Thyroid UK

Free T4 & THS blood tests?

Hi all, I've posted here sporadically a few times but I'm still on a mission to get a diagnosis.

I had my thyroid tested in August and my doctor said it was fine, since then I've had lots of names thrown around but 0 help and no answers, as my health continues to get worse.

Would someone be able to have a look at my thyroid results? A GP the other week said my case looks very much like a thyroid issue, but according to my blood work its not. I realise there can be other tests and false negatives, so I'm desperate for some answers!

Serum Free T4 level: 14.5 pmol/L

Serum TSH level: 2.58 mu/L

My symptoms are briefly:

Constantly cold (low body temperate, blue hands & feet from cold, even in summer)

Extreme fatigue

Dizziness & Confusion

Nausea & vomiting episodes

Low blood pressures

Low blood sugars

Weakness (can't write or hold pen, or walk up stairs)

Joint stiffness

Muscle pain

Shin splints

Tingling down legs and arms, very specific location

Seeing coloured spots & floaters


Very pale with dark circles under eyes (no matter how much sleep)

Frequently swollen glands & lymph nodes (so swollen they are often red and protruding)

Increased thirst

Frequent infections in tonsils and sinuses

Muscle cramps

On top of this all, I have a high Serum Sex Hormone Binding Globulin (SHBG) polysistic ovaries & suspected endometriosis (from free fluid found on my pelvis during a scan to diagnosis ovaries, waiting to see gyno) My doctor says I can't have PCOS because I am slightly underweight and have no hair growth issues. Does SHBG effect thyroid at all?

This is very rambling and probably unrelated to thyroid, but does anyone have PCOS & thyroid issues? Or know anything at all about it?

Thank you all! xx

7 Replies

Oops as well as low blood pressure, I also get random high numbers and a pounding heart!


Kalmillar, it's acknowledged that hypothyroid clinical symptoms can pre-date abnormal bloods by years. Unfortunately, clinical guidelines mean that GPs rarely diagnose subclinical hypothyroidism until TSH is over range which is usually >5 or 6. You haven't put the lab ref range for FT4 but 14.5 is usually lowish, but in range.

Make sure to have your next thyroid blood test early in the morning when TSH is highest and ask for thyroid peroxidase and thyroglobulin antibodies to be tested to rule out or confirm autoimmune thyroid disease (Hashimoto's). There is a connection with PCOS and thyroid disorder but I don't know anything about SHBG and whether or not it affects thyroid.

Ask your GP to test ferritin, vitamin D, B12 and folate as hypothyroid patients are often deficient/low and these deficiencies can cause musculoskeletal pain, fatigue and low mood similar to hypothyroid symptoms. Be insistent about testing B12 as tingling and numbness can be a sign of B12 deficiency although it is more usually in the hands and feet initially. Post your results with the lab ref ranges (the figures in brackets after your results) in a new question and members will advise whether supplementation is required.


Hi Clutter, thanks so much for your help!

The ranges are:

Free T4 (8.8-18.8 pmol/L)

TSH: (0.3-5 mu/L)

I'm seeing an endo next week and will ask for all of the tests you've mentioned, thank you!


kalmiller, FT4 is over half way in range, so not a problem. If endo won't do the vits/mineral tests ask your GP.

Good luck next week.


Kalmiller, ask him for an FT3 test, too. That is THE most important one - for us, anyway. Doctors don't always realise that.


I don't have the problems you state above but female problems and hypothyroidism can go hand in hand. I doubt GPs know this.

Once upon a time, we were medicated upon clinical symptoms alone and dosed until they went. Nowadays, it is all on the TSH and its level with no knowledge of clinical symptoms or taken into account, unless you have a very good Endo/GP. The following is an excerpt and I don't have the link but I think it will interest you:-

Multiple Ovarian Cysts as

a Major Symptom of Hypothyroidism

The case I describe below is of importance to women with polycystic ovaries. If

they have evidence, such as a high TSH, that conventional clinicians accept as evidence

of hypothyroidism, they may fair well. But the TSH is not a valid gauge of a woman's

tissue thyroid status. Because of this, she may fair best by adopting self-directed

care. At any rate, for women with ovarian cysts, this case is one of extreme importance.

In 2008, doctors at the gynecology department in Gunma, Japan reported the case

of a 21-year-old women with primary hypothyroidism. Her doctor referred her to the

gynecology department because she had abdominal pain and her abdomen was distended

up to the level of her navel.

At the gynecology clinic she underwent an abdominal ultrasound and CT scan. These

imaging procedures showed multiple cysts on both her right and her left ovary.

The woman's cholesterol level and liver function were increased. She also had a

high level of the muscle enzyme (creatine phosphokinase) that's often high in hypothyroidism.

Blood testing also showed that the woman had primary hypothyroidism from autoimmune


It is noteworthy that the young woman's ovarian cysts completely disappeared soon

after she began thyroid hormone therapy. Other researchers have reported girls with

primary hypothyroidism whose main health problems were ovarian cysts or precocious

puberty. But this appears to be the first case in which a young adult female had

ovarian cysts that resulted from autoimmune-induced hypothyroidism.

The researchers cautioned clinicians: "To avoid inadvertent surgery to remove an

ovarian tumor, it is essential that a patient with multiple ovarian cysts and hypothyroidism

be properly managed, as the simple replacement of a thyroid hormone could resolve

the ovarian cysts."[1]


1. Kubota, K., Itho, M., Kishi, H., et al.: Primary hypothyroidism presenting as

multiple ovarian cysts in an adult woman: a case report. Gynecol. Endocrinol.,

24(10):586-589, 2008.


This is from and there are other topics on the left-hand side.


Thank you all for your help & guidance, I'm seeing an endo on Thursday and feel much more prepared, so thank you! xx


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