Advice

[4youreyesonly]

Hello, I have sub clinical hypothyroidism with positive tpo antibodies taken a long time ago . I did get in touch a while ago about starting on thyroxine and my dr was happy for me to start on a low dose as I also have many symptoms but not weight gain I must add .I also am on a immunosuppressant for another autoimmune condition with similar symptoms . To try and cut a long story short , before I could start my mum became terminally Ill and I moved to where she lived for nine months to care for her . Her go did my bloods and within a couple of weeks without starting the meds my tsh had gone right down to just above 1 so I didn’t take it . Obviously my health took a back seat but over those months tsh starting to climb slowly again .I’m now back home after a very stressful time and here are some results . October 23 :Tsh 5.5 (0.3- 4.5) T415.3 (10-22) Medichecks Feb24 Tsh 7.73 (0.27-4.2) freeT3 5.5 (3.1-6.8) T4 16.5 (12-22) .Vitamins all ok apart from low ferritin but not anaemic and good iron levels so don’t need supplements. My question is these don’t look too bad to me so should I just wait and see a bit longer till my T 4 drops lower . Sorry for the long post .

[TiggerMe]

I'd say it is very much down to how you feel, like you say your TSH is creeping up but your fT3 & 4 aren't too bad.... if you aren't feeling symptomatic and your cholesterol levels, vits and mins etc are good perhaps just keep monitoring 🤗

What time of day are your results from?

[SlowDragon Administrator]

Vitamins all ok apart from low ferritin but not anaemic

So you can work on improving low ferritin by increasing iron rich foods in your diet

[greygoose]

Medichecks Feb24

Tsh 7.73 (0.27-4.2)

freeT3 5.5 (3.1-6.8) 64.86%

T4 16.5 (12-22) 45.00%

As TiggerMe says, it's very much down to how you feel. But, they may look good to you because you're looking at them individually, not as a whole.

The TSH is much too high. The TSH of a person with no thyroid problems (euthyroid) is around 1. A TSH of over 7 means that your thyroid is needing an abnormal amount of stimulation in order to produce what hormone it can.

A euthyroid FT4 would be around 50% through the range. Yours is 45% - and that's with the abnormal amount of stimulation from the TSH.

A euthyroid FT3 would be around 50% through the range but slightly lower than the FT4. Yours is much higher than the FT4, which is also abnormal. A thyroid that is failing will do that, produce as much T3 as it can at the expense of T4, because you need T3 more than T4.

So, your thyroid is obviously badly damaged by the autoimmune system, and the question is: how much longer can it carry on like that? Eventually, you are going to need thyroid hormone replacement (levo, etc.) and that day might come sooner than expected. So, if you chose not to start it now, do keep a close eye on your levels to prevent the development of symptoms.

[4youreyesonly in reply to greygoose]

Thank you for your reply , I didn’t understand about the higher T3. I think I have symptoms now , fatigue, raynauds, contispation , brain fog , low mood , palpitations, and irregular heartbeat, loss of body hair ,sweats,but no weight gain .If I go on it now will my T3go higher? Thanks

Pp

[greygoose in reply to 4youreyesonly]

I didn’t understand about the higher T3

Well, in a euthyroid person the thyroid makes mainly T4 and a little bit of T3. Most of our T3, when healthy, comes from conversion of T4 in the cells as needed. So, the blood test results of a person with a healthy thyroid could have FT4 and FT3 at around 50% through the range, with the FT3 slightly lower in percentage than the FT4. So, you might have something like FT4 at 51% and FT3 at 39%, depending on the person.

But, when the thyroid is failing, for whatever reason, it makes less T4 and more T3 than it normally would, because T3 is the active hormone, needed by every single cell you your body to function correctly. T4 is basically a storage hormone that doesn't do much until it is converted into T3.

So, if you see that the FT3 is higher in range then the FT4, percentage-wise, you know that your thyroid is failing.

I think I have symptoms now , fatigue, raynauds, contispation , brain fog , low mood , palpitations, and irregular heartbeat, loss of body hair ,sweats,but no weight gain

Most of those are thyroid symptoms, yes. But Raynaud's is a separate disease that is often associated with hypo.

Not all hypos put on weight. Some of them actually lose it. Others just stay the same. There are many, many different hypo symptoms, and every hypo has his/her own personal symptom list.

If I go on it now will my T3go higher?

Unlikely. Because your TSH will gradually fall, and the thyroid will therefore slowly stop making hormone - it cannot make hormone without the stimulus of the TSH.

Levo (T4) does not 'top up' your existing hormone levels, it replaces them, and the thyroid stops producing and goes to sleep. So, then you will be entirely dependant on conversion for your T3. So, it all depends on how well you convert.

[4youreyesonly in reply to greygoose]

Many thanks for explaining that to me .I probably sound stupid here but I’m learning.When your thyroid is failing and your T4 drops if you haven’t much to convert then why doesn’t T3fall as well ?

[greygoose in reply to 4youreyesonly]

It will, eventually. But as long as the thyroid can carry on making decent amounts it will do so, to keep you alive.

[4youreyesonly in reply to greygoose]

So basically I go on it now or wait to see if symptoms get worse

[greygoose in reply to 4youreyesonly]

Yes, those are the only two choices. It's not going to get better and will eventually get worse.

[4youreyesonly in reply to greygoose]

My tsh level has varied for a long time , years in fact .Could you tell me why it went over range and then down to 1 something in a matter of weeks.

[greygoose in reply to 4youreyesonly]

TSH follows thyroid hormone levels. When they are high, TSH is low. When T4 and/or T3 drop, TSH rises. And thyroid hormone levels tend to fluctuate with Hashi's due to the immune system attacking the thyroid and releasing stores of hormone into the blood.

[4youreyesonly in reply to greygoose]

So if I have bloods taken again in a few months and tsh has fallen again , does that mean I don’t start thyroxine . This is so confusing, sorry .

[greygoose in reply to 4youreyesonly]

Yes, it confuses most doctors! lol

You cannot dose by the TSH only. You need FT4 and FT3 levels, as well. Once the TSH gets below 1 it's a very unreliable indicator of thyroid status. But, as a general rule, a TSH around 1 is euthyroid (i.e. not thyroid problem). A TSH over 2 shows that your thyroid is struggling. And when it reaches 3 you are technically hypo. And in some countries they will start treatment at that level, or have a range that just goes up to 4.2 or something and start treatment when the TSH goes over-range. But, if you are in the UK, the NHS wants it to go over 10 before they will diagnose - two consecutive TSH results over 10, about three months apart.

However, if you have high antibodies, and low FT4, some doctors will start you on levo earlier. It all depends on the doctor and the level of understanding he has of thyroid.

[4youreyesonly in reply to greygoose]

Thank you so much for your advice and knowledge .

[greygoose in reply to 4youreyesonly]

You're welcome.