Thyroid UK
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My first thyroid function test

Hi everyone, this is my first post.

I had my first thyroid function test (TFT) about 5 weeks ago. Here are the results and the normal ranges:

Free T4: 10.8 pmol/L (11.00 - 22.60 pmol/L)

TSH: 4.6 mu/L (0.2 - 4.00 mu/L)

Thyroid peroxidase Ab conc: 54 u/mL (<60.00 u/mL).

I have many hypo symptoms: cramp, night sweats, stiff joints, depression, low body temperature, dry skin, fatigue.

I have yet to be prescribed levothyroxine, and have been anxiously waiting for my next TFT, which is next week.

I know many people have worse TFT results than mine, but do you think it reasonable to expect a prescription for levothyroxine based on my results?

9 Replies

hypo_guy Theoretically you should be diagnosed and treatment started, in another country you would be, but this is dear old UK with rotten standards of health care as far as hypothyroidism is concerned.

Your TSH is over range but hasn't reached the magic number 10 which the guidelines say it needs to be. But your FT4 is under range and an enlightened GP may start you on Levo.

Your TPO antibodies aren't far off the top of the range, if it manages to squeeze past 60 then you'd be positive for autoimmune thyroid disease aka Hashimoto's and again an enlightened doctor would start you on Levo. Dr Toft, past president of the British Thyroid Association and leading endocrinologist, says that with positive antibodies then Levo should be started 'to nip things in the bud'.

When you have your next blood test, book the earliest appointment of the day. If already booked and later than 9am then cancel and rearrange it. Fast overnight, breakfast when you get home. These two things will give you the highest possible TSH which is what you want for a diagnosis.


That's very helpful Susie. Thanks!


Definitely reasonable to push for it. I was only borderline as well, in fact my free T4 and T3 were normal! It was my TSH that was just poking its head over the parapet of normality, whatever that is. Also, your symptoms are pretty clear. I'm sure someone else will be along to give further advice. Good luck! :)

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Thanks Jadzhia.



TSH is over range and FT4 below range so, yes, your GP should prescribe Levothyroxine and probably should have done when you had the first results.

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This is what I thought, Clutter, but my GP said I might get the symptoms of hyperthyroidism if prescribed Levo, so they needed to do another blood test. If it hadn't been first thing in the morning I would have given her an intelligent reply ("but I'm already hypo now"), but it takes me hours to wake up these days.



Thyroid blood tests need to be done early in the morning when TSH is highest. It's a good idea to fast (water only) too as TSH drops after eating and drinking.

Your GP will have to shovel Levothyroxine into you before FT4 is >22.60 and you become over medicated.

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If they have not been done ......Suggest you ask GP to check levels of vitamin d, b12, folate and ferratin. These all need to at good (not just average) levels for thyroid hormones (our own or replacement ones) to work in our cells

There are two sorts TPO Ab and TG Ab. (Thyroid peroxidase and thyroglobulin) BOTH need checking, if either, or both are high this means autoimmune thyroid - called Hashimoto's the most common cause in UK of being hypo.

(NHS rarely checks TPO and almost never checks TG. NHS believes it is impossible to have negative TPO and raised TG. It's rare, but not impossible, there are a few members on here that have this.)

When you get results suggest you make a new post on here and members can offer advice on any vitamin supplements needed

If you can not get GP to do these tests, then like many of us, you can get them done privately

Blue Horizon - Thyroid plus eleven tests all these. £99

This is an easy to do fingerprick test you do at home, post back and they email results to you couple of days later.

Usual advice on ALL thyroid tests, (home one or on NHS) is to do early in morning, ideally before 9am. No food or drink beforehand (other than water) If you are taking Levo, then don't take it in 24 hours before (take straight after). This way your tests are always consistent, and it will show highest TSH, and as this is mainly all the medics decide dose on, best idea is to keep result as high as possible

If you have Hashimoto's then you may find adopting 100% gluten free diet can help reduce symptoms, and lower antibodies too. Selenium supplements can help reduce antibodies and improve conversion

You do not need to have ANY obvious gut issues, to still have poor nutrient absorption or low stomach acid or gluten intolerance.

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Thanks SlowDragon.


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