Symptomatic but within range

[Fb104]

Hoping someone more experienced can help advise on next steps...

I've been feeling very tired since Nov/Dec, with brain fog, dizziness and palpitations for the last month. All the older members of my family are diagnosed hypothyroid. I had a basic blood test (annoyingly I didn't realise the guidance for TSH testing so it was non-fasting and c 11am draw) which showed:

Free T4: 13.4 pmol/L (11.5-22.7)

Thyroid stimulating hormone (TSH): 3.32 mIU/L (0.6-4.8)

Also elevated (5.93 vs threshold of 5) cholesterol, which I believe can be common with hypothyroid.

Given my age (30) and weight (within ideal BMI range) my understanding is the reference range is probably higher than where I should 'really' be, but all I got from the GP so far was that thyroid is 'normal' and therefore not a problem, but that a fasting blood test to confirm the potential cholesterol issue would be recommended.

I have another appointment tomorrow. Given family history, symptoms and questions about the appropriateness of reference ranges, I'm going to push for an antibody test (and ideally TSH again and make sure I fast/book an early slot).

Can anyone suggest any more arguments/sources if the GP is reluctant, or suggest anything else I could/should be doing?

[Sparklingsunshine]

Unfortunately a lot of GP's still stick to the cut off of TSH of 10 before commencing treatment, which is stupid and much higher than many other countries. Having said that a below range FT4 and or FT3 can get you treatment sooner or some have used raised antibodies and symptoms. We suggest a blood drawer no later than 9am, fasting, you can drink water, for the highest TSH result.

If your TSH levels are still below the threshold then ask if they can be retested in 3 months time. And you could ask for or test privately for B12, ferritin, folate and vitamin D, all of which are likely to be low, especially in suspected autoimmune hypo disease.

These not only affect your TSH levels but if they arent optimal they will make you feel dreadful. The symptoms you describe could be low iron and or B12. If and only if these are low then consider supplementing. The admins and members are very knowledgeable about optimal levels so please post results.

I know how frustrating it is when you are waitihg for the magical TSH number to appear but being proactive about your nutrients will help both physically and psycholgically. Its a positive step.

[Fb104 in reply to Sparklingsunshine]

Thank you, will ask about B12, ferritin, folate and vitamin D

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

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 TPO and/or high TG 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.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

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)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and 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

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG 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

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Starting levothyroxine - flow chart

Shows you ideally will need 2 separate blood tests with TSH over 5

But high thyroid antibodies and/or low vitamin levels would suggest more going on

gps.northcentrallondonccg.n...

[Fb104 in reply to SlowDragon]

Thank you, lots to read through

[SlowDragon Administrator in reply to Fb104]

Come back with new post once you get retested

[Fb104 in reply to SlowDragon]

Quick question on the blood tests - why do you say Monday or Tuesday morning? I don't know how quickly the kits get sent, so probably I would be looking at next week if that's important.

[SlowDragon Administrator in reply to Fb104]

Because you don’t want to post Thursdays or Fridays and kit then not processed over weekend

Aiming for quickest turnaround

You could do test Wednesday at a pinch ….posting back by 24 hours guaranteed post

[Fb104 in reply to SlowDragon]

Makes sense, thank you