Why Elevated TSH but normal FT4?

I'm new to this- please help? My Free T4 is 12.2, apparently normal range, but my TSH is elevated at 6.1. What's happening in my body and how can I remedy it? I have lots of symptoms which I'd put down to the menopause.

I want to do this naturally if possible. What remedies can you advise please? The GP is going to re-do bloods in 8 weeks and wants to put me on thyroxine then if there's no improvement. When I read all your experiences with it, that troubles me. Please advise how I can naturally bring my TSH down and why my FT4 still presents a normal. Thank you.

28 Replies

  • TSH stimulates the thyroid to produce thyroxine and some other thyroid hormones, principly triiodothyronine which is usually referred to as 'T3'. (Thyroxine is 'T4'). As the thyroid gland starts to fail the pituitary puts out more TSH to give extra stimulation to the thyroid. A bit like pressing the accelerator in a car that has a sluggish engine. In the early stages of thyroid failure the elevated TSH is able to give the thyroid enough of a kick to maintain thyroid hormone levels. This is sometimes referred to as 'subclinical hypothyroidism' but a more correct term is 'mild thyroid failure'. Some such patients have no symptoms and are fine, other patients can have a lot of hypothyroid symptoms.

    It would be useful to know your symptoms. Assuming they are due to hypothyroidism you will need thyroid supplementation. There is no 'natural' way of fixing the thyroid. Occasionally, such as after pregnancy the thyroid can pick up by itself. Levothyroxine works well for the majority of patients, but definitely not for everyone. The people on this forum tend to be those of us with more difficult forms of hypothyroidism. There is a natual form of thyroid hormone called 'NDT' but this is not prescribed by doctors (just one or two exceptions) and is expensive. As levothyroxine works for most people I'd suggest you ask for it and see how you go. It will take months for you to recover, it is not a quick process.

  • Thank you for replying so promptly Jimh111. I'd like to reply in greater depth but will have to do so later. Would that be ok?

  • My main symptoms are burning soles if my feet, restless legs, palpitations, breathless on exertion and lethargy, feeling cold and not sweating. I have printed off the symptoms sheet and realised that a have half of them. Thank you for advising me.

  • Mantha, burning soles are usually due to low B12. Breathlessness can be low B12 or low iron. Restless legs can be low B12, low iron and/or low magnesium.

    It sounds to me like you have nutritional deficiencies - doesn't matter how well you eat, hypos have nutrtional deficiencies because the low T3 (among other things) causes low stomach acid, and therefore difficulty absorbing nutrients.

    I would suggest you ask for your vit D; vit B12, folate and ferritin to be tested - the basic vits and mins. You can post your results on here, and members will be able to advise on your nutritional status.

    Low nutrients will cause symptoms of their own, and can make you very, very ill. So, this needs seeing to as soon as possible. :)

  • Low magnesium can produce some of these symptoms and hypothyroidism produces low intracellular magnesium which cannot be detected in any blood test. Suggest you eat green vegetables and tomatoes and supplement with magnesium citrate. Much of this will correct when your thyroid is treated but it helps to supplement in the short term.

  • Thank you. I will follow this up.

  • Thank you so much for this info. I will make an appointment to the blood tests done and come back with the results. This is really interesting.

  • You're welcome. :)

  • Hi Greygoose,could burning skin sensation also be caused by low B12 do you know or have you heard of this symptom with Hypo?

  • Absolutely. I think it's more likely to be low B12 than hypo. It's one of the neurological symptoms of low B12.

  • thanks so burning on skin all over as well as just soles of feet? somtimes rash too but not always in conjunction with each other out of interest can aching glands neck and armpits be a sign also of either hypo or b deficiency? clutching at straws here :(

  • I don't know about the rash -- never thought about that. Not sure. But, the burning skin, definitely.

    Don't know about aching glands, either. But, the best thing to do is to get your B12 tested, to see where you are, then supplement.

    Aching glands could be an infection.

  • thanks no infection but crp doubled from 3 to 7 range 1-5 last bloods along with tsh went from 5 to 10 range1-5 so dr has no clue not over tired but rash,burning,tingling top lip and aching glands got me worried i must admit thanks :)

  • OK, so there's inflammation somewhere. Do you have Hashi's? I would definitely get that B12 tested rapidly.

  • no antibodies for hashis i think i may start on b12 now as no bloodtest now for 6 weeks currently just takingn a multi b thnx again :)

  • If i were you, I wouldn't start the B12 now. Because once you start taking it, your tests will no longer be valid. You won't know your true level - unless you can get an active B12 test, but most people can't. You need to know your exact level so that you know if you need to be tested for Pernicious Anemia, if you need injections rather than tablets, and how much you need to take.

    Also, stop the B complex. That gives you six weeks for all the B12 to get out of your system so that you get a true result on your test. Sorry, but this has to be done to get the best results.

  • ok il stop the multi and test :)

  • Hi greygoose, I'm having bloods done on Wednesday for B12, folate, ferratin and vit D plus antibodies, as my sister has auto immune thyroid problems and is on Levo.

    I have been taking a multivitamin which contains 9 micrograms of B12 so I'll stop taking that now shall I? Thank you so much for your guidance.

  • Yes, it would be best to stop that now.

    And in future, I wouldn't bother about the multivit, they're just a waste of money. You won't get much out of them, for various reasons.

  • Welcome to the forum, Mantha301.

    TSH is a pituitary hormone which rises in response to low thyroid hormones (T4 and T3) and falls when sufficient thyroid hormone is detected. TSH between 5-10 with FT4 in normal range is described as subclinical hypothyroidism. TSH >10 and/or FT4 below range is described as overtly hypothyroid. If your FT4 range is 12-22 your FT4 is at the bottom of range. Most people will feel well after TSH is 1.0 or lower with FT4 >17.0.

    Your GP is retesting in a few weeks to rule out non-thyroidal illness such as a virus or other infection which can elevate TSH. If your TSH is still over range you should accept the Levothyroxine offered otherwise your TSH will continue to rise as thyroid hormones continue falling and your symptoms will become more severe.

    The vast majority of patients do very well on Levothyroxine so they have no need to access support on thyroid fora. I suspect a large proportion of those who don't do well are under medicated but there is a subset of patients, estimated to be around 15%, who don't do well on Levothyroxine and require the addition of Liothyronine (T3) or natural dessicated thyroid (NDT). Levothyroxine is the only therapy recommended by the British Thyroid Association. The extortionate cost of Liothyronine means it is very unlikely you will be prescribed T3 if you need it, and because NDT isn't licensed for UK use it is rarely prescribed on NHS. If you want alternatives to Levothyroxine you will probably have to pay for private prescriptions or buy on the internet and self medicate.




    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 fot the prompt response. I'm depressed that my body is failing to function normally. I'm about to embark on training as a Midwife and I have to be in good heath to do so. This is really worrying.

  • Your body isn't failing. The most likely cause is autoimmune hypothyroidism which is quite common. This usually resolves with levothyroxine treatment. It is important to get treatment as the tiredness and cognitive impairment will affect your ability to work and learn.

  • Mantha301,

    Hypothyroidism is a manageable condition for the majority of patients. It will take a few weeks to restore your thyroid levels to euthyroid status and possibly a few months more to relieve all of your symptoms, but symptoms will be improving in the meantime so there's no reason not to embark on your training.

  • All "normal" means is that there are some people walking around out there with that level of Ft4 or (not necessarily and) that level of TSH. They have not been diagnosed with thyroid problems (but the only way to diagnose them is using the range they are contributing to - very Alice in Wonderland). it doesn't mean that everyone feels well or functions at that level. Your TSH is probably rising in a desperate attempt to raise your bottom of normal T4.

  • Thank you all for the feedback. I'd like to hear from people for whom the Lavothyroid has been successful as I've read about people struggling to get their levels right and I'm concerned that it seems like a struggle to do so.

  • Mantha301,

    People also experience struggles optimising their levels when taking alternatives to Levothyroxine. All types of thyroid replacement have to be administered at low-ish starting doses and increased slowly and gradually every 6-8 weeks until dose is optimal to avoid shocking the body, and to avoid overshooting and over medicating. When dose is stable thyroid monitoring once or twice a year will be required to make sure levels are maintained. Periodic dose increases will be required to compensate for further deterioration of the thyroid gland.

    If you want Levothyroxine success stories I suggest you ask for them in a new post. Please don't be put off trying Levothyroxine by the negativity towards it on this forum, as I said earlier, the majority of patients do well on Levothyroxine.

  • Thank you. I'll take your advice and wrote another post.

  • Apparently there are some interesting results with applying red and infrared light on thyroid gland. I wonder if anybody on the forum tried it. Few links are given on the following page:


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