Sub-Clinical Hypothyroidism - should i be receiving treatment

I have tested 3 times with a high TSH over recent months, it was 7 on my last test which was the lowest it had been. My Free T4 is normal (i dont know the level). I will be tested again next week for my TSH and for the first time for thyroid anibodies. My Mum has Hypothyroidism and i am always exhausted and feeling low/depressed. I have also been trying to conceive and have had fetility tests which have not identified any problems.

Should i be treated maybe for subclinical Hypothyroidism? I understand it could have an impact of fertility. My doctors don't seem to be doing anything beyond repeat tests. If it is high and I have positve antibodies should I push for treatment?

Many Thanks

18 Replies

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  • This is an answer from Dr Toft in a Pulse article :-

    The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat the thyroid function tests in two or three months in case the abnormality represents a resolving thyroiditis.2

    But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive – indicative of underlying autoimmune thyroid disease – the patient should be considered to have the mildest form of hypothyroidism.

    In the absence of symptoms some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow-up.

    Treatment should be started with levothyroxine in a dose sufficient to restore serum TSH to the lower part of its reference range. Levothyroxine in a dose of 75-100µg daily will usually be enough.

    If there are no thyroid peroxidase antibodies, levothyroxine should not be started unless serum TSH is consistently greater than 10mU/l. A serum TSH of less than 10mU/l in the absence of antithyroid peroxidase antibodies may simply be that patient’s normal TSH concentration.

  • Thank you for your reply. I will be having the thyroid antibody test too next week so I guess i should wait to see if they are positive or negative. I have gained approx 20lb in the last 18 months and I eat well ( i saw a nutritionalist to check things were ok), I go to the gym 3/4 times a week, walk the dog every day and go to dance lessons once a week and I do not even lose a lb. I have no energy and feel disinterested in doing anything due to being tired. I have to force myself or be pushed by my partner to do the things i have just listed.

  • Before the TSH blood test became the way many doctors nowadays seem to diagnose hypo, doctors used clinical symptoms to diagnose and you seem to have quite a few. Weight Gain is very common and is due to a low metabolism which is why you cannot lose. Everything becomes difficult, expecially exercising .When you are on optimum meds, raising your metabolism your weight should come off but some GP's insist on keeping patients' TSH in the normal range, and if we are undertreated we can get more serious diseases. I am not medically qualified but have read a lot of info, especially Dr Lowe who had Drlowe.com, Thyroidscience and Fibroymalgia Research. Unfortunately he died earlier this year and his websites are under probate at present. This archived website may not allow the links within. There are a other topics at the top of the page.

    web.archive.org/web/2010122...

  • Not sure I can answer your question but perhaps my situation will help to explain a bit. I had some blood tests 2 months ago as I was feeling under the weather but no obvious other symptoms. everything was normal except my TSH was elevated at 7.11 whilst my T4 was just about in the normal range. My GP decided to repeat the tests 2 weeks ago and my TSH was now 7.38 and my T4 the same but this time she also asked for antibody test and that was elevated at 112 and should be under 60 so she consulted internally and they recommended I start with levothyroxine daily at 25mg which I did yesterday and to recheck weekly for the next 8 weeks. They think I either have early or mild Hashimotos. I have to say whatever it is its not stopped me doing anything and but for feeling a bit off a couple of months ago I wouldn't have gone to the doctor at all.

  • Thank you for taking the time to reply. Hopefully once I get my antibody results back if they are abnormal they will treat me. My mom has hypothyroidism and wasn't diagnosed until ended up in hospital with her neck being operated on, I don't want to end up in that situation.

  • Hi. I understand what you're going through. I had a TSH of 5.6 and a T4 at the low end of normal. I had many hypo symptoms and, most importantly, couldn't conceive. I managed to get referred privately to an endocrinologist who said I should be treated if symptomatic. I started on 75mg thyroxine and was pregnant within 2 weeks. That was 6 years ago. I now have 2 lovely girls that I'm sure I'd never have had without treatment.

    I truly believe that you should be treated if you are symptomatic, not if your blood levels hit a magic number. Please find someone willing to help you and persevere!!

  • Thank you for sharing your experience with me, it helps me to feel like I'm not alone in this and not being a hypocondriac. I had read that if your TSh is below 10 but above normal and your symptomatic it is beneficial to be treated. Also that when trying to conceive a TSH of approximately 2 is ideal. My doctors ignored me when I said this.

  • Hi

    Firstly you are not a hypocondriac! Secondly, you must listen to your body and believe what you feel. I was actually urged to get my subclinical hypothyroidism sorted out on a skiing holiday by a retired endocrinologist who I met on the slopes. I was finding it really tiring and feeling exhausted after half a day, which was not at all like me. He started asking me about children and when I said we'd been trying for a while, he immediately said that I looked hypo and sounded like I was. I wasn't your typical case - no goitre, not overweight, but he diagnosed me just like that. I forced my GP by asking for a private referral, and that is how it all happened.

    There are doctors out there who want to help, you've just got to find one! This site has a list of favourable ones, and if you're near Brighton, PM me and I'll tell you mine. He's not perfect, but he treated me. If you have private medical insurance, please use it. Someone will treat you and you will most likely feel much better, at least initially.

    Good luck!

    Emma

  • Thank you. I have joined bupa, staring on 1st December. Although I have not been diagnosed they are saying ill probably not be covered as its a pre existing condition. I wish it was as it would mean I had been diagnosed! Ill pay if necessary as I just want this resolved. I'm 34 an mindful of the time it's taking to conceive and also you are totally right I am listening to my body and I know something is wrong. I'm just so frustrated that I'm not being listened to. Hence I'm going on about it here! It's good to hear I'm not on my own. I will continue to pursue this.

  • Hi Emma, i was really interested to hear your story, we have been trying to conceive our second child for 8 months now which doesn't sound like a long time but it happened v quickly with first one. I have just started having tests with doc but have had a tsh of 4.7 for at least a year now and periods are a bit different (spotting before starts properly- sorry tmi!)although regular. I am also quite fatigued a lot of the time but no other real symptoms apart from the changes in my periods. Gp swears our difficulty in conceiving has nothing to do with thyroid but I am not so sure. I think he is going to refer me to a fertility clinic but I am worried that my thyroid will also be overlooked there. I really feel I need to see an endo but gp won't refer. I live in the Brighton area so was wondering if you could let me know about your gp and who you were referred to?

  • Hi You also need a Free T3 test. When I started treatment , a long time ago FT3 was always tested ( cost) and my only blood test out was FT3 which was below range. If GP will not test FT3 you could use Blue Horizon, the intermediate test through the thyroid blood test page as then you get a £10 discount.I need my FT3 just below top of range.

    Jackie

  • Forgot to say T3 normally lowers theTSH.

    Jackie

  • Thank you, when I go to th doctors I will check if they did this and if not ask for it. I didn't ask to ranges in T4 or about T3 as I didn't understand the details until I starts to look into this. I didn't know T3 lowers tsh

  • Hi Come back to us if we can help again or send me a PM if it helps. Good Luck with GP.

    Jackie

  • That's not quite right. TSH is Thyroid Stimulating hormone produced by the pituitary gland, in turn the pituitary gland is stimulated to produce TSH by a secretion from the hypothalamus. It's the hypothalamus which detects if your body has too much thyroid hormone or too little. This is a classic feedback loop, think of a central heating system with a room thermostat telling the boiler to switch on or off. Both T3 and T4 re forms of the thyroid hormone. T4 is what the Thyroid produces and in your body it can be bound to a protein or not, hence if not bound its called free T4. Your body will convert T4 to T3 as it needs it and its T3 which acts as a precursor in the production of energy in your cells (look up Krebs cycle). So as you use T3 your body will convert T4 into T3, the hypothalamus detects this and tells the pituitary to produce TSH and this in turn tells your thyroid to make T4. Normally all things things are in relative balance but as we know things go wrong. If TSH is elevated then its an indication that the thyroid is being told to make more T4, if the thyroid can cope then the levels of T4 and T3 will be in the normal range, when it can't cope then symptoms can develop.

  • You are correct in saying that hypothyroidism has an impact on fertility. When you see your GP ask for the result and reference range of your TSH. Also let him know that you are trying to conceive and that you understand that a different reference range is used in this instance. I think that the highest it should be is 2.

    Also, there is evidence that thyroid antibodies can influence important pregnancy outcomes, the BTF are carrying out a trial, click on this link for info;

    tinyurl.com/cthgetx

  • I have been for more tests and my TSH is up to 8 and my antibodies are too high (I will be finding out the level today when i go to see my doctor).

    I spoke to the doctor on the phone and will be seeing her at 4.30 to be put on Levothyroxine. She has made this decision without me pushing her, although 2 doctors previously ignored me. I am relieved, lets hope i fell better soon.

    Thank you for all your help and advice.

  • That is good news. Most people start on 50mcg but this is usually just a starting dose. You will need to go back in about 6 weeks time for some more blood tests and probably an increase. Hopefully you will be feeling better soon. I felt initially worse on thyroxine but then gradually started to feel better - hopefully you won't have this dip like I did xx

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