Subclinical hypothyroidism advice for next appointment

[bluepenguin]

Hi, I was told I was I had Subclinical hypothyroidism in 2017 but was not significant so no further input. Unsure of exact results but TSH was raised, but <10 with normal T4 (but do not have a copy of the results). Past few years have noticed hair loss, muscle aches & pains, tiredness, some weight gain despite trying hard to loose weight, alcohol intolerance, but symptoms getting worse last 3-6 months. Went into surgical menopause in 2018 and been on HRT since. I am now 54 and have put all my symptoms down to the menopause, but thinking now maybe not.

I have now had repeat bloods done TSH 6.84 (0.38-5.33) Free T4 9.3 (7.9-14.4)

CRP, Rheumatoid factor, bone profile, U&E’s, LFT’s, FBC, HbA1c are all normal.

I have a follow up to discuss my TFT’s next week. Any advice to other blood tests I may benefit from, or if a trial of medication would be worth exploring. Thanks for any help.

[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)

Is this how you did your test

Hair loss often low ferritin

Joint pain low vitamin D

[bluepenguin in reply to SlowDragon]

Many thanks for your reply.

Test was done at 9am but I had eaten breakfast & had coffee. Will know not to do that again!

I will definitely discuss the further tests you advise when I have my review.

[SlowDragon Administrator]

With two separate blood tests with TSH over 5 and symptoms you should be offered trial on levothyroxine

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

Guidelines of dose Levo by weight

approx how much do you weigh in kilo

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

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

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

[bluepenguin in reply to SlowDragon]

Thanks for your previous advice, be grateful for your thoughts on the following results I have now had done 6 weeks after my last raised TSH test, done at 10am and had only had water prior to test

TSH 3.42 (0.38-5.33)

ATP 1 (normal below 22)

Vit D 79 (>50 adequate)

Vit B12 163ng/L (146-200 may indicate deficiency)

Ferritin 47ug/l (30-99 indeterminate)

Folate 22ug/L (3-20)

I am still having the same symptoms but confused as TSH is now normal.

I have an appointment this week so would like to do in as informed as possible.

[TiggerMe Ambassador in reply to bluepenguin]

Edit, sorry just realised you aren't on thyroid hormones

Without fT3 & 4 levels its just guessing really

Ideally test before 9am when TSH is at its highest

It would also be a good idea to up your Vit D as that really is better above 100... ferritin also on the low side both needed for good thyroid function