Thyroid UK
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TSH within normal range so no further testing

Hi, I'm a newbie in need of advice.

I've been feeling dreadful for months and I've had a load of blood tests done. Strong family history of thyroid (my mother, grand mother, great aunt and great gran).

I've just collected my test results from my GP and as my TSH level was 1.38 mu/l (0.3 -5.6) the notes state TSH is done as the first line test and FT4 is reflexed if TSH is <0.5 or >5.0 mu/L.

My mum's thyroid was missed for years and was only picked up when she had an angioplasty - the consultant said it was a common mistake for only the TSH to be looked at and estimated hers had failing for 10 years!

Thing is I can't really see the above story putting my GP in the mood to go against the current protocol and I've not found any guidelines to back the statement up.

My results also picked up a few minor things so not sure if my symptoms are down to that:

Vitamin D 16 nmol/L deficient <50 nmol/L

Plasma bilirubin level below range 6umol/L (7-35)

ESR above range 19mm/h (0.0-7.0)


Mean cell volume (42A) 81.8 (83-101)

Mean cell haemoglobin level 26.9 (27-32)

Red blood cell distribution width 16.2% (11.6-14)

Any comments/advice greatly received

5 Replies

Welcome to the forum, Friedstuffwithcheese.

If your GP won't step outside the protocol for testing FT4 you can order a private thyroid panel to test TSH, FT4, FT3 and antibodies from Blue Horizon and Genova. Blue Horizon have an offer of £80 (usually £99) until Friday for Comprehensive 10 which includes some vitamin and mineral tests, it would be good to add ferritin, B12 and folate if optioned.

VitD 16 is deficient. NHS usually prescribes supplements when deficient but sometimes at ridiculously low doses. I suggest you supplement D3 10,000iu daily for 6-8 weeks to boost levels and reduce to 5,000iu daily until April when you should retest.

If you don't order private ferritin, B12 and folate blood tests, ask your GP to do so to rule out iron, B12 and folate anaemia. Low MCV and MCH can indicate iron anaemia, and high RBC DW may indicate iron anaemia &/or pernicious anaemia which causes B12 deficiency.

Elevated ESR indicates inflammation somewhere in the body and may be due to infection or anaemia.

Low bilirubin isn't usually of concern, it's high bilirubin which indicates liver disease.


I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.


Thank you so much for your comprehensive reply.

My B12 & folate were tested and normal although the folate is at the bottom end.

Serum vitamin B12 level 305pg/ml (180-914)

Plasma folate level 4ng/ml (4.0-20.0)

My haemoglobin concentration was also bottom end of normal

120.0 g/l (120-150)

I'm considering the private test but wonder as my TSH is good at 1.38 whether the vitamin D deficiency & possible anaemia accounts for my symptoms.

Lots to think about and thanks again.


Friedstuffwithcheese, B12 311 is low, top of range is optimal. Supplement 1,000mcg methylcobalamin sublingual lozenges, spray or patches and take a B Complex vitamin to improve folate and keep the other B vits balanced.

It's certainly worth seeing whether supplementing vitD and B12 and addressing low iron if ferritin is low improves symptoms before splashing out on private thyroid testing. It's likely to take around 8 weeks before you feel much improvement after supplementing.


It is so frustrating as doctors will not diagnose hypothyroidism until the tsh is above 10! I had a tsh of 7.9 and thyroid antibodies off the scale and could barely function but was told it was t my thyroid!

Sadly you will have to pay for B12 supplements yourself as your B12 is in range but needs to be above 500. Your vitamin D is too low, if your GP will not prescribe D3 then like many of us that is another thing to buy yourself.

Seeing an endocrinologist doesn't help either as they look at your tsh.

Don't spend a fortune on seeing doctors like I did.

Ask your GP for your thyroid antibodies to be tested and if they are high together with your family history your doctor 'should' give you a trial of levothyroxine but I am sorry to say that he/she will not as they are told to wait until tsh is above 10!

where abouts in the country are you?



All this ignores the possibility you have Central / pituarity hypothyroid its far more common than they will admit and why its so very very wrong to only test TSH because TSH and free t4 and free t3 will all be low unlike in primary hypothyroid where TSH rises

Go back to your GP and tell him thats why your mothers central hypothyroid was missed so free t4 and free t3 and thyroid antibodies need testing

Its also vital that




Vit d3

Are all halfway in their ranges ...yours are typically for hypothyroid very low


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