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Thyroid UK
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what do i do next after borderline hypothyroid results?

Where do I go from here? What do I do next please?

Feeling very down, exhausted, anxious and frustrated tbh.

1) Should I get reverse T3 tested?

2) If my free t3 is middle of range does it matter that my free t4 is on the low borderline?

3) Have my two normal antibody test results ruled out Hashi etc?

4) Should I get my iodine tested and do I test urine or blood for that?

5) Does the 3.4 TSH rule out central/secondary hypothyroidism? Or shall I test pituitary function through private blood tests?

Sorry for so many questions and thanks for anyone who reads this. My GP would never listen or answer or know any of these questions I bet so I don't know who else to ask.

(My medichecks results are below and doctor left comments saying all fine.

I've never been diagnosed and never taken thyroid medication but have many hypothyroid symptoms especially in the years after birth. I am vit D deficient and on prescribed vit D. My B12, ferritin etc were norm but not great. Thanks.)

10 Replies

1) No point in getting an rT3 test at this point - if ever - it wouldn't give you any useful information.

2) Your FT3 is not in the middle of the range - if you've posted the right results - it is right at the bottom of the range. Mid-range would be 4.95. That might not be much of a difference for some things, but it is a huge difference for an FT3 test. Your FT4 is below range, and yes it does matter. Very much. T4 is converted to T3. If you don't have any T4, you can't make T3. Your thyroid obviously isn't doing very much.

3) Testing iodine is very controversial. I've no idea what the best test is. But, I don't think these results hint at low iodine, because...

4) Those results don't rule out Central hypo. With those Frees, one would expect the TSH to be much higher. I don't know if you can test for pituitary function with private tests. You would be better off learning about Central hypo, then go to your GP and suggest it to him - he's probably never heard of it - and ask to see an endo who can do the pituitary tests.

Actually, on this set of results, your TSH is 5.15, not 3.4. A TSH of 5.15 is actually primary hypo - although a UK doctor would never admit it. In some countries, you would be treated with a TSH of 3 - especially with below range FT4.

'Normal' is an opinion, not fact. And when a doctor says it, all he means is 'in-range'. It's meaningless. Do you have the actual numbers? Do you have the result for vit D? How much vit D are you taking?

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thank you for your reply. i am a little confused as though we might be looking at different things although i am new to this so please explain if i am missing something.

where does the TSH of 5.15 come from please? On the first line of my photo screenshot of my medichecks results i see TSH 3.41 (range 0.27 -4.2)


Oh! Excuse me! I downloaded your photo and then looked at the wrong one! I'm so sorry. Well, that doesn't change all that much. That TSH is still hypo, and doesn't rule out Central hypo, it rules it in! Still worth checking it out. You would expect the TSH to be higher with an FT4 so low - it's right at the bottom of the range. And the FT3 is just under mid-range. But, with so little T4 to convert, it might not stay there for long.

Still not point in testing for rT3. And, you could check for iodine deficiency - if you can find the right test, and a doctor that understands iodine deficiency.

It would still be a good idea to post your nutrient results.

Your Tg antibodies are actually positive for Hashi's. Very low, but over-range. Which doesn't mean that they aren't sometimes a lot over-range, because antibodies fluctuate all the time.

Once again, my apologies for my mistake!

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hey greygoose, I think antibodies are in range but perhaps I need a magnifying glass, it's very small print??

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Oh! You're right! It's actually 15.8. I thought that 1 was a two. But, on enlarging it, I see it isn't. My bad.


Are you taking any medication? Some medication might interfere with normal thyroid function. Being very overweight might affect thyroid function as might an infection. You need to rule out other factors.

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Not taking any medication apart from paracetamol every month.

I am very overweight. I have just entered 'obese' bmi range. That's one of the many reasons I looked into hypothyroid as I am struggling to lose weight in ways that have worked for me before.


Nanaedake - just thinking about what you said.

So is being overweight and borderline hypothyroid like a vicious circle? Metabolism sluggish due to sluggish thyroid increases weight gain which itself worsens thyroid function which then makes it even harder to lose weight? All of which makes exhaustion and depression worse!

How do I break the cycle?


If you want to do an iodine test, do a non-loading one that measures existing levels. Loading tests, where you take iodine beforehand, apparently show virtually everyone deficient, so best to do one where you don't take an iodine dose first.

Look at Genova, must be ordered through ThyroidUK as your 'practitioner', see here on how to order and receive results


The test is on page 3 of the PDF

Urine Iodine Test:

Specimen requirements: Urine

Cost: £71.00

Order Code: END25

Turnaround time: 5 - 10 days

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Thank you that's very helpful I will consider doing that


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