TSH - Optimal Test Results

Hi everyone, so glad I have found a place to talk about thyroid issues. I have congenital hypothyroidism and am currently medicated with 225mcg levothyroxine daily. I have started feeling agitated, restless, anxious and I dislike the heat - makes me panic. I'm under the impression these are hyper symptoms, so I think I might be over medicated. Went to the docs today and requested both TSH and cortisol levels (I read somewhere that the cortisol level is important) - and so I was wondering if anyone can tell me what the optimal results will be. I'm having bloods done on Wednesday.

Thanks everyone


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7 Replies

  • Welcome Jaygale

    I am sorry you have congenital hypo as it is difficult enough if we develop it later on in life. It can be a struggle with medication.

    I would suggest you ask for a TSH, T4, T3, Free T4 and Free T3 plus vitamin B12, Vit D, iron, ferritin and folate. The Free T3 is the most important of all the T's but unfortunately GPs only go by the TSH which doesn't always conform to how we feel.

    Do not take levothyroxine before the blood test, leaving around 24 hours between the last dose and the test and make the earliest possible appointment. TSH is highest then.

    As you have congenital hypo, there's no reason they cannot give you the addition of T3 to a reduced T4. T4 is sometimes not the 'best' for some people although some seem to do o.k. on it.

  • Hi shaws, thanks for the reply. I didn't ask for any of those other tests, I think I will wait to see what the TSH says, and then demand all the other tests. My GP is pretty good to be fair, I asked for cortisol and he arranged it even though he had no idea why and was going to research it. At some point I hope to be seeing an Endo for an unrelated issue, but I might ask his opinion as well. Will post back when I get my results :) thanks again

  • P.S. if your test on Wednesday isn't the earliest change your appointment. The TSH varies throughout the day but is highest first thing which may benefit you. If the test shows you are a little hyper, still ask for the addition of T3 to a reduced T4 you might find it of benefit.


  • my appointment is 8:40 because cortisol has to be done early, is that early enough?

  • Yes, that's certainly early enough :) . Get a print-out with the ranges and post for comments.

  • Jay, there isn't an optimal TSH, but from a patient perspective it's where you feel well. As a guide most people will feel well with TSH just above or below 1.0, but some need it lower, around 0.5 while a few won't feel well unless their TSH is suppressed <0.03.

    Your symptoms do sound like over medication. You could reduce your Levothyroxine by 25mcg to see whether symptoms improve but it'll probably take a week to feel anything.

  • If my results come back normal then I might do that, thank you

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