Thyroid UK
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Morning all.

Went to discuss my latest blood results this morning,it's my third doctor in 5 months and was hoping he would be different. I'm taking 200mcg levothyroxine every morning. I feel lethargic,cold all the time,muscle and joint pain and generally miserable. Before I was told I was hypothroid I was working full time and had three older boys at home. Had horses and had lots of energy,never sat down.

Now I have no energy,no enthusiasm,no interest in house work. Tell myself tomorrow will be the day when I blitz the house but when I get up next day I feel awful and just want to sit down.

Gp tested cholesterol,folic acid,iron,B12 and estrogen which were all in the reference ranges.

My thyroid results are:

Serum free T4 18.5(11.0-23.0)

Serum TSH 2.4(0.27-4.5)

Serum free T3 3.06(3.1-6.8)

Was told that he does not take into account any T3 results and has been told to go on TSH only.

Any tips you lovely people.

11 Replies

Your FT3 result says it all, it is under range. It is the active hormone so no wonder you feel like you do!

The aim of a treated hypo patient generally is for TSH to be 1 or below with FT4 and FT3 in the upper part of their respective reference ranges if that is where you feel well. So going on TSH alone you can see that you are under medicated. Ask for an increase in dose and use this information to back up your request > Treatment Options:

"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)."

Dr Toft is past president of the British Thyroid Association and leading endocrinologist. You can obtain a copy of the article by emailing Dionne at

And just because those other tests were "in range" doesn't mean that they are optimal. If you post the actual result with reference ranges then members can comment.


Thank you all very much for your replies. It's so frustrating going to see a UK doctor because you're made to feel as though you're wasting their time.

I plan on getting the private tests done and gave already made an appointment to see another doctor within the same practice.

Do I order T3 from abroad and start on a low dose or do you recommend I persevere and see what progress I can make with the gp?

Again thanks,you guys are amazing x


Forget T3 for the moment, there are other things to do first.

You need to know if your have raised antibodies confirming autoimmune thyroid disease aka Hashimoto's. If you have then this needs to be addressed

You also need to know your vitamin and mineral levels. Any low levels or deficiencies mean that thyroid hormone can't work.

SlowDragon has covered these on her reply so you need these tests done either through your GP or with Medichecks or Blue Horizon as mentioned.

Once you have these results, make a new post on the forum, members can advise where to go from there.


Hi Wizzy68 I had exactly the same here in France with Doctors and endos alike.

I then joined this site had private blood tests taken and then posted the results on here.

I received brilliant advice on here and 19 months later am feeling well again.

I self medicate with NDT adn T3 which I purchase myself and only costs me about 6 euros per month. The blood tests are extra. By the way I have no thyroid now either.

You do not have to feel the way you do please take action for yourself.


Its t3 that matters he is wrong wrong wrong

Without kniwing what your exact resukts are for ferritin,folate,b12,vitd3,

Its not possible to help you solve this


Your doctor's comments are similar to the thousands of GPs and doctors in the UK - maybe worldwide too.

That's why we,on this forum, know far more than most professionals, through the necessity to recover our health. We cannot go to doctors or endocrinologists who are going to only look at the TSH and T4.

Your TSHis 2+ too high - the aim is 1 or below.

FT3 is woeful and should be nearer the upper part of the range. So your dose of levo isn't converting to enough T3. Levothyroxine is T4 and inactive. It has to convertto sufficient T3 and T3 is the only Active thyroid hormone needed in all of our T3 receptor cells. Our brain and heart have the most but we have millions in our body which run our whole metabolism and if FT3 is too low, we don't have the energy in our receptor cells.

Increase levo or source some T3 of your own and take a combination of T3/T4. Researchers have shown that a combination suits many and returns them to good health.

Also, B12, Vit D,iron, ferritin and folate have to be optimum as well.


First step to getting this sorted is to get full testing

You are under medicated or more likely have poor absorption as gut is often affected when hypo. Low stomach acid reduces effectiveness of Levothyroxine and also causes low vitamins

Your FT3 is far far too low so you probably also have low vitamin levels.

Your TSH is too high, and FT4 has room to go higher you have room for a small dose increase

Do you know if you have high thyroid antibodies? Ever been tested?

If high this is Hashimoto's also called autoimmune thyroid disease

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 thyroid antibodies and vitamin testing from GP.

Essential to get the ranges on all test results

Private tests are available

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, lowest FT4 and most consistent results

Link about antibodies

Link about thyroid blood tests

List of hypothyroid symptoms

If you have Hashimoto's then the majority of us find strictly gluten free diet helps a lot.

So you need to find out about antibodies result


Hi thanks for your reply,I've never had a test for antibodies,had to beg for the FT3 test. Gp was quick to say that although the test was under range he is dismissing it as he's spoken to someone and they said to focus on the TSH.

I would imagine I will need to pay for private tests and see what they show up.

In your experience would you recommend increasing my levothyroxine or stay on 200mcg?

Thanks honey xx


first step is to get private tests.

If you put dose up

a) you need increased prescription from GP first to get some 25mcg tablets (must be same brand)

B) you need to wait 6 weeks before testing

So I would suggest testing first. If you wait till Thursday to order from Medichecks they may have an offer on - sometimes reduced to £79

you need

either finger prick or if you have clinic nearby you can pay extra for private blood draw

Do test on Monday or Tuesday latest and post off same day - full results emailed in a day or two


Thanks for that.

How high can the levothyroxine go up to?

Is 200mcg still low or is it down to a patient's individual needs?



You are not going to become well if your GP fails to address your deficient FT3 and doses by TSH only. You are undermedicated to have TSH 2.4 on 200mcg. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in Email if you would like a copy of the Pulse article to show your GP.

NICE recommends:

Advice should be sought from an endocrinologist (or referral arranged) if the person:

Has adverse effects from treatment with LT4.

Has cardiac disease.

Has an abnormal thyroid gland structure, atypical thyroid function tests, or an unusual cause of hypothyroidism (for example due to drugs such as amiodarone).

Has persistent symptoms despite treatment with LT4.

Vitamins and minerals results within range is not the same as optimal results. If you post the results and ranges members will advise whether supplementing will help.


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