Thyroid UK
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Downward trend of T4 and upward trend of TSH, but doctor reluctant to prescribe thyroxine

Hi everyone,

I am new to this forum & new to the idea that I might be hypothyroid. I have battled with depression for a number of years and just put all of my physical symptoms down to that. These include tiredness (even after 10 hours sleep), feeling cold all the time (especially hands and feet), blue lips, dry skin, nails that break all the time & hair that breaks, difficulty concentrating etc etc. I recently asked for a copy of my medical records as I was changing doctors and noticed that my Free T4 have been dropping over time & TSH has been rising - I asked my doctor to check this out and he said it was fine as they are still within the normal range.

Here are the results I managed to get:

Nov 2009 Free T4 12.6 pmol/L TSH 1.46 mU/L

Dec 2010 Free T4 11.9 pmol/L TSH 1.65 mU/L

Oct 2013 Free T4 11.3 pmol/L TSH 1.32 mU/L (not sure why this went down as T4 went down!)

The normal reference range for free T4 is listed as 9-22, though I have found other sources that say 10 or 11 up. I have a serious complication though in the fact that I used to suffer from severe anorexia. My weight is now comfortably within the normal range & has been for a while and I don't engage in any eating disordered behaviour. I am very active, which means my weight is fairly steady, but if I take a few days off I seem to put on weight very easily. I know this is why my doctor is unwilling to prescribe thyroxine - his actual words were "it would overcomplicate things". I can definitely understand why prescribing thyroxine to a recovered anorexic would not be on the top of any doctors to-do list but I'm just so fed up of being constantly tired and cold! What do you reckon? Should I ask for a second opinion/ask to see an endocrinologist? Despite the fact that my thyroid levels are still in the normal range, there is a definite trend. Thanks in advance.

P.s. I am female & 22

11 Replies

Have you ever asked your GP to test for iron deficiency?

Moggie x


Yeah Iron is fine and Haemoglobin is actually on the high side.


Could you list everything else you have had tested please, like B12, VitD etc with their ranges - the more info you can give us the more we have to go on.

Moggie x


Moggie's right, the vitamin and mineral results could be really important. Because of your previous history you are more susceptible to have suffered from nutritional deficiencies. These can greatly affect the communication between the pituitary and the thyroid, and also affect the conversion of T4 to T3.

So it's the ones we always mention to start off with - B12, folate, iron and vit D. With iron, to get a really good picture, you need a full iron panel. This can include - Serum iron, transferrin or total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC), transferrin saturation %, and serum ferritin.

Hampster x


I'll have to get the actual figures for you but I do remember my GP did a full vitamin/iron profile in December of last year & he said my bloods were "fantastic" - whenever I tell him I'm eating well he never believes me :P Can't blame him I guess! Thanks for your input.


What you have got to realise is that what your GP says is fine might not be fine for you and, with your previous history (and that is not ment to be a critisism) your body must have taken a hammering.

Ask for a print out of all your results and post on here for further help.

Moggie x

1 like

Okay, I got a print out of my results today.

Vitamin D: 92nmol/L ("optimally replete" 70-200nmol/L)

Serum Ferritin: 38ng/mL (10-200)

Serum Vitamin B12: 560pg/mL (190-910)

Serum Folate: 12.7ng/mL (3-20)

I was on iron supplements before but have since started eating red meat. I think my iron levels were around 15 at the time. These all seem fine to me?


Your ferritin level needs to be over 70, and nearer 90, for thyroid medication to work to it best ability. It needs iron to covert your levo (T4) into T3 and then it needs the iron again to transport the T3 into your cells, which is what your body is crying out for.

If I were you I would start taking the iron again, with vitC to enable the body to absorb it and on a full stomach so that it does not damage the lining of your gut.

Moggie x


The variations in TSH you report are quite small. I wonder if they were all done at close to the same time of day? Or not?

Have a look here:



at that's really interesting - yes they would all be from the same time of day as my GP surgery only takes blood tests in the morning's


Thers no way your t4 level is adequate it should be well in the upper quadrant of the 10 to 22 range

Your symptoms scream hypothyroid

Its possible your previous anorexia has actually damaged the pituarity so that it can barely push out tsh

This is central hypothyroid and its not as rare as they like to pretend and its often the reason doctors fail to act because they assume low tsh is ok when actually its not

Has your gp done thyroid antibody tests because ifvthey are positive then you definitely need treating

It would also be very wise to get intrinsic factor etc done to rule outvpernicous aneamia


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