What's is tsh level and t4 supposed to be to feel better?

Hi ive been on levothyroxine since oct started off on 25 now on 50 but my tsh level is still out of range, my gp asked what i wanted when increased to 50. ive got blood test wednesday my question is what level should tsh be to feel good? My tsh was 5.06 then 4.71 so increased levo. Thanks in advance for any help x

12 Replies

When you are first diagnosed the norm is 50mcg levo, with a blood test and increase in levo after 6 weeks and so on until you reach an optimum when you feel much better. This is a link (links within may not work) but all questions/answers are informative. For you, especially, read the date November 28, 2003.


Dr Toft of the British Thyroid Association says in a Pulse Online article:-

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

I only feel well when it's 0.01 maximum, I'm afraid. I am very poorly indeed before it goes anywhere near your levels - it's individual specific

Can i ask how long it took for you to get to feeling well again? My new gp is great but leaves it to me which i guess is good for symptoms but i had no clue on what level i need to get to feel ok again! My gp will ask me if i feel need to increase so if i do, id it best to increase to 75 or 100? Sorry for questions! Thanks

My tsh is around 0.02 and i feel really good with that if i drop my levo dose by 50mcg even if gradually i start feeling all the symptoms again (im on 200mcg of levo) so there is plenty of scope for a levo increase for yourself yet but i recommend to go by symptoms if you don't feel well you need an increase with a bit of give and take with the gp of course, but he/she sounds like they are open to discussion on your treatment.

Hi I suspect your FT3 is too low. normally we like T4 to be in top third of range and FT3 near the top of range, never over. Often best treatment is with T4 and T3, depends on blood results for tSH, T4 and FT3., then repeats on treatment, 6 weeks. FT3 helps symptoms and lowers the TSH.

Best wishes,


I cant get them to test t3? I only ever get results for tsh and t4? How do i get them to test that or is it tested just not put on results? My last results were tsh 4.16 and T4 14.1 is that still indicate under medicated? Sorry for so many questions its all so confusing and with gp asking me about medication increase its hard! Lol

Looks under medicated to me, but do you have the reference ranges?

Yes sorry should have put them up, TSH 0.30-3.94mlU/L and T4 12.30-20.20pmol/L

I'm no expert cos they haven't given me any treatment yet, but yes that looks undermedicated! Most places won't do t3, you might be lucky or you might have to do it privately. Yes I know you shouldn't have to! :-(

Oh and I think you have to take the dose up slowly, but someone els will know better than me

Hi First always have a print out, receptionist, of all blood tests with vital ranges as they vary according to which Lab. My NHS Labs will not do FT3 for anyone, docs powerless. I now have my tSH, T4 and Free T3 test done by Blue horizon. it is very quick , results to you by e maill. it is then up to you who you show them to. A Harley st doc checks them, anything much wrong they advise you. If you do this go on their main site, there is a test called a finger prick, more reliable than this but all DIY. or they will send you a phial for a venous blood, but unless someone will take it for free, that works out dearer. Do not go to an expensive private hospital. Blue Horizon are well known and accepted as usually the in house Lab at the private hospitals, but 3 times the cost there. Quote TUK 10 for a discount. All by post and on line.

Best wishes,


Ok thanks i guess its going to be an increase then! Just want to feel better again like everyone on here i guess! Hope you get some treatment soon thanks again for taking time to respond x

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