Treatment for hypothyroidism if blood test within normal range

July 21, 2023 9:43 AM

Low thyroid runs in both sides of my family. For the last year or so I've been feeling just really slow, physically and mentally. At my annual check-up this year my thyroid levels were still within the normal range. My understanding from Dr. Google is that it's not that unusual for folks to be within the normal range but also to benefit from treatment for low thyroid.

Details below, but my main question is how did you know it was time to try thyroid treatment even if your blood tests were within the normal range?


You Are Not My Doctor and This is Not Medical Advice

I get my thyroid levels tested every year at my annual check-up. They have been going down over time, but are still within the normal range.

I talked to my doctor about my family history of hypothyroidism and the increasing severity of my feelings of fatigue, sensitivity to cold, just generally mental and physical 'meh-ness' and low energy. My doctor was very...IDK try taking a multivitamin but it's not a thyroid issue.

Blood levels were normal for things like iron and vitamin D, but for the first time my alkaline phosphatase (ALP) levels were below the recommended range. My doctor said this is nothing to worry about but Dr. Google said this is associated with low thyroid.

I try to follow all the normal good health behaviors: at least 30 minutes of physical activity per day, eating healthy with lots of veggies, and good sleep hygiene.

posted by forkisbetter to Health & Fitness (15 answers total)

Best answer: My mom had hypothyroidism, and so do I, and she encouraged me to ask my doctor to keep my TSH (thyroid stimulating hormone) at the low end of the "normal" range.

(High TSH means your body is saying, "not enough thyroid hormones! make more!" but your deadbeat thyroid isn't.)

I definitely get fatigue when my TSH is at the high end of "normal." My cue to start pestering the doctor is when I want to sleep like 10 hours a day, every day.

I've also heard the advice to ask your GP for a referral to an endocrinologist if they are not taking your thyroid concerns seriously. The endo can do more tests (for thyroid hormones T3 and T4, not just TSH) and get a clearer picture of what's going on, and will have more experience, possibly including patients who had symptoms with high-but-"normal" TSH.
posted by BrashTech at 9:50 AM on July 21, 2023 [4 favorites]

One thing to be aware of is that if your blood results are "normal" your insurance likely won't pay for the synthroid/whatever med.

edit: assuming you're in america.
posted by misanthropicsarah at 9:50 AM on July 21, 2023

I haven't had a problem with my drug coverage (possibly because of my history which does include out-of-range readings.)

Generic Synthroid (Levothyroxine) is pretty cheap, though.
posted by BrashTech at 9:57 AM on July 21, 2023 [2 favorites]

It’s worthwhile to talk to an endocrinologist about this.
posted by Bottlecap at 10:05 AM on July 21, 2023

Levothyroxine is dirt cheap and potentially cheaper without insurance than with (Cost Plus Drugs), so I wouldn't let that be a factor in your health.
posted by meowzilla at 10:31 AM on July 21, 2023 [3 favorites]

Best answer: I have every single symptom of low thyroid but test normal. Then I was bloated and felt so weird I thought I had some kind of cancer so I requested an ultrasound. Thank god my nurse practitioner agreed. Turns out I have fatty liver. It is my understanding that if you have fatty liver, your body could be producing thyroid hormone but the fatty liver is blocking the absorption. This makes perfect sense for my situation. I AM NOT A DOCTOR. THIS IS NOT MEDICAL ADVICE. This is just what I do for myself. I follow the rules for treating a fatty liver. Instead of taking thyroid hormone.

I would ask for an ultrasound to rule out fatty liver. Fatty liver, if you really keep going and don't treat it can be fatal. Your liver will eventually fail. I know, I'm sorry.

On the bright side, doctors are saying coffee is good for fatty liver so I didn't have to cut that out. Thank God.
posted by cda at 11:12 AM on July 21, 2023 [1 favorite]

Best answer: This is not advice, but what happened to me.

Got my thyroid tested, *just* within normal ranges and my family doctor said they would not normally worry about it BUT I was trying to get pregnant so they put me on Synthroid immediately because even being a little out of whack can impact that. So, in my case the additional context of trying to conceive changed the treatment I received.

I would say I noticed probably less than a ten percent difference in function and no difference in weight on it. It mostly made it so I needed one less cup of coffee to function. So in my case this was no kind of supermagic solution.
posted by Sweetchrysanthemum at 1:20 PM on July 21, 2023 [1 favorite]

Best answer: An endocrinologist was the answer for a family member of mine. The endo needed zero convincing, they started out a position of “the reference ranges are actually pretty bad”, and medicated my family member to the number they felt was appropriate, which was a big quality of life improvement.
posted by Stacey at 1:29 PM on July 21, 2023 [2 favorites]

Best answer: I also have hypothyroidism with normalish values. An Endocrinologist started levothyroxine actually for fertility reasons but the second I reported all the benefits of being awake for a normal amount of time and being excited that I wasnt tired every second of the day, she was willing to continue it for the rest of my life.
posted by AlexiaSky at 6:13 PM on July 21, 2023

Best answer: Given your family history and how you're feeling, I also think you should see an endocrinologist for a comprehensive thyroid panel (example).
posted by Iris Gambol at 10:58 PM on July 21, 2023

Best answer: I was just within the boundaries of normal test results for hypothyroidism but reported enough of the symptoms for my doctor to try me on the medication to see if it would help, it is a slow process as you have to increase the dosage, try it for a while, retest, repeat, but I’m at least sleeping a slightly more reasonable length of time than I was in the spring.

I would say, if the symptoms for hypothyroidism are impacting your day to day life, it’s time to speak to an endocrinologist or doctor (my doctor took me more seriously than my endocrinologist with these test results but YMMV).
posted by ellieBOA at 4:17 AM on July 22, 2023

Best answer: My enlarged thyroid was noticed when I was at an ENT for a sinus infection. I'd never noticed it, but once she pointed it out it was obvious. I was referred to an endocrinologist and had a work-up for possible thyroid cancer, an ultrasound and fine needle aspiration (FNA). Both showed only inflammation. So far so good.

Of course I had a full panel of bloodwork, including Anti-thyroid antibody (which is used to check for possible autoimmune throiditis). Negative. All my other numbers were barely in the normal range, but the doc added levothyroxine in order to try to shrink the thyroid.

I focused on how I felt after starting medication, and noticed with pleasure that the nagging fatigue, which I had just pushed through, and nagging constipation completely resolved. I felt absolutely wonderful, energetic, and with more supple skin and shiny hair. It wasn't until I was on the meds for a few months did I realize that the decision to prescribe medication should not always by the numbers - it should include a consideration of CLINICAL experience, that is, how does the patient feel, what symptoms are bothersome and could be based on the diagnoses under consideration.

Perhaps a conversation with an endocrinologist would be helpful, as I think PCPs are usually more reluctant to prescribe outside their specialty and where a treatment algorithm (medical societies focus unbelievably closely on algorithms and docs are often worried about acting outside them: They often focus mainly on numbers). I've been on levothyroxine for over 20 years now, and had yearly thyroid ultrasounds at first, with periodic ultrasounds since. The thyroid has shrunk back to normal size. All this is now managed by my PCP but the endocrinologist sorted out the initial condition. Good luck.
posted by citygirl at 5:52 AM on July 22, 2023 [1 favorite]

A doctor, internist, prescribed low-dose thyroid for me when my levels were low normal. Side effects are uncommon. It's inexpensive. Once it's been prescribed, the next doc was happy to continue it. My insurance has always covered it. It helps.
posted by theora55 at 8:56 AM on July 22, 2023

Best answer: I was in my thirties, getting fat, EXHAUSTED, and hating myself for getting fat because I was obviously lazy. GP was all "Nope! All within normal levels!"

She went on sabbatical, thank god. I saw her replacement and WITHOUT EVEN TESTING ME she said "Let's try you on a low dose of Synthroid."

I've NEVER forgotten waking up about three days after starting the meds feeling RESTED. Rested like I hadn't felt in YEARS. And the weight fell off as my energy levels improved. Also, I wasn't freezing all the time.

I came back from years abroad and my new doctor said, "No prescription for you; your levels are normal." And I basically said, "Fuck you, I can get Synthroid from AllDayChemists.com."
posted by cyndigo at 9:20 PM on July 24, 2023

Every woman in my family has either hypo or hyper thyroid. I ended up going from hypothyroid to hyperthyroid in a short period of time (Graves disease) and since then I've gone back to hypothroid. I get my numbers checked every six months or so, for this reason.

I too had numbers within the normal range, but felt like crap. The endo said the ranges aren't really a way to gauge how you personally feeling at that range, and it indicates that an endo might not be keeping up with the literature and current best practices. A good endo will ask lots of questions and help you be within a range that improves your well being.

Another thing my endo did is switch me to Armour Thyroid, since my mom and grandmother both had terrible results with Synthroid. That has also helped a lot.
posted by answergrape at 8:49 AM on July 25, 2023