Subclinical Hypothyroid diagnosis

[Rose2050]

My daughter, age 32 has recently been diagnosed with Subclinical Hypothyroidism.  We have suspected something wrong with her thyroid gland for about two years.  I have been on Oroxine myself for 29 years so am aware of a lot of thyroid symptoms.

She has been referred to two different Endo's within that time who both sent her away after test results were within the range – although I recognise that they were low within the range.

27/2/2014
TSH 2.60 (0.40-3.50)
FT4  9.7  (9-19)
FT3  3.2  (2.6-6.0)

She has refused to go to any doctors for the past eighteen months as she says they humiliate her and make her feel like a hypochondriac.  She has been suffering from most of the usual thyroid symptoms but the worst one is muscle/bone back pain for which she relies heavily on painkillers.  I managed to get her to her GP for some blood tests recently and the results came back 'out of range' for TSH but the other results seem to have improved a bit since the first test possibly to her taking iron for the past couple of months.

30/6/2015
TSH *4.59 (0.40-3.50)
FT4  12.2  (9.0-19)
FT3    4.0  (2.6-6.0)

The GP has started her on 50mcg of Oroxine which she has taken for the past seven days.  My worry is that she has progressively slept less over that time and last night not at all.  GP said she could cut the tablet in half if she wanted to.  GP also said to check her BP and heart rate which I have done.  Upon starting the meds BP was 126/91 and heart rate 74 but this morning it was BP143/103 and heart rate 72.  Also she now has a continuous headache!  She felt good for the first few days on the meds but now not so good.  I suggested that she not take the Oroxine today and should take the lower amount in a day or two.  Do you think that is the right decision?  Also, could some of you knowledgeable people let me know what your thoughts are about the second blood test showing better results but a higher TSH?  Maybe if she just kept on with the iron there would not be a need for taking the meds?  However, I am desperate to get her off the painkillers as soon as possible.

Sorry for bombarding you with info .. I'm just so worried about the situation.

[Rose2050]

Thank you for all the information I appreciate your reply.  It really is annoying the way the doctors rely on that TSH reading.  She could have been helped 18 months ago when her results were actually worse than they are now.  So much time wasted and so much misery just to keep their paperwork in order and symptoms completely ignored.   I forgot to mention in the previous post that she has had an ultrasound done on her thyroid gland 18 months ago and the results showed about 40 nodules on the gland.  A couple of them bigger than others.  The Endo's were not concerned with the nodules.  They said "Yes we see this often"!  I asked the GP if we could do another ultrasound soon and he agreed.  At her last appointment I went in with her to see the GP and asked him if he could test for ferritin so that one has been done but don't have the results yet.  Next time I will go in again and talk to him about the Vitamin D and B12 tests.  She had two cortisol tests done over the last year or two but they were the ones where urine is collected for 24 hours.  The results from them were ok.  Also, thanks for the link, there is a lot of great information on that site.  Yes, she is more willing to see the doctor now that she has a diagnosis.

[gimel]

A couple of things to keep in mind are that TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  So TSH cannot be shown to correlate well with either Free T4 or Free T3, much less correlate well with symptoms, which is the actual concern of a patient.  

Further, when a doctor diagnoses a patient by comparing test results to the so-called "normal" ranges, they are erroneously assuming that the ranges are valid and that everyone is basically the same.    The ranges for FT4 and FT3 are established based on all test data at the lab, with the only exclusion being those patients that exceed the reference range for TSH.  With the variability of TSH, plus the many patients with central hypothyroidism in the data base, it is no wonder that the range is skewed to the low end.  So much so that the lower half of the range should be suspect for possible hypothyroidism.  Consistent with that our members say that symptom relief for them required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, or as necessary to relieve symptoms.  

A good thyroid doctor told me, "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."  Of course he is relating to test results with different units of measure and ranges, but you can understand that the lower half of the range is suspect.  You can also get some good insight from this link written by the good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html


So, now at least you have a doctor that is wiling to prescribe thyroid med and start her on the way to adequately raising her FT4 and FT3 levels.   Unfortunately she had an unwelcome reaction to the med.  That brings to mind two possibilities:  Low ferritin or low cortisol.  Either condition can cause unwanted reactions to thyroid meds.  So I recommend that she be tested for serum ferritin.  Since hypo patients are also frequently too low in the ranges for Vitamin D and B12, those should be done as well.  For cortisol, the serum test is not very good.  The best is a diurnal saliva cortisol test, which is actually 4 tests during the day.  

So so you think you can get her to do those tests?