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Help Please! I am back! Results are in and i am very confused ;-( Any help in interpreting them much appreciated!

Hi All,

I will give a bit of back ground to try to give a fuller picture of what has been happening...

but i will try and keep it short! I have had numerous hypo symptoms for a while now my doctor tested my tsh & t4 and said it is low but within range and we do not treat it if within range,she also said that my results veer towards hyper but my symptoms are hypo so it doesn't make sense?? But she still would not do any further blood tests. Previously from great advice on here and in desperation for some answers, i have gone private for my tests and will post results below i have also requested copies of all my blood tests from my surgery the last 6 months for comparison to these new results.

My doctor was not impressed to say the least that i was going for these private tests and said that we have been monitoring your thyroid and you are always low but within

range between 0.2 and 0.6, so this is normal for you.

I feel like i am 70 yrs old rather that 39 yrs so def not normal!!

I am so confused about my results and really don't know what to make of them?

I think the t4 looks a bit low on the urine test and am thinking that i am converting to t3 fine but that my t4 is low to begin with?? - please feel free to correct me as i am on a huge learning curve.

If anyone could interpret these results below and offer any advice as to what my next steps should be i would be so grateful...

Jan 2013

B12 - 742 ( 211 - 911)

Serum ferritin - 56 (10 - 291)

Serum folate - 3.1 (2.8 - 19.0)

April 2013

Serum free t4 - 11.08 (9.0 - 22.71)

Serum tsh - 0.37 (0.35 - 5.50)

Plasma Glucose - 4.3

Serum cholesterol - 6.0 (<4.0)

Serum HDL cholesterol 1.09 (No range on sheet)

serum triglycerides - 2.90 (0 - 1.69)

serum LDL - 3.59 ( target <2.0 )

Serum cholesteral/HDL rate - 5.5 (no range on sheet)

Latest private results, June 2013:

FT4 - 12.7 (9.0 - 22.0)

FT3 - 4.59 (2.63 - 5.70)

TSH = 0.54 (0.35 - 4.94)

Thyroid 24hr Urine test:

T3 - 1027 ( 592 - 1850)

T4 - 216 ( 347 - 1994)

T3 : T4 Ratio - 4.8 (0.50 - 2.00)??

Anti - thyroglobulin abs -<40 (0 - 40)

Anti- thyroperoxidase - <15 (0 - 35)

HCT - 0.389 (0.33 - 0.45) - not sure what this is?

Active B12 - 155.8 (25.1 - 165.0)

Red cell folate -545 (158 - 1099)

Ferritin - 51 (13 - 150)

VIT D3 - 44 ( 75 - 200)

Adrenal saliva test:

Sample 1 - 13.2 (12 - 22)

Sample 2 - 4.1 (5.0 - 9.0)

Sample 3 - 3.4 (3.0 - 7.00)

Sample 4 - 2.4 (1.0 - 3.00)

Total daily cortisol: 23.1 (21 - 41nmol/L)


Sample 1 - 0.85 (0.40 - 1.47)

Sample 3 - 0.64 (0.40 - 1.47)

Mean .75

Cortisol ratio: 3.23 (2.00 - 6.0)

Any help much appreciated, sorry it was so long! :-(

Many Thanks

Angel x

10 Replies

Ok, so I think I may have some answers for you.

Normally with a T4 as low as yours you would expect a higher TSH. There are several reasons why your TSH might be lower though. One of these reasons is low B12 but yours looks pretty good. Another is a pituitary issue, but I suspect the reason your TSH is low is because of your cortisol levels. Your low TSH might actually be the cause of your low T4 rather than your thyroid.

The reason I have come to this conclusion is because your cortisol levels aren't great, indicating adrenal fatigue. In cases like this, TSH tends to be much lower than expected compared with T4 and T3 results. Your morning cortisol should be towards the top of the range gradually dropping off towards a low at night. All your first three results are at the bottom of the range yet your night time sample is at the top of that range, suggesting a slightly abnormal cortisol rhythm which can affect all sorts of things including TSH and your symptoms. You would probably benefit from researching adrenal fatigue, or adrenal insufficiency, on the internet and following the self-help measures suggested. There isn't really anything your doctor will do to help. Getting this sorted out will probably help towards you feeling better.

You seem to have reasonable T3 levels despite your low T4. This might actually be because your T4 is low (because your TSH is low and not telling your thyroid to produce enough) so it has ramped up conversion to T3. I also have a low TSH even when my T4 is low. More evidence that TSH can't be relied on for diagnosis and dosing.

One other thing I have noticed is that your vitamin D is low. This will not be helping. Low vitamin D can make you feel lousy and needs treating. Try to get plenty of sunshine. 20 minutes a day in the middle of the day will give you a fair whack of vitamin D. You will also need to supplement but it is best to get plenty of it from (safe) sun exposure.

If you can get the vitamin D and cortisol sorted out and you are still having problems with lowish TSH even though your T4 is low, it might be worth looking into pituitary tests but I suspect it is to do with the vitamin D and cortisol, at least partly.

I hope this is helpful and not just more confusing!

Carolyn x


Wow! Carolyn, you know your stuff!

Thank you so much for taking the time to reply, I think i might have to re read a few times to get it all to sink in though! I will definately be researching adrenal fatigue and see what i can do or take to help me improve my cortisol levels, and i will buying some vit d supplements during my lunch hour tomorrow! I don't understand the higher levels of cortisol at night i am so so exhausted by then thought they would be low then too?

Thanks so much for sharing your time and knowledge, your so knowledgable! I would have been lost without your reply.

Thanks again


Angel x :-)


You're welcome :)

Your cortisol isn't high at night but it could be lower. If you have trouble sleeping it could be because of that. I would say you were in the early stages of adrenal fatigue so you should be able to treat it successfully yourself. Vitamin C, healthy diet, reducing stress, plenty of rest and sleep and regular exercise are all a good start. It's also good to avoid stimulants such as caffeine, nicotine and sugar.

There's lots of information out there so I'm sure you'll find something useful.

I hope it all helps you so you can start feeling "normal" again :)

Carolyn x


Thanks again Carolyn, yes you have helped me loads and i have just been on line and ordered myself a book on adrenal fatigue, and hopefully i can treat it and start to become normal again:-)))))

Thank you!

Angel x ;-)


Carolyn's answer is superb. If you supplement with Vitamin D, make sure it is D3 and not D2.


Hi shaws, thanks so much for your reply, I didn't know there were even to types, so will ensure I get D3, thank you! Do you think I should book an appointment with an endo or would it be better to wait 3 or 4 months while I take the supplements and have another test before hand to see for improvements? I have done a little research for adrenals and glandulars are supposed to be good support, any thoughts??? As I don't feel my knowledge is sufficient.

Many thanks

Angel x


I would wait a couple of months to see if you feel better before asking for a referral to an Endo. If you email louise.warvill@thyriduk.org she has a list of NHS Endos/private doctors.

With regard to adrenals/glandulars, post another question and someone who has taken them can give their opinion.I don't think the Endocrinoligsts know much about treating adrenals.


Thanks shaws I will wait as you suggest and everything crossed i will start to feel better! and I will seek advice re glandulars thank you for your help!

Kindest Regards

Angel :-)


My saliva cortisol levels were a bit low and they improved a lot when I just made sure I ate within an hour of getting up and went no longer than 4 hours without food during the day. Hope yours improve too!


Hi Zabby, I have been trying to eat less but more frequently and this has certainly helped my stomach issues also, So hopefully it will raise my cortisol too! How long did you wait before getting your adrenals re tested?

Many Thanks for your support

Angel x


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