Underactive symptoms but high t4? Help!

Hi all,

Wondering if anyone can assist me, since Christmas I have felt like my thyroid has gone rogue, I have put on a stone, fatigue has returned, brain fog, constipation, floaters in my eyes on some days and crystal clear vision on others, muscle ache and tenderness, anxiety, itchy scalp, dry skin, generally just feeling lousy. With a new symptom of a dry mouth, it's very strange, it comes on suddenly and lasts for a few hours, and craving salt....

So off I went to the docs, who refused to acknowledge it was thyroid and instead wanted to change my contraception from the depo to the hormonal coil, I settled on the mini pill instead. Now I must admit my anxiety has really calmed itself a few weeks after the depo ran out, but I still have all the other symptoms.

First set of bloods showed tsh at 1.61

Ft4 at 23.00

Ft3 at 3.8

And gfr kidney levels at a concerning 65...which I obviously found a tad concerning, reduced ibuprofen, salt, increased water and started eating loads more veg, results come back on Tuesday

The problem I'm having though is trying to explain how I know it's thyroid when my bloods indicate hyper, the doc was even talking about reducing me from 100mg levothyroxine to 75mcg every other day!

I've asked for full thyroid bloods (to include rt3, which the docs and nurse both deny is a test they can do) antibody test, another kidney function and a cortisol test (saliva -also doesn't exist so I have to make do with blood) and I get the results on Tuesday.

I have had a rather turbulent past year with lots and lots of stress, so I'm trying to make allowances for that, but everything smacks of thyroid, I intend to start a low dose of dhea to try and pick myself up as it worked wonders last time I was stressed, and possibly selenium to see if that helps.

A very long winded post, but I wanted to be thorough, any advice on dose, supps, what to do next, or anything would be greatly appreciated :)

21 Replies

Missdee666 Your bloods do not indicate that you are hyper. You haven't given the reference ranges for your test results, have you got them please?

Sorry, yes I have :)

Tsh 1.61 - 0.30-5.50mu/L

Ft4 23 - 11.50-22.70pmol/L

Ft3 3.8 - 0.00-7.00pmol/L

You can't be over medicated unless your FT3 is over range.

You don't appear to be converting T4 to T3 particularly ​well. Good conversion takes place when FT4: FT3 ratio is 4:1 or less. Your ratio is 23 : 3.8 = 6.05 : 1

My opinion is that you would benefit from a slight reduction in Levo and the addition of some T3.

There might be an element of rT3 so it would be worth testing with Blue Horizon or Medichecks, I would suggest BH Thyroid Check Plus Twelve or Medichecks Thyroid Check Ultravit plus rT3 rather than just testing rT3 on it's own because you need the FT3/rT3 ratio as well. I know Blue Horizon includes the ratio, not sure about the Medichecks one.

Ahhh thank you so much seasidesusie! This is exactly the kind of information I need! I have felt like I've been banging my head against a brick wall for months over all of this, I've never had ft3 tested before so I don't have a gauge for what level I should be at, and I did propose an addition of t3 but the doctor just started talking about heart attacks through overdosing and refused


TSH 1.61 and low FT3 do not indicate over medication. What is the FT4 lab ref range? FT4 23 may be within range or mildly over but it doesn't mean you are over medicated. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email louise.roberts@thyroiduk.org.uk if you would like a copy of the Pulse article to show your GP.

NHS doesn't test rT3. You can order private rT3 tests via thyroiduk.org.uk/tuk/testin... but you will need to arrange for a phlebotomist to do a venous draw for this test.

Hi Clutter, thanks for that, the ranges are

Tsh 1.61 - 0.30-5.50mu/L

Ft4 23 - 11.50-22.70pmol/L

Ft3 3.8 - 0.00-7.00pmol/L

I have just started a new job which offers corporate medicash and that includes diagnostic tests, I will have to see if that would cover it


FT4 is so mildly over range it really isn't significant. Certainly not necessary to reduce dose.

I'm glad someone agrees with me lol! I'm just really struggling with how to go about getting this resolved when on paper I appear to be fine, due to me mentioning anxiety in my initial appointment the doctor is really pushing antidepressants as the cure and seems to think my symptoms are psychosomatic


Just love how antidepressants are pushed at you even though there is no blood test to show Prozac deficiency!

I know, they've really gone overboard with this whole mental health awareness push, I was also accused of "thinking" all my symptoms are thyroid related because I'm diagnosed with it already.... what can you say to that?!


Catch 22! Unfortunately, what patients aren't told is that symptoms can lag behind good biochemistry by several months and it can take up to a year after diagnosis to become optimally dosed and for symptoms to resolve.

Hypothyroid patients often have low or deficient ferritin, vitamin D, B12 and folate which can be similar to some hypothyroid symptoms. Ask your GP to do blood tests because they may not be thyroid related but neither will they be psychosomatic.

Ferritin is 22 - 6.00-81.00ug/L according to my last bloods, I take it I'd need to ask specifically for vit D and B12 tests? I take daily supplements for both, but only 100% rda, I'll pick up some folate and add that to the regime :)


Ferritin is optimal half way through range so 22 is rather low. You can raise ferritin by supplementing iron which should be taken with 1,000mg vitamin C to aid absorption and minimise constipation. Iron must be taken 4 hours away from Levothyroxine.

You would need to ask for vitD, B12 and folate tests. I don't recommend supplementing folate without a blood test first. There's no point in guessing at levels and doses.

Ah, the standard quack's response. We're all half-mad, apparently.

It's so frustrating! Antidepressants and counselling, I did advise that I have a degree in counselling so consider myself pretty self aware and he laughed dismissively *sigh*

Yes, he laughed to put you down and assert his 'authority'. What he was really thinking was: S**t, someone who knows their onions and can see I'm a complete w****r. (Excuse my asterisks, I meant to be more polite...) ;-)

He was a very young, oxbridge kinda doctor, first name Rupert...which probably says it all, I asked for tsh levels which he said were fine at 1.61, and I asked what my last tsh result was and it was 2.09 (January this year) it was only then he decided that perhaps ft4 and Ft3 tests might be a good idea


"I did advise that I have a degree in counselling so consider myself pretty self aware"

Oh, back of the net!!!!!

Absolutely bl00dy brilliant 😁

I bet his laugh was one of embarrassment!

Get your vitamin D, Folate, B12 & ferritin levels checked out

Do you have Hashimoto's? High antibodies. If not been tested, ask for them to be done

Hi slowdragon, I actually went today for antibodies, and a few other bits including a repeat on kidneys and cortisol, 5 vials they ended up taking! I've honestly had more blood taken in the past month than I have in my entire life, I'll ask about vit tests when I go to get my results on Tuesday, hopefully they'll oblige

Well. I was going to say we're all in the lap of the gods, Missdee666, but with a username like yours I'm not sure how appropriate that might be... ;-)

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