Hi everybody
I was recently seen by an endocrinologist about my osteoporosis. Following blood tests, he has sent a letter to my GP saying my TSH level is 6 and I should be monitored and if there is evidence of hypothyroidism, started on thyroxine. At what TSH level are people normally started on thyroxine?
My GP is ringing me on Monday and as this is a new condition to me, I wondered if there are any questions I should be asking.
Thank you,
Welcome to the forum Lopera,
So we can offer better advice, it’s good to share blood test results (with ranges in brackets) for:
FT3
FT4
(in addition to TSH provided)
Also ask for antibody tests (to see if you have an auto immune thyroid condition, AKA Hashimotos) and key thyroid vitamin tests (ferritin, folate, vitamins D and B12)
In the first instance, do ask your GP for the above tests. We don’t recommend supplementing key vitamins without testing first (and sharing results with us).
If your GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of your thyroid health:
thyroiduk.org/help-and-supp...
GP will probably want 2 significantly elevated TSH readings before considering medication (Levothyroxine). A patient to patient tip for your next blood test is to have an early morning blood draw (before 9am) when TSH at highest.
Thank you for your reply. I will ask if there were any results for FT3 and FT4. I was being tested prior to starting teriparatide for my osteoporosis so I'm not sure what the focus of the test was. I will also ask for antibody tests and the vitamin tests.
I am already supplementing vitamins D3 and K2 and calcium for my osteoporosis and iron as when I was last tested, I was borderline for iron.
Thank you for the link for private testing.
Low thyroid hormone levels can cause osteoporosis
with 2 separate tests on NHS with TSH over 5 and hypothyroid symptoms you could/should be started on levothyroxine
Symptoms of hypothyroidism
thyroiduk.org/signs-and-sym...
You need further testing including thyroid antibodies for autoimmune thyroid disease (hashimoto’s)
Also testing vitamin D, folate, ferritin and B12
What vitamin supplements are you taking
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
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
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)
NHS only tests TG antibodies if TPO are high
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
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...
Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee
Only do private testing early Monday or Tuesday morning.
Tips on how to do DIY finger prick test
support.medichecks.com/hc/e...
Thank you SlowDragon, a lot of information here. This is a whole new language for me. I'm not sure what TPO means.
As well as osteoporosis, I also have PMR and ulcerative colitis which I think is auto immune. I supplement with Vitamins D3, K2, C plus a bone health mix which includes calcium. Plus I take turmeric and omega 3.
Having one autoimmune disease makes others more likely
Link about thyroid blood tests
thyroiduk.org/testing/thyro...
Link about Hashimoto’s (autoimmune thyroid disease)
thyroiduk.org/hypothyroid-b...
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies or by ultrasound scan
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)
NHS only tests TG antibodies if TPO are high
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
I'm not sure what TPO means.
There are several types of thyroid antibodies that can be found in various thyroid diseases.
btf-thyroid.org/thyroid-ant...
Subclinical hypothyroidism
Should I treat subclinical hypothyroidism
Subclinical
is this subclinical hypothyroidism? 
Subclinical Hypothyroidism
