T4 and TSH numbers not adding up?

Hello...this site has helped me out so I thought I would ask for my friend who is having all the symptoms....here are her results:

T4 13.9 (9.0-24.0)

TSH 4.27 (0.3-6.0)

T3 not done

I think that her T4 has to come up as it is functioning at 32.67% and should be higher (66% or higher). The TSH should be at 0 or 1. I think she should go back to doc to get these numbers adjusted. just wanted to confirm I'm on the right track advising her.....

14 Replies

  • Is she on any thyroid medication?

  • thanks for your reply...no she is not on anything, but has some of the symptoms of an underactive thyroid. But usual story Oh your in the range so your fine. I am going through that right now myself....I have posted my vitamin and minerals results just waiting for someone to let me know how my levels are

  • Saltcoats,

    NHS doesn't usually diagnose primary hypothyroidism until TSH is over range which means >6.0 in your friend's case. Your friend's TSH is high because FT4 is low in range but unfortunately TSH is not yet high enough.

    Suggest your friend asks her GP to check ferritin, vitamin D, B12 and folate which are often low or deficient prior to being diagnosed hypothyroid. Symptoms of musculoskeletal pain, fatigue and low mood are very similar to hypothyroid symptoms.

    When your friend has her next thyroid test she should arrange an early morning appointment when TSH is highest and fast (water only) as TSH drops after eating and drinking.


  • thank you for your quick reply....

  • On the link above posted by Clutter there is a page - Understanding Test Results. It does indicate in the 3rd column that a TSH over 2.5 should be considered Hypo. In healthy and treated folk even lower. It may be a good idea to have anti-bodies tested to help her case ☺

  • Marz,

    NHS won't usually make a diagnosis until TSH is over range or FT4 below range even when antibodies are elevated.

  • Doesn't Toft suggest treatment if you have antibodies ?

  • Marz,

    Yes, but that was his personal suggestion. It wasn't adopted as policy.

  • Oh - it is oft quoted here on the forum but as you say not adopted policy. It could add to the case in some small way as could the chart on the Thyroid UK website - especially as TUK features on the website of NHS Choices.

  • But how is she going to get the numbers adjusted if she's not on any thyroid hormone replacement? The only way to lower TSH and raise FT4, is to take levo. There's not much else he can do.

  • that's what she is hoping for, but just gathering all the info, as you know how docs are.....

  • Yes, I do know. But, there's little chance of her getting diagnosed, until her TSH is at least over-range, and/or her TSH being under-range, I'm afraid.

  • A healthy patient has a TSH of 1.0 or below and a free t4 and free t3 in the upper quadrant of the ranges

    Ie t4 would be nearer 19 or 20 and t3 near 6

    Those result even just looking at TSH mean undertreated and underactive

  • Your friend is hypothyroid in my opinion.

    In some countries (allegedly) a TSH over 2.5 would lead to an offer of treatment with levothyroxine. Unfortunately, if you live in the UK people like your friend are left to rot until their TSH is over the reference range, at the very least, and in the case of some particularly sadistic doctors they make patients wait until their TSH is over 10.

    If your friend also had positive thyroid antibodies treatment may be offered just a little bit quicker than it would be if antibodies were negative, but there are no guarantees even for that.

    The best things your friend could do now are

    1) make sure that all thyroid function tests from now on are done by 9am at the very latest (earlier would be better), while fasting except for water. (This helps to maximise TSH.) Once treatment is offered, Levo should not be taken in the 24 hours before testing. (This helps to minimise Free T4.) Any delayed dose of Levo should be taken after blood is taken.

    2) Get tested for levels of ferritin, folate, vitamin D, and vitamin B12, ask for feedback from the forum, and optimise levels.

    Testing can be done privately, without the interference or involvement of a doctor, with Blue Horizon Medicals or Medichecks. Some useful links :





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