Thyroid UK
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Help needed with blood test results

I have just joined this forum so apologise in advance for my ignorance. I have been on lvothyroxine 50mg for 3 years but I am having symptoms again conducive with hypothyroidism. My nails are brittle, hair falling out, headaches, exhausted, cold hands and feet (unusual for me) and unexplained weight gain, to name a few. I have just had normal results from my blood test but I'm sure my symptoms are thyroid related. I am told my T4 is 14 and TSH 4.1. Please can anyone advise?

10 Replies

Welcome to the forum, MonkeyMonkey.

You are under medicated to have TSH 4.1 while taking Levothyroxine. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 1.0 or lower with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in Email if you would like a copy of the Pulse article to show your GP when you request a dose increase.

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Monkeymonkey Do you have the reference ranges for those results, usually in brackets eg

TSH 4.1 (0.2-4.2)

Ranges vary from lab to lab but my guess is that you are quite close to the top of range for TSH and quite low in range for FT4.

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges.

You need an increase in your dose of Levo. 50mcg is actually a starter dose.

When having blood drawn for thyroid tests, always book the first appointment of the morning, fast overnight (water only) and leave off Levo for 24 hours. This gives the highest possible TSH which is what is needed when looking for an increase in dose or to avoid a reduction.

Always take your Levo on an empty stomach, one hour before or two hours after food and two hours away from any other medication and supplements (iron, calcium, Vit D four hours).

Have you had vitamins and minerals tested? If so please post the results with reference ranges, if not it would be an idea to get them done as we need optimal levels for thyroid hormone to work properly:

Vit D




Have you ever had antibodies tested? There are two types, TPO and TG. Positive for either of these means autoimmune thyroid disease.

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I've just come back from the doctors because I have been floored again by my fatigue! I am in so much pain in my joints, my skin is sore to touch, tinnitus is unbearable, My short term memory doesn't exist, my nails are literally snapping off they are so brittle, my hair is dropping out, I can't get my hands and feet warm and I can't lose weight no matter how healthy I eat or how much water I drink...just to name a few symptoms. The doctor just smirked at me and said just keep going there's no need to tweak anything. My TSH is well within the range of 0.3 - 5.5. When I said about aiming at the bottom end of the range he just laughed at me and said no no. It seems that unless you have a few hundred pounds spare to see a specialist you don't get any help in this country. Is there anything I can buy over the counter? I need help now not 6 months down the line when I'm back to square one.



Pain in joints - could be low vit D

Tinnitus - could be low B12

Hair loss - could be low ferritin

Fatigue - could be low ferritin as well as not optimally medicated

Can't lose weight - not optimally medicated thyroid-wise

Smirking doctor - slap in the face (you'll have to imagine that though :) )

Doctor saying no need to tweak anything/no need to be at bottom end of range - needs to learn about hypothyroidism

As I said in my previous post you need to test the following:

Vit D




The must be optimal for thyroid hormone to work, and you can see that you may already be suffering some symptoms of low levels.

I think the best thing you can do now, if you've not had vitamins, minerals and antibodies tested, is to do a home fingerprick test to get everything done at the same time. Medichecks have a special offer on at the moment, their Thyroid Check Ultravit covers everything, is normally £99 and until 24th March there is 15% off.

Use code MED32 for the discount, as mentioned here

Once you have all these results, start a new thread and post them, with reference ranges, and members will advise of any vit/min deficiencies and what supplements will help.

We can also see, with FT3 as well as FT4, how well you're converting.

If you're GP wont help you have a few choices - firstly, you gather evidence to show him he is wrong and how he needs to treat you. This is one thing that might help, and has already been suggested to you by Clutter. Did you email Louise for the article? Did you take it to discuss with your GP?

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, wrote this in a Pulse Online magazine article:

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

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.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

If you email she will let you have a copy of the article which you can print out and show your GP

If that doesn't help then push for a referral to an endocrinologist. Email Louise for a list of thyroid friendly endos and ask for feedback on any you can get to. Members will have to reply by PM.

The other option is to take things into your own hands treatment wise, for which you will need all those test results and ask for help on the forum.


Straight away - you are on insufficient thyroid hormones. 50mcg is a starting dose and doses should be much higher, i.e. until patient is well - not until the TSH is somewhere in range.

If we want to get well, we have to read, learn and Do It Ourselves.

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Thank you for the quick responses (now I've worked out how to actually post😛). I don't know the ranges, the Dr just said all was ok and I had to ask what the actual levels were. I am a difficult case because I also have m.e./c.f.s and fibromyalgia so a lot of symptoms cross over but after 13 years of dealing with those conditions I know when it's something else affecting me.

My dr did tell me my folate was too low and told me to buy over the counter medication (folic acid). I wasn't told how much I needed so the pharmacist advised to take 400 as prescribed for pregnancy. My vitamin D level is ok, which apparently is unusual for someone with all my conditions.

I am exhausted, gaining weight week on week despite eating sensibly and have a multitude of other symptoms. I have been tempted to up my dose myself but this would mean I will rapidly run out of medication and further tests will be inacurate for the prescription I've been given! I will have to try to see another Dr and see if they are more sympathetic to my condition. Thank you for all your advice, it is very much appreciated.


Monkeymonkey Always ask for a print out of your test results, never trust your GP when he says everything is OK, that just means it is somewhere within the range (sometimes members have had below range results and told they were OK). You are legally entitled to your results under the Data Protection Act so just ask your surgery and make sure the reference ranges are included. Some surgeries make a small charge for printing, mine just prints them when I ask and doesn't charge.

As your folate was low there is a good chance that your B12 is as well. They work together so you really need to know your results to see what needs supplementing and at what dose.

Do you know your Vit D level?

If you want a member to know you are responding to them, write your reply in their message box directly under their message and click the green Reply button. That way they get an alert that you have replied to them, otherwise they won't know you have replied. They are also notified that you've mentioned them if you put @ directly in front of their name (no space), a list of suggestions pops up and you need to click on the right name and it highlights it blue.


Thank you so much SeasideSusie. And thank you for the lesson. I've never joined a forum before so don't have a clue! (I think you can tell 😊)


We all have to start somewhere, you'll soon get the hang of it :)


Starts today, some great info. Just pick the experts that interest you. Loads to learn.


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