Newbie - Healthy FT4 reading coupled with high TSH

[NellieBee]

Hi everyone,

I've just joined as I have an underactive thyroid & have been taking Levo in various doses for over 10 years now, having regular 6 monthly checks. I'm currently on 75 mcg daily but feel that I'm constantly struggling as I work full time and changed my job role in the summer.

My gp said that my latest thyroid test results in September were fine but a fellow sufferer looked at the results for me (I find it hard to understand things like this!). My serum TSH level was 5.32 and there was an exclamation mark as the range is 0.35 - 5.00 and Serum Free T4 level was 21.2 (range is 11.0 - 23.0).

I'm tired all the time and feel overwhelmed at work - my brain can't cope with an overload of information, constant juggling of tasks and trying to meet deadlines. When I come home I can fall asleep in the chair before my dinner is even cooked! All of this is making me really anxious because I'm "on probation" and although I've tried to explain to my manager I found it almost impossible to be clear so I didn't get much sympathy or help.

However when I started with the company I had to have an Occupational Health appointment because of my medical condition and I remember being told that if the thyroid isn't "under control" it is classed as a disability. Unfortunately as my test results are classed as OK I don't feel that I can ask my manager to refer me back to OH so I'm in limbo.

Has anyone got any thoughts on my results and/or any useful advice to help me cope?

[SlowDragon Administrator]

Your under medicated to have TSH so high. It should be around one

Your FT4 is quite high, considering TSH is so high

Did you take Levo before blood test

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

Have you had your vitamin D, Folate, ferritin and B12 tested? Post results and ranges if you have them

Or ask GP to test if not done

Do you have high thyroid antibodies? This is Hashimoto's also called autoimmune thyroid disease

[NellieBee in reply to SlowDragon]

Hi SlowDragon, wow that was a quick response, thanks! I didn't fast before my blood test and did take Levo as I take it first thing in the morning - in the past I had been advised that it wouldn't affect the test.

I haven't had the Vit d, folate, ferritin & B12 tested recently and have no idea about thyroid antibodies - I feel that I should understand more about how my body works! Have you got any advice on how i convince my gp to do the tests when she has said my thyroid is ok?

[greygoose in reply to NellieBee]

Oh dear! Whoever advised you to take your levo before the test, doesn't have any common sense, let alone know about thyroid. If you take your levo before the test, all you are testing is the dose you just took. Not your normal circulation T4 levels. Of course it's going to affect the test. So, that test is useless, really. And you are still hypo.

[SeasideSusie Remembering]

NellieBee

Thyroid test results aren't too hard to understand really. 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 if that is where you feel well. So you're looking for a lowish TSH and highish free Ts.

Your TSH is over range. Top of your range is 5.00 and your level is 5.32 so that indicates that you are undermedicated. However, your FT4 is near the top of it's range. What is needed now is FT3 to be tested because thatnisbin most important test. You need to see if your T4 is converting to enough T3. If your FT3 is low in it's range then you're not converting well. Low T3 will cause symptoms.

Also, have you had thyroid antibodies tested? Have you had vitamins and minerals tested - Vit D, B12, Folate and Ferritin? All are an important part of the thyroid jigsaw.

[NellieBee in reply to SeasideSusie]

Thanks for your reply Seaside Susie - sounds like i need to get more tests then. I was on a higher dose of Levo (100mcg) but my results have been up and down for quite a while - when I saw my results on the screen once there were huge zig zags!

I find it difficult to take information in and actually remember it these days and that did cause a problem when I initially started my current job. So I think I need to write down all the things to ask my gp otherwise I'll garble and forget my words, as other sufferers have done.

[SeasideSusie Remembering in reply to NellieBee]

Your results could be fluctuating because of Hashimoto's so ask to get antibodies tested. There are two types - Thyroid Peroxidase (TPO) and Thyroglobulin (TG). NHS rarely do TPO and almost never do TG. Your GP may get TPO tested and if they come back negative you could possibly have positive TG. You can get them tested privately with a fingerprick test at home if necessary with one of our recommended labs.

Also, another reason for fluctuating results, especially TSH, is timing of test. TSH varies during the day, it's highest in the morning and falls during the day, it also falls after eating so we always recommend having thyroid tests done at the very first appointment of the morning, fast overnight and leave off Levo for 24 hours. If you don't every time then results can be compared accurately.

[SlowDragon Administrator]

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

If you can not get full thyroid and vitamin testing from GP private testing is possible. Lots on here have to do this

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

Link about antibodies

thyroiduk.org.uk/tuk/about_...