Thyroid UK
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TSH too high

TSH too high

These are recent bloods tsh high. My bloods a year ago are almost identical except tsh was 6.21. Last year ..If there is such a difference in tsh why is freet4 the same and folate still low I'm confused why a higher tsh doesn't affect the free t4 I had a total thyroidectomy 22 years ago All I know is I feel exhausted but if I increase levo I then get panic attacks and adrenal rushes

8 Replies

What you need is a Free T3 blood test and I don't know why they rarely test both Frees i.e. T4 and T3.

Your FT4 is high which suggests to me (and I am not medically qualified) that you may not be converting T4 into sufficient T3. T4 is inactive hormone and has to convert to T3.

T3 is the only active thyroid hormone required in our T3 receptor cells. Without sufficient our body cannot function optimally and we get clinical symptoms.

You may not be converting T4 into sufficient T3 and your TSH is far too high which suggests you need more thyroid hormones.

Research has shown that combination of T4/T3 suits many people.

T3 is the only Active thyroid hormone and it is T3 which drives our whole metabolism from head to toe.


Is anything being done about your folate deficiency? It's below range, your GP should be addressing this.

Your Vit D is too low, the Vit D Council recommends a level of 100-150nmol/L. You should take 5000iu D3 daily for 3 months then retest, along with its important cofactors K2-MK7 and magnesium. Once you've reached the recommended level you need to find your main dose by trial and error, maybe 2000iu daily, maybe more or less.

It says "Specialised Chem Review Needed" - what is your GP doing?


What does "specialised Chem Review Needed" mean


They gave me D3 800


They're only allowed to give you 800iu (unless you're deficient, which you're not, you come into the Insufficiency category) but it's not enough. 800iu will take forever and a day to get you up to the recommended level. You need 5000iu at present, it's up to you whether you buy your own supplement.


I don't know what "specialised chem review needed" means but it is an instruction for your GP to do whatever it is, which is why I asked what is your GP doing. If he hasn't mentioned it, ask him.

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Your low vitamins with be affecting conversion of FT4 to FT3

Would suspect your FT3 is low

You need to improve folate and vitamin D.

Then get TSH, FT4 and FT3 tested together

NHS usually won't test FT3 , so will need to do privately

For full Thyroid evaluation TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies. Plus vitamin D, folate, ferritin and B12.

Essential to test thyroid antibodies plus vitamins

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. (Patient to patient tip, GP will be unaware)

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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 articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

also request list of recommended thyroid specialists, some are T3 friendly

Professor Toft recent article saying, T3 may be necessary for many. Note especially his comments on current inadequate treatment following RAI or thyroidectomy.


thank you


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