Thyroid UK
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Help with optimal blood results

I started levothyroxine 50mg in January after a repeat bloods showed a tsh of 16 and a t4 of 15. I had to convince my gp for a trial levothyroxine due to my symptoms.

Today's results are:

Tsh 4.7 (0.35-5.5)

T4 is 16 (9.0-23)

Free t3 4.6 (3.5-6.5)

B12 301 (190.0-910.0)

Foliate 5.9 (3.3-99999.0)

Ferritin 24.4. (13.0-300.00)

Rheumatoid factor 11.4 (0.0-15.00)

Since starting levothyroxine I have seen a slight improvement in fatigue and pain levels however I am nowhere near back to normal. The lab says results are all normal but I have been reading about the need to be in optimal areas of the ranges, am I correct in this thought? Also I notice that my tsh has dropped dramatically but my t4 hasn't changed much, is this normal? Many thanks in advance.

23 Replies

The whole truth is you cannot tell if you are hypothyroid or not, only from a blood test. What our modern doctors lack is seeing the symptoms as more important than only the blood tests. I urge you to read Dr. Mark Starr's "Hypothyroidism type 2: the Epidemic." There wasn't any treatment before the 1890s, when Dr George R. Murray started treating his patients who showed hypothyroid symptoms, with thyroid injections, an extract from domestic animal thyroid. Before his discovery, hypothyroid patiens would in the end die from lack of medicin.

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I disagree with DiNiro, in January your results of TSH 16 clearly shows that you are hypothyroid. With your treatment of 50 mcg thyroxine, your TSH has improved but there is room for improvement still. Most of us with hypo feel better when our TSH is at or around 1 and with your FT3 still being fairly low in range your GP should be increasing your dose of thyroxine. Your B12 could do with supplementing as could your folate and ferritin. You need to have these at optimum levels in order to utilise the thyroxine for conversion to FT3. Clemmie


Thank you for the reply, it's so frustrating when you need to be armed with the correct info before you go to the gp and I am still trying to wrap my head around it all!


Oh jeez, another clueless GP. A TSH of 16 and you had to convince him to give you a trial of Levo 😣. Even if he sticks strictly to the guidelines then he should know that a TSH 10+ indicates an underactive thyroid.

Well, at least you're going in the right direction now. When on thyroid meds your TSH should be 1 or below so there is room for a rise in your thyroxine and this might improve your FT4 and FT3 both of which could be higher in their ranges.

Your B12 is too low, needs to be around 900-1000.

Your ferritin needs to be higher, at least 70, preferably around 100-130.

I don't understand the folate range but whatever it is you should be half way in the range.

You need optimal B12, Vit D, ferritin and folate for thyroid hormone to work properly. Have you had Vit D tested? If you can't get your GP to do it then City Assays do it for £28, it's a fingerprick test.


Luckily I had printed off some bits from thyroid UK and the British thyroid foundation to convince him to start a trial! Thanks for mentioning the vit d, it should have been done at the same time but I have just realised it's missing, so will have to chase that up! Thank you for the info, very helpful 😀


You will see from this link that you'd be classified as hypothyroid (and I do know you have been). So you are not on sufficient thyroid hormone replacement and at 50mcg is a starting dose with an increment of 25mcg every six weeks till you felt much better with symptoms diminishing.

Also your B12 is extremely low and the updated info is a B12 of around 1,000. You can ask doctor to test your intrinsic factor re your B12 if there's a cause for it or do you have pernicious anaemia. You can take sublingual B12 methylcobalamin if you don't have a deficiency or P.A. for P.A you'd need quarterly injections.

You also have rheumatoid arthritis it would seem from you test but I wonder if pain will be relieved when you are on an decent dose of thyroid hormones.


I do not know if I have P.A so will look into that. I do think I have rheumatoid arthritis but a rheumatologist dismissed me without blood tests or much examination or discussion. He insisted I have fibromyalgia, but I feel the creaking, swelling and clunking of my joints don't fit with fibromyalgia. I am intending to discuss this further with my gp. Many thanks for your reply


Low vitamin D will give you sore and aching joints and muscles. This is why it is important to get tested.


There are no tests for fibromyalgia so they go on clinical symptoms. Ignoring hypo ones of which muscle/joint pain are included.

I would think if you have RA indicators in blood you have R.A., so I'd look into this further as it needs a different type of medication. It is painful and can make you disabled if not kept in check.


Shaws, the Rheumatoid factor test was within range so there is apparently no RA. However it is possible to be sero negative. I myself was diagnosed with sero negative RA but that was because of having other symptoms too. That diagnosis has been revised several times and I now have a diagnosis of Psoriatic Arthritis/arthropathy, again due to other symptoms indicating inflammatory arthritis. Clemmie


Yes, in range but nearly 12 when top is 15. I would have expected near bottom of range not near top. It's like the TSH - wait till it reaches 10. :)


I'm sorry, I disagree with you, this range is nothing like TSH and thyroid diagnosis. As I've already said, you can be sero negative and still have RA, as happened with me. It was only has other auto immune disorders reared their ugly heads that appear with inflammatory arthritis that I was reclassified as PsA. Until that time I was sero neg and diagnosed with other inflammatory blood tests, anti nuclear antibodies and most importantly, scans.


I do know nothing about R.A. tests.

I do know someone who has R.A. had clinical symptoms as a child but remained undiagnosed.

The GP was very angry with the mother for 'suggesting' in front of the child that could R.A. be a possiblity and no investigation were done.


I do think I have Ra as I have other symptoms, amongst others my joints are very painful, stiff and swollen, creak and grind. I have also read research suggesting results towards the top end of the range with other symptoms should be considered for further investigation of RA


I agree you should be investigated but this is my experience:


If your dose is too low it is common to feel muscle/joint pain. I had the same and was so stiff and painful I could only shuffle instead of walk. It is also a clinical symptom of hypo. Particularly if quite newly diagnosed and on levo.

I had absolutely no muscle/joint pain until I started taking levothyroxine.

I am pain free now although it took some time to reach this. First I improved when some T3 was added and then onto T3 only.

I have looked at your previous post and see you are on 50mcg of T4, and that's quite a small dose yet and many, as their hormones are increased, the pains diminish. I hope it's the same for you.

I think we are surprised at first when taking levo and seem to have more symptoms than before.


I have had the joint pain for a couple of years now, so before the levothyroxine. However initially I took the levothyroxine at night and did notice an instant increase in joint pain. could I ask if you had any swelling or heat in your joints too.


No, thankfully I didn't.


You can have a positive Rheumatoid Factor and yet never go on to develop RA and vice versa in that you may never have a positive Rheumatoid Factor, yet have RA. I myself never had a positive RF but do have inflammatory arthritis ( mainly without any inflammatory markers) but with all the joint pain and damage that goes with it. Clemmie


I am aware that you can have Ra without factor and that you can have factor without ra. I however feel I have symptoms that fit with ra and am getting worse, but I guess I will have to wait until I have deformity until the doctors will listen to me.


It took me more than 20 years to get my arthritis diagnosed.


CarpaBob - most arthritic or inflammatory conditions can start with an unhealthy inflamed gut - have you considered cutting out gluten ? - in an effort to heal the gut .....


Statistically, with that TSH you are more likely to hypo than "normal". But your folate, ferritin and B12 are far too low. I'd start supplementing 5000iu per day of sublingual B12 until your results are around 1000. B12 under 5000 can cause permanent neurological damage. And get your GP to prescribe ferrous fumarate for the low iron (as you are hypo prescriptions are free, otherwise it would be more cost effective just to buy it from the pharmacy).


i would opt for feeling well, not great looking labs. Meds with t3, help pain, weight and depression.


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