Test Results - How bad is it?

[LeanneMK]

Hi all, I went to the GP as I keep getting sharp pains in my right abdomen (upper quadrant) and multiple bruises appearing beneath my ribcage area, mostly on the right side but sometimes left. The doctor ordered a whole bunch of tests, including thyroid.

My results came back abnormal for thyroid. Everything else was normal. The GP called me to tell me I have an underactive thyroid and reiterated a number of times it was severely underactive. Prescribed 50mcg levothyroxine and waiting now for next test end of the month which will also check for Hashis.

I am constantly in pain from the carpal tunnel symptoms. I have a 10 month old son and it is making life so difficult, especially with the fatigue!

Here are my test results (I know people provide more than this on here but this is all that is stated in my NHS app):

Serum free T4 level 4.7 pmol/L [7.7 - 15.1]; Below low reference limit

Serum TSH limit 50 miu/L [0.34 - 5.6]; Above high reference limit

This is all very new to me. I am still learning about it. Any ideas how severe this actually is?

Is the carpal tunnel likely to be resolved through medication when I get to the correct dose or is the damage likely to be permanent?

Any ideas of the dose I'll probably need before I start to feel better? (50mcg starter dose at the moment isn't really touching the sides!).

Also, has anyone ever experienced the abdominal bruising and pain I mentioned with thyroid issues? I'm failing to see how they are connected through any research. Worried something more sinister is going on inside me!

Thanks all

[jimh111]

Hi Leanne, Welcome to the forum. Your TSH and fT4 indicate you have hypothyroidism, probably fairly advanced but there isn't a simple link between the blood tests and how bad a patient's signs and symptoms are. Assuming your carpel tunnel is at least in part to hypothyroidism it would suggest you have been hypothyroid for some time. Your blood tests are sufficient to diagnose and treat primary hypothyroidism (a failed thyroid gland) but if you don't get better more tests are definitely needed.

I think people usually notice a benefit from 50 mcg levothyroxine within a week or two. It's important to take levothyroxine on an empty stomach and not with coffee or tea. It is often recommended to take it one hour before eating but I have my morning porridge a few minutes after taking my tablet! You can take levothyroxine at bedtime if you wish, this may be simpler.

In recent times there has been a trend to starting non-elderly patients on 100 mcg levothyroxine, the idea is to get them better sooner. Your GP is taking the traditional approach of starting on 50 mcg and working up. To be honest I don't think it makes much difference, some tissues e.g. the heart, respond quickly to thyroid hormone and some such as the bones can take a long time. I wouldn't worry about your doctor's slower approach, you could ask to go to 100 mcg at your next appointment.

if you become pregnant again it's important to see your doctor and get your levothyroxine dose increased, you need more levothyroxine when pregnant. Your doctor can also give you a form to get free prescriptions for life because you are hypothyroid (in the UK).

it generally takes at least three months to feel a lot better although you should feel some improvements after a week or two. I don't know how well bad carpel tunnel responds to thyroid treatment, I'm guessing it will gradually improve over the coming months.

I had gall bladder disease caused by hypothyroidism which became worse when I started levothyroixine, it woke up my diseased gallbladder. As regards your abdominal pains and bruising I would see how you are in a month or two, you will then know if it's related to your thyroid or not.

[LifeintheMed in reply to jimh111]

Hi there, do you think you could say a little more about your gall bladder disease please?

[jimh111 in reply to LifeintheMed]

Hypothyroidism causes high cholesterol. I developed gall stones and a diseased gallbladder. I also had bile reflux which I suspect was caused by my hypothyroidism, gut motility was slow allowing bile to drift back into the stomach. I discussed it with my gastroenterologist and he suggeseted I don't have the gallbladder removed because it might make the reflux worse.

After my hypothyroidism was diagnosed and treated I started to get typical gallbladder pain as I passed stones, very painful. Treating my hypothyroidism had woken up the gallbladder. I then had it removed and all the problems ceased.

[LifeintheMed in reply to jimh111]

Thank you - I'm worried about this. I have high cholesterol and have had some pain in the region of my gall bladder (very mild)... I had no idea I had thyroid issues until recently and so I'm worried that over the years my health has suffered without me knowing.

[LeanneMK in reply to jimh111]

Thank you for the welcome and response!I had my thyroid tested when I was pregnant last year and all was well back then. It hadn't occurred to me that it had broken but seems to have been at some point in the past year. No plans for anymore pregnancies though (I'm 40-something haha).

Interesting info about your gallbladder issues. Thank you for sharing! I did have two episodes of gallstones in 2022. I never got checked out though despite the agonising pain from which there was no escape - foolish of me, really but when it didn't happen again I just got on with things and forgot all about it. I wonder if I've experience similar issues with the gallbladder awakening.

[jimh111 in reply to LeanneMK]

It's quite common for hypothyroidism to cone on after pregnancy, sometimes it recovers after a few months. During pregnancy the woman's immune system adapts as the baby is 50% alien (the father's DNA).Hopefully your gallbladder will be fine now. If you get another attack of biliary colic try to get your doctor to do a blood test straight away to confirm it. When passing a gallstone it blocks the duct and some liver enzymes such as bilirubin go through the roof, so the blood test is very diagnostic. Gallbladder operations are very effective provided the pain really is due to the gallbladder. Do, an accurate diagnosis is very helpful.

See how your symptoms are in the coming weeks and hopefully they will increase your dose soon.

[RedApple]

'Is the carpal tunnel likely to be resolved through medication when I get to the correct dose or is the damage likely to be permanent?'

Yes, it can resolve with the right dose of medication and healing time, so you might want to put surgical intervention on hold for a while.

'has anyone ever experienced the abdominal bruising and pain I mentioned with thyroid issues? I'm failing to see how they are connected through any research.'

Every aspect of the body and brain requires adequate amount of thyroid hormones to thrive. As your levels have likely been well under par for quite a long time, this will be causing many things to go wrong. So yes, the abdominal pain and bruising could be caused by your being hypothyroid. If the bruising gets worse, bring it to the attention of your GP.

[LeanneMK in reply to RedApple]

Thank you! I am more hopeful now that there is an end in sight for the pain and discomfort. Next time (if) more bruising appears I'll make an appointment to see the GP in person as when I originally went they were fading and I only had photos of previous occurences

[FancyPants54 in reply to LeanneMK]

Bruising is a well known symptom of this condition.

[thyr01d]

Hi Leanne, I'm hoping this will make you feel a bit better. I had carpal tunnel syndrome and it has completely resolved with thyroid treatment, I know that could be coincidence but I can't think of any other reason, I take no other meds. For a few weeks I wore splints to ensure I did not ask too much of the wrists, that sounds tricky with a baby, but it does help you remember so might be worth trying. Also, people might think I shouldn't say this, but I do think it will cheer you. The TSH of 50 is likely to make you feel awful, symptoms are often noticed even as early as 10 (in the range your lab used). Why that might cheer you is because you are likely to feel much, much better once you have been on the right dose of thyroid meds for long enough. People on here are wonderfully supportive and can give a lot of information, so keep coming back if it helps.

[LeanneMK in reply to thyr01d]

Thank you, that is definitely reassuring! I do have wrist splints but I just use them at night in between waking to feed little one. It does help to an extent but all of the benefit tends to be undone by all of the strains of the day, sadly. I'm now hopeful that there is light at the end of the tunnel (no pun intended!)

[Sleepman]

Worth checking antibidies TPO is what NHS test. Shows if autoimmune type. I see you have this planned.

Be kind to yourself you have to take it easy to help recovery. It is a bit slow. Levo T4 takes weeks to fully get into your system. Then your body has more energy to heal and get back to normal.

Get through this step on 50 mg which shows you are ok on this brand of T4 hormone and there are no other complications. If not going well get adrenals tested.

1.With your level which were were high like mine... push for a blood test at 5 weeks. If no thyroid anti body test get that done. Get a dose increase.

2.Get celiac test done also.

3.Vit d and b12 ferritin and folate are key things for UAT. Get these tested to see if you need supplementing.

4.Ask them to measure T3 levels. They likely will not but seems to vary by region.

I wrote my symptoms and to do list on an email chain to myself every few days then once a week.

My brain was mush, this helped

Home T3 blood test is about £30.

UAT has all sorts of symptoms, different in different people. Carple tunnel will go. I had something called trigger finger.

My high cholesterol went also.

All sorts of aches and pains went.

Most UAT cases are simple but if you are not this is where this forum excels. So do not be scared !! when reading posts you are seeing worst say 10%. The admins are incredible. The struggling peeps do not convert T4 to T3 or have to have just T3 due to difficulty in getting T3 into cells.

Hopefully you are simple to treat.

[LifeintheMed in reply to Sleepman]

I'm so encourgaged that your cholesterol went down! Do you know how long that took?

[Sleepman in reply to LifeintheMed]

Less than a year. Need to dig out my results. I was prediabetic too and that is now clear.

[LeanneMK in reply to Sleepman]

Thank you for your response and info. I will definitely try to get the blood test booked in earlier than the GP suggested - good call!

Thankfully general muscle aches have eased off now after a couple of weeks of 50mcg levo.

I'll be looking into celiac testing too for sure! Thanks

[FancyPants54 in reply to LeanneMK]

Don't rush it. It takes weeks for a dose of levothyroxine to stabilise. I'd say 6 weeks is the minimum. 8 weeks is better. If you rush now, you risk missing your ideal dose and suffering much longer. This is a softly, softly approach.

Tell your family. Ask for help. You have a serious condition and treatment takes time. You need as much help as you can get. You can't be your usual self for a while.

[Sleepman in reply to FancyPants54]

I would respectfully argue you can make large jumps on levo at the start before optimising /tweeking going slow. TSH is so high you are no where near your sweet spot. 1.6 x your weight in kg is rough guide to final dose.

I was desperate to feel better and have no heart issues.

Really good news you are ok on levo and aches reducing.

Look at my profile to see how mine went. I had forgotten about my feet warming back up.

I too doubt you will see endo. My doctors surgery knowledge was poor.

youtu.be/GCM5Q0AHZzM?si=mZq...(Not working as expected?)

This is link to a London GP who has no thyroid and talks about GP knowledge level and NICE guidelines.

Private T3 blood tests will show if you have complications.

I am remembering I wrote to GP and asked about all blood tests mentioned above, I think this helped.

Keep a written log of your symptoms. It shows dictor you are serious and really helps if you have any of the brain fog stuff.

I measured temperature under my tongue as you wake.

As a man I do not have a monthly temperature cycle... It was under 36 C then when better over 36.6C. My feet became warm again ...

The peeps on here are wonderful.

[Sleepman in reply to LeanneMK]

See reply to FancyPants just below.

[Mifford]

Has your gp referred you to an endocrinologist? If not then request a referral. You could be lucky and respond well to meds and have a doctor that understands thyroid well but many don’t. Most gps will tell you you are fine as long as your TSH comes down to within range. For me I still feel awful if my TSH level is above 0.8. Endocrinology understand that and keep me medicated to reach that level whereas my gp would have reduced my medication levels.

Your TSH is very high and your T4 very low so it’s also possible an endocrinologist would want to carry out other tests and has more experience in helping you feel better quicker. They’ll also recognise that different med combinations or even brands can help for some people.

I hope the meds kick in soon and you start to see some improvement quickly - good luck xx

[LeanneMK in reply to Mifford]

Thank you! xMy mum suggested I should see an endo so I'll ask about it at my next appointment.

[FancyPants54 in reply to LeanneMK]

You are unlikely to get a referral to an Endo. at this stage. You have to see how you go first on the meds. Again, as I said further up, you can't rush this. And I'm sad to tell you that Endos. in the UK are diabetes specialists now and most know less than we the patients about thyroid disease and treatment. You might have to run the gauntlet with them later if you struggle to improve. But right now, avoid and just keep going.

This site is excellent. Read all you can here. thyroiduk.org

And here is a link to their very useful tick list of common symptoms of hypothyroidism. Print it, fill it in and date it and start a file folder for your symptoms tracking and your blood test results as you go.

thyroiduk.org/wp-content/up...

[LeanneMK in reply to FancyPants54]

This is fantastic thank you!

[FancyPants54 in reply to LeanneMK]

It helps us to be very organised with this illness because our doctors just don't know enough. For example always complete a blood test the way it is recommended here. Before 9am if possible (make up reasons why it must be early if you have too). Nothing to eat or drink from the night before (you can and should drink water before the blood test so that you are not dehydrated, if you are they can't find the veins). 24 hours between the last dose of your levothyroxine and the test.

A couple of days after the blood test ring reception and ask them to email you a copy of your test results. You are legally entitled to them so you must get hold of them. Write the dose of medication you are taking at the time of the test and file it. These results prove very helpful later on to refer back too if any issues arise. If you have the NHS app on your phone though you can pick up your results that way. Find a way to print them to keep.