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Thyroid UK
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Hi my GP has sent me away today saying my symptoms aren't thyroid? Constipation, puffy eyes, tiredness, sweating, feeling cold, weight gain? TSH over range. Taking 125mcg levothyroxine. Diagnosed 2012

TSH 4.5 (0.2 - 4.2)

Free T4 15.6 (12 - 22)

Free T3 2.6 (3.1 - 6.8)

Thanks in advance

10 Replies


TSH 4.5 (0.2 - 4.2)

Free T4 15.6 (12 - 22)

Free T3 2.6 (3.1 - 6.8)

GP has sent me away today saying my symptoms aren't thyroid

Well, he certainly doesn't know how to treat hypothyroidism, does he?

Your TSH is over range and your FT3 is under range. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo.

Go back and see your GP and ask for an increase in Levo and use this information in support of your request. From thyroiduk.org.uk/tuk/about_... > Treatment Options:

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor.

Also -

Dr Toft states in Pulse Magazine, "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)."

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org print it and highlight question 6 to show your doctor.

Tell him your information has come from NHS Choices recommended source of information for thyroid disorders (which is ThyroidUK).

Make sure that you are retested 6-8 weeks following your increase, you will undoubtedly need another increase of 25mcg, then repeat 6-8 weekly testting/increase of 25mcg until your symptoms abate and your results are where they need to be for you to feel well.

Always book the very first appointment of the morning for thyroid tests, fast overnight (water allowed) and leave off Levo for 24 hours. This gives the highest possible TSH which is needed when looking for an increase or to avoid a reduction.


Have you had thyroid antibodies tested? Were they positive - Hashimoto's?


Have you had vitamins and minerals tested? If so please post results with reference ranges, say if you are supplementing anything and at what dose.

Vit D




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Thanks antibodies were TPO 274 (<34) TG antibodies 256.3 (<115) will post vitamin and mineral results now



TPO 274 (<34) TG antibodies 256.3 (<115)

Your high antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Gluten/thyroid connection: chriskresser.com/the-gluten...






Clutter sums it up as follows: "The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.4 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted".

Has your GP commented on why your FT3 is below the reference range and why s/he is OK with that given that, ultimately, the point of levo. is to increase the sufficient availability of T3?

Do you have the results of any vitamin and mineral levels (complete with their reference ranges) to share - if so, please post them. It's difficult for thyroid hormones to work effectively if these levels aren't in an appropriate range and it's common for hypothyroid people to have several deficiencies.

ETA: x-posted with SS, so follow her suggestions :)


Thanks I will post vitamin and mineral levels, GP didn't comment on low free T3 and said I didn't need an increase because my TSH only went up a little bit more from last time



GP didn't comment on low free T3 and said I didn't need an increase because my TSH only went up a little bit more from last time

He really doesn't have a clue!

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Email Louise at Thyroid Uk for list of recommended thyroid specialists


Your vitamin levels are dire in part because under medicated and also due to leaky gut and gluten intolerance

Improving vitamins by significant supplements is essential

You need to see a different GP who has more idea than current one

Many, many on here find it reduces symptoms to be strictly gluten free




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Is there another GP you can see at the surgery as this one has no idea and will never get you well!

Those are all classic hypo symptoms which he would know if he had ever read the NHS symptom and treatment guide. Go onto the NHS choices website where the symptoms are also included for us mere mortals to see, puffy face is in the section for later symptoms which apparently we are unlikely to suffer as we will have been diagnosed and treated before it appears - unless our GP is an idiot of course.


If you go on to the main TUK site and you will find a symptom checklist, print it off and fill it in, you probably have more than you think.

Sweats are a more common hyper symptom but it is not exclusive some get it when hypo too.

125mcg is not a high dose, we need what we need, I had increments every 2-3month for 18 months and sometimes my new results (3months) were worse than the previous ones, that just meant I still wasnt on the right dose yet and neither are you.

When seeing a GP/endo always try to quantify symptoms, I used to need 8 hours sleep but now wake up tired after 10 is much better than ‘Im tired’ all the time or I can only eat 1100 calories or I put on weight rather than ‘I cant lose weight’, it tends to make them take you more seriously and not start ticking the ‘neurotic female, youve got kids what do you expect, its your age its to be expected’ boxes they seem to default too.

PS I saw 4 GPs before I found one I could work with so dont stick with a bad one, he may even have been good with routine stuff but not thyroid.


Thanks I tried to be specific with my symptoms like saying I now sleep about 13 hours instead of 8 but still the GP didn't listen.

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So what are they, given that your free T3 - the most important one - is under range? You need to see a doctor with a clue.


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