Why is my TSH elevated while I don't have Hashi?

[Laura221]

First of all, I would like to say that I am NOT on any medication.

My TSH has been between 4 and 7 for years. My endo tested for Hash, but that was negative. Free T4 was also in range.

What could be causing this?

[Greybeard]

Thyroid antibody levels rise and fall all the time. One result within range isn't a guarantee that they aren't raised at other times. Anytime you are told your results are normal ask for the exact number and the reference range.

[shaws Administrator]

You may be undiagnosed. In other countries we are diagnosed when the TSH reaches 3+.

Unfortunately, in the UK, the instructions are we aren't to be prescribed until the TSH is 10. Some doctors will prescribe if it is slightly lower with symptoms. Many doctors do not know any clinical symptoms and ignore when patient tells them.

You need a new blood test, and it has to be at the very earliest, fasting, (you can drink water) and if you were taking thyroid hormones you'd allow a 24 hour gap between last dose and test and take afterwards.

You need to test (and doctor most probably wont but we have private labs which will do so)

TSH, T4, T3, Free T4, Free T3.

Your doctor should definitely test B12, Vit D, iron, ferritin and folate as deficiencies also cause symptoms.

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

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

Get a print-out of your results, with the ranges, Ranges are important as they enable members to interpret.

[greygoose]

Do you always do your tests at the same time of day? TSH is highest early in the morning, and fasting. It drops throughout the day, and after eating.

As Greybeard63 says, one negative test for Hashi's doesn't prove anything. Quite apart from anything else, there are two tests for Hashi's antibodies, but the NHS only ever does one of them. And, some Hashi's people never develop high antibodies, anyway.

But, even if you don't have Hashi's, there are so many things that can cause you to be hypo and have a high TSH. And accident, like whiplash; endocrine disruptors in food etc.; high consumption of unfermented soy; iodine deficiency or excess iodine; etc. etc. etc. Very few people ever find out why they're hypo.

A more important question is: why aren't you on thyroid hormone replacement? Your TSH says you're hypo. And your FT4 just being 'in-range' proves nothing. Where exactly is it in the range? And where is your FT3? Do you have any symptoms of low thyroid?

[Laura221 in reply to greygoose]

My FT4 was 14 (ranges 12.6-21) and T3 has never been measured.

Symptoms: Hands and feet which are cold ice blocks, a lot of mood swings, thinning eyebrows, hair falling out, not able to concentrate (not easy as a uni student), dizziness when standing up,..

[Laura221 in reply to greygoose]

My symptoms are always the worst when waking up. Does this have anything to do with the thyroid?

[greygoose in reply to Laura221]

That sounds more like adrenals. They're bound to be stressed if your thyroid is low.

It might be a good idea to ask your doctor to test your vit D, vit B12, folate and ferritin. They are more than likely low, adding to your symptoms.

[Laura221 in reply to greygoose]

Vit D and B12 were low, after supplementing (like B12 injections) they're high up in the range, but still no lessening of symptoms.

[greygoose in reply to Laura221]

After supplementing? You mean you've stopped supplementing? The levels will go down again, if you stop. You need to keep taking a maintenance dose. You need to maintain optimal levels of nutrients so that your body can use what little hormone your thyroid is presently making, and will be better able to use levo when you finally manage to get treated. Starting levo with sub-optimal levels of nutrients in not a good idea.

[SlowDragon Administrator]

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

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available

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. This gives highest TSH, lowest FT4 and most consistent results

Link about antibodies

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

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Print this list of symptoms off, tick all that apply and take to GP

thyroiduk.org/tuk/about_the...

Your low FT4 and high TSH strongly suggest you are hypo

About 20% with Hashimoto's apparently never have raised antibodies

Also you may have only had TPO antibodies tested, not TG antibodies

[Angel_of_the_North]

There are a very few people who are healthy with TSH around 4, but usually their free T4 and free t3 are well over mid range, and they don't have any hypo symptoms. For most people, a TSH over 3 shows that the thyroid is struggling but the NHS won't treat until TSH is over range or free T4 is under range. Not everyone who is hypo has Hashis.

[Maxxxx]

It sounds to me as if you should be on medication to lower your TSH level. Your symptoms show that you are hypothyroid.

NICE Guidelines say that if you are symptomatic (as you are) you should be treated even if your TSH level is below 10. By the way most people agree that waiting until your TSH level reaches 10 is inhumane but hey that's the NHS! Somewhere on the Thyroid UK website there is a list of symptoms you can print off - tick all that apply and show your doctor.

I also bought a thermometer and took my temperature every morning. It was very low (hence my feeling cold all the time). That is extra ammunition to show your doctor to get them to prescribe levothyroxine - a starter dose is 50 mcg - then re-test after 6 weeks and increase the dosage by 25mcg increments until your TSH level is below 1.

If all else fails tell your doctor that you are trying to get pregnant and he/she will have to start you on levothyroxine.