WWYD Elevated TSH, wait or act? (s/o)

[sbgrace]

This is a follow up of a post I made earlier. 

I saw my primary care physician today. My TSH was 4.79 with a normal T4 total. My sister has Hashimoto's.

My doctor said my thyroid doesn't seem enlarged and, given my normal T4, he thinks we should just wait and see what happens with my TSH. He said a fair number of people will see TSH normalize. He would follow up next year. I am definitely not going to wait that long. 

I'm not anemic, but my iron levels are low/deficient. He suggested supplements 3 days a week to raise my iron stores. 

I can order labs online and follow up with an integrative medicine doctor. Just after this appointment I placed an order for Free T3, Free T4, reverse T3, the two thyroid antibodies, vitamin D, b12. I am confident in the integrative med doctor's thyroid knowledge. 

Now, after looking online a bit I wonder: 

--Should I wait a few months to see if TSH  and the fatigue normalizes as I correct my iron, then run TSH again, along with Free T3/T4, Reverse T3 and the antibodies? I wonder because I am reading that often people are told to wait for a period to see if TSH normalizes. I am also concerned the low iron might impact the T3 and TSH numbers. 

--Alternatively, should I follow up with my planned thyroid labs now? If so, is it ok that I decided to skip TSH this round, given I just had the test a couple of weeks ago? (The thyroid madness site seems to indicate TSH isn't very helpful, and it adds to the cost) 

--Should I do something else? Like just check the antibodies and wait on the rest? 

Edited January 10, 2023 by sbgrace

[MercyA]

I personally wouldn't wait long to treat a TSH that high. Thyroid medication is cheap, effective, and has virtually no side effects, and lowering your TSH can make you feel so much better.

However, if it would give you more peace of mind to wait and test again in a few months, I think that's a perfectly valid choice as well. (If you were pregnant or trying to become pregnant, I would say you must fix it right away.)

[Dmmetler]

Follow up with the labs. If you have Hashi's, getting that TSH down is important to stop future damage and autoimmune effects. Even if you don't, it would make sense to me to lower the TSH now and test again in a few months. You can always go down on thyroid meds ifbloodwork shows that you don't need them, or if you're getting a faster heart rate or other signs that it was too high. 

[Pawz4me]

I feel confident saying that you'd have a very hard time getting a doctor around here to medicate that TSH with a normal T4. My TSH was almost 8 when I was diagnosed and my doc was iffy on medicating that, even though I was having an absolute ton of other symptoms. My DH's TSH got up to 15 but his T4 has fine and he felt okay (his cancer medication kills off the thyroid, it's a very common and well known side effect). His oncologist held off on medicating until his T4 got out of range. So your numbers don't ring any immediate alarm bells for me. But with a family history of Hashi's I'd want to check the antibodies. That might change my thinking about medication.

[gardenmom5]

T4 total is a worthless number, it doesn't tell you what is available for your body to use.  You need FREE T4, and FREE T3. - RT3 is also good as it can tell if things are "pooling".

TSH is a pituitary hormone - it is what is made to tell your thyroid to make thyroid hormones.  When I feel my best, my TSH levels are below 1.0.

And if Hashi's is in your family, at a minimum you should do the antibody test.

I would find another dr - there are sites that allow you to order your own labs and bypass your dr.

[Trilliumlady]

I tested my TSH a month ago (5.69, has NEVER been this high).  Started a regimen of inositol, kelp tablets, Vit D, selenium, Ashwaganda, zinc, among some other supplements for my slightly elevated tryglicerides and LDL (HDL, the good cholesterol, is also way high, which I hope might balance out the other elevated numbers….).  Tested my FT4 and Ft3 and thyroid antibodies two days ago and they were extremely normal.  My Vit D level was 36 I think last I checked which I’m definitely working on improving.  ANYWAY, all this to be said…

I don’t really have any obvious symptoms of thyroid problems.  I suppose some fatigue in afternoons, but then again I often wake at 530 to 6 and go to bed around 10.  Exercises every day at least 30 minutes, usually 60+.  Don’t always sleep the best but could also chalk that up to cyclical issues.  Often cold, but I’ve also lost some weight in the last year and half and don’t have padding lol.  Not having problems with struggling with gaining weight.  The big key is that I have over the last year and a half to two years also been under a lot of stress which I’m guessing might have knocked things awry.  

AND ANWAY, all THAT to be said…

In my research, I think I chalk my dx up to subclinical hypothyroidism.  And all I’m finding says that it is likely not wise to treat with my picture (which, possibly, looks similar to yours).  Often, even, people with subclinical hypo can stay this way for years, (it does not at all mean a guarantee it will progress to full blown hypothyroidism), or even be back to much more normal labs in 5 years or so.  SO, i think waiting at least 6 months, at least, if not a year, wouldn’t be unreasonable.  I am not opposed to medicating, but I definitely don’t want to just go full board.  I do think it was kind of a fad a number of years ago (or at least in some medical circles) to really over diagnose thyroid issues, possibly to the detriment of women.  Because I feel my particular case can be chalked up to stress and anxiety, I’m going to work on supplements to heal pituitary and thyroid and work on some mental stressors I have in hopes to get my body reset and then recheck myself in 6 to 12 months.

Aviva Romm thyroid articles (google her) and endocrineweb.com have been very helpful at helping me self dx which I feel comfortable at this point doing (I am in a medical field and can consult with friends as needed. I probably will at some point when I’m hanging out with someone).

So, maybe spend some time self analyzing what symptoms you have and what has been happening in your life to possibly cause this increase, research on endocrineweb.com, and see what you feel comfortable with?