Blood result: tsh 0.06; t4 22.2

Hi, hopefully someone will advise / reassure. I've been hypothyrd for about 4 years. When first diagnosed I read up on the t3/t4/tsh distinctions and how to interpret no.s but I've since forgotten most of it!

My annual screen revealed tsh reading of 0.06. That sounds ok (I think?). But my t4 is 22.2. This is a bit high, right? And the other number is low in comparison.

Can anyone tell me if this sounds right? I'm talking 150mcg levothroxine per day. Perhaps I'd be better on 125?

I feel absolutely fine. The best I've felt in a while so would only change dosage reluctantly.

I'm in the uk and my gp doesn't even see the need to have a conversation. He's happy with these numbers. I got results over the phone from the receptionist.

Fair enough I suppose- so long as these numbers really are good. I'll feel reassured if some kindly soul might interpret a bit - particularly in relation to the dosage

I usually take Levo first thing with water - about twenty mins before eating. My blood test was a fasting test at 10am and I waited til afterwards to take that day's Levo.

Thank you (I hope)

9 Replies

  • plymouthrocks The aim of a treated hypo patient is for TSH to be 1or under or wherever it needs to be for FT4 and FT3 in the upper part of their respective ranges, if that is where the patient feels well and symptoms alleviated.

    Your TSH will be under range but that shouldn't be a problem because you are on thyroid meds (except maybe for your GP because they get very jittery about under range TSH). What is the range for your FT4? Yes, it will be high but without the range we can't tell if it's outside the range. However, it's the FT3 that is the important one and that should stay within range.

    If you're happy and feel well on 150mcg Levo then leave it at that, yoirbGP is obviously happy and not worried. If you're unsure then get your FT3 tested.

    By the way, Levo should be taken one hour before food so you might want to leave a bit longer after you've taken your dose to eat or drink anything but water.

  • Anthony Toft: "But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. "

    22.2 seems to be very ok if FT3 is in range

  • Thank you both for your replies. I haven't got any data for t3. But tsh at 0.06 is very low and close to 0 so I'll be content with that. I do feel much better and I think this low tsh no. may be the reason why.

  • If someone on thyroid hormone replacement feels well, the blood tests are immaterial. It's how we 'feel' which is the best guide.

  • Firstly: feeling well every day is more relevant than fear of some small risk maybe sometimes in the future

    Secondly: good news is that that small risk does not exist if TSH is 0.04 to 4.00:

  • Once you are on thyroid hormone replacement, the TSH is irrelevant - unless it goes high. It does not matter how low it goes, as long as your FT3 is in range. But, they never test that, so...

    However, your TSH would have been higher if you had had your blood test at 8.0 o'clock, and even higher if you hadn't had breakfast - I imagine you'd had breakfast by 10 o'clock?

    As long as your doctor doesn't object to a low TSH, carry on as you are. If he gets worried about it and starts talking about heart attacks (he'd be wrong, of course) arrange to have your blood test early in the morning, and fast over-night, next time. :)

  • Greygoose, it was a fasting blood test at 10am so I'd eaten and drunk nothing since 9pm the night before. And I waited until after the blood was drawn to take that day's dose of Levo.

    So all things considered, this is a great tsh score, right? Regardless of the high t4?

  • TSH can be suppressed whatever thyroxine you take. If you feel OK then stick to your regime.

  • Thank you all for replying. My tsh level was once as high as 15.5 (and I felt terrible) so to have it down to 0.0 something is marvellous.

    That said, my t4 score has never ever been as high as 22!

    I'll disregard the latter reading - particularly since I don't really understand it - and just be pleased about the former 🙂

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