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Symptoms of hyperthyroid but normal TSH?

Hi this is my first time posting :) I've been having some minor health issues that seem to resemble hyperthyroidism but just had my result back and TSH was normal. 1.4, whatever that means!!

I've lost a load of weight, have a racing heart (you can literally see my chest pounding sometimes), occasional palpitations, am always really sweaty and feel breathless and exhausted a lot of the time.

I'm assuming that a normal TSH means that if there is something going on it can't be an overactive thyroid. Is there anything else I should ask to be tested? I have had a cortisol test and it was 300 which I think is normal. In a way I was hoping for something conclusive as I don't feel well a lot of the time and was hoping for an easy answer! I'm struggling a bit (especially with my sport, the heart rate thing is offputting lol!) but I feel like I can't keep pestering the GP with non specific problems when my tests are coming back normal. Can I ask for beta blockers? My heart itself is fine - had it looked at when I started getting palpitations.

I am female early 20s. I have a family history of Graves disease. Sorry for the essay!! X

7 Replies

People can get the symptoms you describe with hyperthyroidism and hypothyroidism and/or with nutrient deficiencies. High or low cortisol could be another contributory factor.

Having just had TSH measured you haven't actually learned much about your thyroid status. You could still have thyroid issues despite a "normal" TSH.

A blood test for cortisol won't actually tell you much unless your result is at one of the extreme ends of the reference range. The best test for cortisol levels is using saliva testing. Doctors will often tell you that this test is quackery, but the NHS uses the test themselves when testing cortisol levels in the middle of the night. See this link from the NHS :


NASA uses saliva testing for their astronauts too, apparently. And scientists researching anything requiring cortisol levels frequently use saliva testing.

Testing cortisol with saliva allows for 4 - 6 saliva samples to be done throughout the day from early morning until late at night. Blood and saliva testing don't measure the same thing. Blood measures total cortisol and saliva measures free (unbound) cortisol. Unbound cortisol is the bit that your body can make instant use of without any further processing. It is actually a better test than blood for that reason, and having more tests done means that you get a better idea of what your levels are like at multiple times in the day. Levels could be great in the morning, and terrible at night (for example).

Another issue is nutrients...

Low iron can cause the symptoms you describe. You should ask your doctor for tests to see if you are anaemic. A full iron panel would be a good start, and a full blood count would help as well.

Anaemia can be caused by deficiencies in other nutrients too, for example low folate and/or low vitamin B12. So ask for these to be tested as well.

Low vitamin D is very common as well.

Since your TSH currently seems reasonable, I would suggest that you start by testing nutrients first - the ones I mentioned above.

Make sure that you ask for copies of all your test results including the reference ranges. You are entitled to copies of your results under the Data Protection Act, so don't allow yourself to be fobbed off by receptionists or doctors. You should expect to pay a small amount of money for paper and ink.

Another option, if your surgery has this option is to register for access to your GP record online. Some surgeries have already made this available, others are dragging their heels. This option is free if you can set it up. You would require proof of identity, and you would have to go to the surgery to ask for access to your record. You get given various codes you need to use to log in to register.

Once you have your nutrient results you could do some research on here and/or post results and ask for feedback.

If you still have symptoms after optimising nutrients, then depending on what your remaining symptoms are you would probably need to get more info on your thyroid.

If thyroid was okay then you would then look at saliva testing for cortisol.

1 like

Would be well worth doing this test


It's finger prick, so you can DIY at home.

Will give you a full picture of Thyroid & Anaemia panels.

You may get some discount with a Thyroid UK code.


Ah, that's my favourite blood test. It does the usual thyroid stuff as well as T3 which I was never able to have tested on the NHS. Does antibodies and vitamins B12 and D as well as ferritin and folates. You get the kit through the post! Do the test at home, post it back to them and usually get results emailed to you next day. Can definitely recommend it.

Would also stress the Graves link in your family. Have to say I felt like a total hypochondriac by the time I fell to bits and my Graves was diagnosed.


i would seriously suspect you have early Graves Disease its vital that thyroid antibody tests are done PDQ in view of your family history

its possible you might have Graves and Hashis running together or you are in Graves phase of Hashimotos but without thyroid antibody tests no one can tell

as for sport do not go putting your body under that stress currently given all your other symptoms

simply go back to your GP and because of your family medical history request that he does




thyroid antibodies

tell him you sought help from NHS choices website

whatever you do dont take anti depressants or anti anxiety pills


There is something else you might want to consider and that is mineral loss through sweating when exercising. Low levels of calcium, magnesium, potassium, selenium and iron can cause palpitations. In addition iodine can be lost through exercise and deficiency can cause excessive sweating. This is a link on studies done on iodine loss through sweating during exercise, and of course iodine deficiency can impact on your thyroid:-


This link relates to the importance of magnesium in arrhythmia:-




Hi there

You might be interested in this post (linked below) which discusses something called central resistance or pituitary resistance which is apparently common in people whose mothers had high circulating hormones whilst pregnant. This causes the pituitary gland to not respond to circulating hormones and tsh will appear with normal tsh but high T4 and T3 levels giving the same problems as hyperthyroidism although thyroid is actually okay.


So yes, you do need to get your T4 and T3 levels to absolutely sure there are no thyroid problems as some conditions mean tsh is not responsive.

Checking your vit levels is always useful as things like iron anaemia can cause heart palpitations etc. Antibodies also if you want to see if anything forming.

Also electrolytes = potassium/sodium/blood glucose levels and even calcium can cause symptoms like you mention.

Also in regards to unexplained weightloss, you might also want to check stomach issues as these can cause weightloss and low nutrient levels. Things like coeliac/NCGS and others. Do you have any unresolved digestive issues? although even coeliacs can present with no stomach disorders :-)


Thanks so much for all of your kind comments!! I have ordered the home thyroid test recommended above, I will let you know the outcome :) x


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