I had routine bloods done last week mainly because of high cholesterol.
My results showed not just high cholesterol, but also:
Serum TSH 8.7
Serum free T4 12.8
So there's a note about me being subclinical hypothyroid and another about statins. So I'm guessing the GP is just going to want to put me on statins.
I'd rather the hypothyroidism was treated which would presumably help the cholesterol (I eat really healthily, run and lift weights regularly, hardly drink alcohol and barely ever eat junk, so not much diet wise I can do to help).
What kind of things should I be asking my GP? Has anyone successfully persuaded their GP to try hypothyroidism treatment even if it's subclinical?
Thanks in advance.
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Bishbashbosh74
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If this is your first TSH and T4 test, you need to ask for a another in approximately 8-12 weeks time to confirm the diagnosis of subclinical hypothyroidism.
Alongside the second test, a thyroid antibodies test (usually TPO) will help confirm the diagnosis also.
if this is your first over range TSH test , then before any thyroid treatment can be offered ,it will need a repeat test in 3 months time (some GP's may do it a bit earlier ie. 6wks depending on circumstances ) ~ this gap is necessary to rule out a temporary raise in TSH from other causes.
Assuming TSH is still over range at the repeat test, then yes, NHS GP's 'can consider' offering treatment for subclinical hypothyroidism IF IT IS CAUSING SYMPTOMS .
if thyroid autoantibodies (TPOab and /or TGab ) are over range, this makes a stronger case for starting treatment at sub-clinical levels. ( because they confirm an autoimmune cause for the 'sub-clinical' hypothyroidism , making it more likely it will eventually progress to overt hypothyroidism ).
and yes, you are correct ...NHS guidelines say untreated hypothyroidism should be addressed before offering statins for high cholesterol , as hypothyroidism is a known cause of raised cholesterol and it should reduce by itself once the hypo is treated.
"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. "
For comparison purposes, I was given Levo with TSH 5.7 , then 6.8.
I had some typical symptoms of hypo... cold all the time / slow brain and speech / fatigued /constipated/ slow reflex return ... but not entirely typical as i had no significant weight gain, just developed a lumpy/ waxy looking face mainly around the bridge of my nose/ eyes.
my TT4 was still in range but towards the lower end (and was lower on the repeat test) , however the main deciding factor for my GP offering levo while still subclinical was probably my TPOab which were very high indeed 2499 [0-50]then >3000 [0-50]
if they had not been so unusually high, i suspect i may have had to wait MUCH longer to be offered levo ..... it had already taken 4 yrs of slowly worsening symptoms / repeatedly offered antidepressants, while no one (including me ) thought to even look at the thyroid because i wasn't remotely fat.
I also suspect that the fact that i wasn't ASKING for levo, (or even for thyroid testing) had something to do with it .... they presumably will be more cautious if they feel the patient has been on the internet and has an end goal of Levo in mind.
"If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid." nice.org.uk/guidance/ng145/...
Meanwhile request GP test thyroid antibodies, vitamin D, folate, B12 and ferritin
Likely low vitamin levels when hypothyroid due to low stomach acid and poor nutrient absorption
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)
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 and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
You need to get your antibodies checked as this is a clear indication of thyroid disease if they are raised. It’s good to check TSH, T4 and T3 but antibodies are generally considered the best way to check for sure. Also check your vitamins D, folate, ferritin and b12. These need to be optimal to ensure good conversion from T4 to the magical T3 hormone. High cholesterol does also have a link with low thyroxine When my T3 was too low my cholesterol was quite high as soon as I started taking t3 medication combined with my usual T4 levothyroxine my cholesterol dropped significantly
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