Tsh results

[Darcybelle1]

These are my recent blood results doctor said thete normal

[shaws Administrator]

Darcybell1, I cannot read the results and have tried to enlarge page but still cannot read them.

I think you will have to type in results and ranges for comments to be made.

[Darcybelle1]

Serum tsh level 4.3mu/l(0.35-4.7)

Serum free t4 level 12 pmol/L(7.8-21.0)

Serum free triiodothyronine level 4.0 pmol/L (3.8 -6.0)

Hope this is clear i dont understand it at all

[Clutter in reply to Darcybelle1]

Darcybelle1,

TSH is 'normal' because 4.3 is within range 0.35 - 4.7. 4.3 is very close to the top of range and indicates your thyroid is struggling. When you have a follow up thyroid test arrange it early in the morning when TSH is highest and fast (water only) as TSH drops after eating and drinking.

Free T4 and Free T3 are also within range (normal) but FT3 is very low in range.

[Hidden in reply to Clutter]

This is what happened to me. My tsh was creeping up and I had to push to get my dose changed. I still don't feel well but have to wait until it's time for PCP to check levels again. I think it's time to switch thyroid care from PCP/GP to an endocrinologist. BTW I am on levothyroxine and I understand tsh should be low on this med. I feel my thyroid is really out of whack, Need to straighten it out. It's time; have been busy with a-fib stuff but that is now pretty well- managed. My big problem now is rls pain and I think among other things my thyroid plays a larger part in this than my PCP believes. Have appt in April with new, recommended neurologist who specializes in rls(dx in May 2017). Sometimes I get frustrated with so many doctors dealing with their own little piece of the body. I'm a retired nurse and try to find out as much info as possible and be involved in my care. But sometimes it all gets very frustrating and tiring-esp when drs become recalcitrant and have the attitude"my mind is made up don't confuse me with facts!" I call these 'medical skirmishes.' I'm 74 and am tired of having to go to bat so fiercely at times to get the care I need. Thanks for listening. irina1975

[Clutter in reply to Hidden]

Irina1975,

It's about time patients were treated holistically not as a bunch of diseased body parts. As you have atrial fibrillation it will probably mean that your doctors will be unwilling for TSH to be too low.

[SlowDragon Administrator]

You are on Levothyroxine I believe?

In which case these results are not Normal

On Levothyroxine TSH needs to be LOW in range

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

[e-mail]

Also request list of recommended thyroid specialists

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

Ask GP for 25mcg dose increase in Levothyroxine and also to test vitamin D, folate, ferritin and B12

These are often very low and need supplementing if been under medicated

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

rcpe.ac.uk/sites/default/fi...

[SlowDragon Administrator]

Also even though you had RAI changing to strictly gluten free diet may help too

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

You might want to retest thyroid antibodies. GP may not agree

Can get tested privately along with vitamins if GP won't test those

[Darcybelle1]

Thanks for replying i have just been to see my gp she agreed a 25 mcg increase and retest in 6 weeks if im still tired she will refer me to a endo can i ask what a ft3 is

[SlowDragon Administrator in reply to Darcybelle1]

FT3 is the test called free triiodothyronine

Detailed explanations here

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

Your FT4 test should be high in range if on correct level of Levothyroxine

Yours is 12 (range 7-21)

Increase in dose in 25mcg steps, retesting after 6-8 weeks.

Ideally FT4 should be 18-20, but some patients might need it even higher (see Prof Toft article in my first reply)

The most important test is the FT3 test.

Your FT3 is too low at 4.0 (range is 3.8-6 )

Looking for FT3 to be at least above 5, may be higher

T3 is the active hormone, the only one we can use. T4 (Levothyroxine) is inactive and must be converted, mainly in the liver, but 20% in the gut, into T3

If the gut is affected, or we have low vitamin levels conversion is affected. There are other things that can affect conversion too (it's very complex) or how we use it

Once we are on any thyroid replacement medication, just testing TSH and FT4 tells very little

Essential to test FT3 as well.

Plus vitamin D, folate, ferritin and B12

Ask GP to test these when Thyroid is retested

Or sooner if you feel she's open to more testing

Brilliant film explaining a little more

drbradshook.com/understandi...

[SlowDragon Administrator]

Also - just to say you got very different reply from Clutter because you did not say you had had RAI and on Levothyroxine

That's why it's Essential to either give some background info or write a profile

Link showing that important to test vitamin D, folate, ferritin and B12

See Box 1. Towards end of article

Some possible causes of persistent symptoms in euthyroid patients on L-T4

You will see low vitamin D, folate, ferritin and B12 listed

onlinelibrary.wiley.com/doi...

[Darcybelle1]

Tbh i have had this affliction for over 20 years sadly i know very little i have always left it to my doctor which i now regret so ill be doing my homework thanks for all you're replies