as she prescribed 25 (although I’m taking 50). Again didn’t realise this was against guidance. I really do think you need to go in and tell them what you need because all I have had is incompetence from my Dr and yours sounds worse!

mrsturnertobe profile image
mrsturnertobe

I’m so sorry to hear your story, I got diagnosed with Hashimotos 3 years ago but it was long battle which took its toll on my mental health.

My first test was out of range like yours but my 2nd was within and the GP made me feel like I was insane, telling me my symptoms weren’t related to thyroid problems. They even tried to diagnose me with fibromyalgia!

Once you are diagnosed you get free prescriptions for life so I feel everything they can to prolong that diagnosis.

I was actually trying for a baby and struggling to conceive/having miscarriages which is what made them take me seriously in the end as your TSH needs to be under 2.

I spoke to a private doctor on the phone but he wasn’t any quicker with the diagnosis. I eventually got diagnosed by a fertility clinic who took my bloods and my TSH was 42! So the TSH fluctuates all the time.

I really hope you get sometime to take you seriously soon. Unfortunately you really have to push hard and find loopholes in the system like I did. All the best x

ClareP5 profile image
ClareP5

Good luck - you're not mad, you need medication - you will get there, but you do have to push hard when you're at your lowest. You can do this....

Tufty73 profile image
Tufty73

Hi Jeanette, your story sounds very similar to mine (without the weight loss - I had weight gain). I ended up going private because my doctors knew nothing about Hashimoto’s/Hypothyroidism, how to treat it and would not do their job and research the condition. You have definitely come to the right place! Stand firm with your GP but be prepared to go private if you need to. Hopefully you won’t, but your health and wellbeing need to be your priority. My GPS refused to treat my condition adequately but my private consultant put them in their place. I am now on the right treatment and am feeling the best I’ve felt in 6 years. As well as all the fabulous advice you have been given here, there are a plethora of helpful videos on YouTube with Doctors (mostly American) who specialise in Thyroid disorders.

woosMum profile image
woosMum

For a long time my doctors kept telling me I was subclinical even though I was listing symptoms and my TPO was way out of range. They have always said that I had an elevated auto immune system but never offered any sort of treatment. I remember a doctor ringing me to tell me that my latest blood test results were "normal" while I was in a supermarket. I was stood next to the milk, crying through frustration telling her all of my symptoms again and she reluctantly agreed to put me on 25 mg of Levothyroxine. When my symptoms worsened they wanted to increase my antidepressants but I said no, its not that, its my thyroid. I asked to increase my Levothyroxine and they put it up to 50mg which even though its a piddling amount still made a difference.

waveylines profile image
waveylines

So sorry to a hear of the situation you find yourself in. I went through something simular 20yrs ago and was given a CFS/ME label which I didn't have! I'm afraid you will have to push your doctors for that 2nd blood test ASAP done first thing fasting. Being a single parent with a child to look after is no fun when poorly and being left by your doctor not treated is outrageous tbh. You don't say whether you are getting any sick pay.

GPs are generally not very knowledgeable over Hypothyroidism. They go by what the labs say and pathways on their screens. Are usually not familiar with signs and symptoms of Hypothyroidism even though it is a fairly common condition. I had one GP tell me recently "that signs and symptoms are 'old medicine' These days we go on blood tests and scans!!! " So shocking.

So you, am afraid, when you feel sooo poorly need to become a patient expert so you effectively can politely direct the doctors and stand up to their bull. Thyroid UK have library of books. I would ask if you could borrow ' Living with my Thyroid' by Barry Durrant Peatfield. It was written by a renowned doctor who treated many patients let down by the NHS. Sadly he passed not long ago.

When you book your next appointment if you can face to face, take a good friend, family member who has Hashi with you. Doctors tend to listen better when patients are accompanied. Sad fact!

Always get copies or download copy of your blood test results from NHS app.

Ask for a trial of Levothyroxine of 50mcg. Point out all your signs and symptoms are typical of Hypothyroidism & list them. Point out the family history. Draw their attention to your blood test results which support that you too have developed Hypothyroidism (High TSH, High level of antibodies) . It really is pointless making you wait so you become more ill with a longer pathway back to health. You are a single parent and you need your job. You want to work but are physically too ill due to your condition not being treated.

(The government are now worried about the number of people on sick leave so hopefully your GP will listen).

Really important to take someone with you. Ideally a family member with diagnosed Hashi (to doctors Hypothyroidism) as they will know the score and can point out the family history.

This should be enough to sway them to give you a trial of levothyroxine.

Reassure yourself that all your symptoms can be resolved with treatment but I'm afraid it's not necessarily a quick fix.

Keep. Posting on here where you will get very good advice.

Sending you big hugs.

Bristolians2 profile image
Bristolians2

Has your cortisol been tested? Have a 9am test. You could order a 4 or 6 point saliva test and do it yourself. If cortisol is OK maybe look to iherb to order yourself something natural. Or seek guidance from a thyroid specialist.

As mentioned get tested for celiac and then go gluten free.

You need plenty of sea salt, b2, b3,b1, magnesium and vit with it. Selenium is necessary but too high made my hair drop possibly so this should be checked.

If your b12 is high you may have the mthr gene mutation so also may not process selenium well.

Wwwdot profile image
Wwwdot

Hi Jeanette

So sorry to read your plight but at least you are getting great advice and support here and you will never walk this health path alone again.

Trust your instincts and push for those blood tests as soon as possible. Could you try another GP in the practice. My hubby just been diagnosed and we are trying to get beyond the wait and see phase too but fortunately he doesn’t have the symptoms you have.

Try to keep a diary of symptoms and as someone said earlier be kind to yourself and rest as much as possible although I can imagine you smiling wryly when you have a child. But prioritise what must be vs what could be done so you do get some respite.

🤗🤗🤗🤗

silverbelle51 profile image
silverbelle51

Iodine maybe low! Might be a Reverse T3 issue. Be sure before you get on the "Thyroid Roller Coaster Syndrome" . Get rid of soy from your diet agutstygirl.com good resource to let you know the many names for soy like 75+

Kazania profile image
Kazania

Jeanette, I am so sorry to hear the struggle you are having with your uncaring and ill-informed GP. Like you I was off work for 5 months before I got some help. I can’t add anything more to the excellent advice that other posters have already given you. Believe us when we say with the correct treatment you will get better. Sending hugs and sympathy.🥰🥰. Well done health advisor Julie👏

littlemo76 profile image
littlemo76

Hi Jeanette, just to say I know how you are feeling. I was messaed about and made to look like a hypochondriac, but my advice to you is be your own advocate. Learn the methods, tips and tests results suggested to check all your levels. GPs havnt a clue about thyroid symptoms etc and endocrinologists are not much better in my experience. Thyroid UK has lots of info to take with you to the GP if necessary. I struggled for yrs but there wasnt internet back then. Antidepressant just made things a whole lot worse for me to point of almost giving up. Its not in your head. Give Julie a pat on the back in showing you the right door. There are lots in the same boat and we are here to support each other. Goodluck and keep going til you get answers. Even suggest a trial of thyroxine? I wish you well.

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