Do I need to be on thyroid medication

[Beautifulday66]

Good morningFirst time post for me.though have been a avid reader on this forum

So past history 6 years ago I started to lose my eyebrows to the point where I don't have hardly any now.

Gained a lot of weight .dry skin and red rash on forehead that seems to be heat and stress related,vertical lines on finger nails slow nail growth and nails that break easily, constantly tired even tho I get 8 hours sleep a night,brain fog most days trouble with concentration..so the symptons of under active thyroid?!

Over past years tsh been tested all within range..but still can't find reason for all the above..especially loss of eyebrows.

Now this year I had following bloods taken

March these blood were taken,results and ranges below

Free T4 12.5 (11.9-21.6)

B12 312 (197.0-771.0

Folate 7.5 (3.0-20.0)

Ferritin 73 (13.0-150.0

TSH 7.42 (0.27-4.2)

Also diagnosed with prediabetes and high cholesterol (now taking statins)

Retested for tsh,T4 and tpo antibodies beginning of July,results below with ranges

TSH 5.78 (0.27-4.2) Above high reference limit

T4 13.6 (11.9-21.6) marked as satisfactory

TPO 1542IU/mL positive >35IU/mL

A appointment has been made by phone for gp to discuss my results

Question would you say I need thyroid therapy and do you think I'm going to have a battle getting it prescribed.

Sorry for long post ..I appreciate your help

Thank you..have a great day

[helvella Administrator]

My view is that you definitely should be!

Low FT4.

Elevated TSH - repeated.

High TPO antibodies demonstrating autoimmune issues - viz. Hashimoto's Thyroiditis.

If you had previous results that were similar, try plotting them out as a simple graph (Free T4 and TSH - no need to do all of them). For me, a graph of TSH alone showed a steady rise and gave the final push to get diagnosed.

Your B12 is also low. You are unlikely to persuade a doctor to do anything. Hence, suggest you try 1000 microgram oral B12 once a day (many forms available) - I like the ones which taste nice and contain methylcobalamin. Then make sure you get re-tested to check you are absorbing and the level is rising.

[Dahliasanddaisies]

Evening, my results were really similar to yours. I eventually got Levothyroxene by asking (firmly) for 'trial' on 25mcg. It's actually in the NICE guidance that 2 tests of TSH that show above range, but below 10, should be offered a trial of Levothyroxene. It's taken me over a year to work up to 100mcg, it was a battle to get an increase every time. I hope you have a good GP

[tattybogle]

yes , a GP could prescribe Levothyroxine based on:

~ those two sets of results showing TSH over range

~ and your symptoms of hypothyroidism ,

~ and the raised TPOab (thyroid peroxidase antibodies) ~yours are very high ~ which confirm that you have autoimmune thyroid disease.

TSH above range while fT4 is still within range is classed as 'sub-clinical' hypothyroidism.

Current NHS guidelines say GP 'can consider' a trial of levo :

nice.org.uk/guidance/ng145/...

"1.5 Managing and monitoring subclinical hypothyroidism

Tests for people with confirmed subclinical hypothyroidism

Adults

1.5.1

Consider measuring TPOAbs for adults with TSH levels above the reference range, but do not repeat TPOAbs testing.

Treating subclinical hypothyroidism

1.5.2

When 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

1.5.3

Consider 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.

1.5.4

Consider 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."

I was started on levo with TSH initially 5.7 then 6.8 at repeat test , and symptoms of hypothyroidism that were affecting my ability to work and function properly (T4 was still within range but falling ), i had extremely high TPOab 2499 [<50].

my TSH was not considered very high , i think my very high level of TPOab helped GP decide to give levo while i was still only 'subclinical'... also the fact that my TSH had risen on the second test, and the T4 had fallen........ be aware that TSH has a circadian rhythm , it is highest early am and falls to it's lowest around 1-3pm , then slowly rises again. So the time of testing matters ~it's best to get TSH tests done at a similar time of day (preferably @9am if possible) ~so you get a proper comparison between tests.

[crimple]

Beautifulday66 you have had some good advice I was diagnosed with TSH over 6. I have a strong family history of hypo. I see you are taking statins. Being hypo causes raised cholesterol .Before the TSH was introduced, hypothyroidism was diagnosed by raised cholesterol. Many hypos, especially women, cannot get on with statins, they made me very ill. Proper treatment of your hypothyroidism with levo will lower cholesterol. Hope you get sorted with levo and things improve, be warned it takes time!