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Thyroid UK
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Query symptomatic thyroid issue

Hi guys,

Thyroid issues were picked up by my GP following me going to them with some symptoms and a blood test being taken.

My blood results apparently did show abnormalities but my GP said it wasn't at treatment level and bloods will be taken again in a year.

The symptoms I presented with at my GP remain, but I feel unable to challenge this incase it really isn't to do with my thyroid levels.

Does anyone have any idea in regards to what thyroid levels have to hit to be symptomatic?


Serum TSH Level 5.3 mu/L.

Serum free T4 Level 13.3 pmol/L.

Thyroid Peroxidase ABS 19.

Thanks in advance!

13 Replies


Have you got the reference ranfes for those results please.

I expect your TSH is over range but most doctors wait until lit reaches 10 before diagnosing and prescribing Levo. Very cruel to make symptomatic patients wait as it could take years. In other countries diagnosis is made when TSH reaches 3.


Hi SeasideSusie,

I'll just copy and paste the test result now as I can't work out how to add a screenshot/photo.


Thyroid function test

Serum free T4 level 13.3 pmol/L [12.0 - 22.0]

Suggests borderline hypothyroidism repeat in 12 months and measure TPO antibodies unless already

done so. If patient on T4, results suggest slight

under replacement or poor patient compliance with


Serum TSH level 5.3 mu/L [0.3 - 4.2]

Above high reference limit




So what you're looking at here is classed as Subclinical Hypothyroidism. See


....... snipped to show relevant parts but useful to read the whole articles

Blood tests for thyroid stimulating hormone (TSH) and free thyroxine (FT4):


◾Suspect subclinical hypothyroidism (SCH) if TSH is above the reference range and FT4 is within the reference range. In non-pregnant people repeat TSH and T4 (ideally at the same time of day) 3–6 months after the initial result to exclude transient causes of a raised TSH (such as intercurrent illness) and to confirm the diagnosis of SCH.


BUT also see



If TSH is between 4 and 10 mU/L and FT4 is within the normal range

◾In people aged less than 65 years with symptoms suggestive of hypothyroidism, consider a trial of LT4 and assess response to treatment 3–4 months after TSH stabilises within the reference range — see the section on Prescribing information for further information on initiation and titration of LT4. If there is no improvement in symptoms, stop LT4.


I would be selective in the information you choose to discuss with your GP from those articles, maybe use the information quoted above from the second link.

You could say that you have taken advice from NHS Choices recommended source of information about thyroid disorders (which is the charity ThyroidUK, don't mention internet or forums, that definitely don't like that). Point out that you are symptomatic - print off this list from ThyroidUK and tick whichever applies thyroiduk.org/tuk/about_the...

and say that the NICE Clinical Knowledge Summary suggests that a trial of Levo can be given when TSH is over range but below 10 where symptoms are present.

I would also suggest that as Thyroid Peroxidase antibodies have come back negative, can Thyroglobulin antibodies be tested to rule out autoimmune thyroid disease.

1 like

Thank you, Susie, for the information you have shared with me. It is really appreciated.

I have booked a GP appointment at my surgery for Friday, it's with a locum so hopefully a fresh face will also help.

I feel so much better going armed with some knowledge.



Serum thyroid peroxidase antibody concentration 19 ku/L [0.0 - 34.0]

In subclinical hypothyroidism, if TPO is positive

suggest monitor TFT annually. If TPO is negative

then suggest monitor TFT every three years.

TPO does not usually require repeat measurement.

[UK Guidelines for the use of thyroid function

tests. London: ACB, BTA, 2006].



TPO does not usually require repeat measurement.

That is really only applicable if you have had a positive result, once you have positive antibodies which confirm autoimmune thyroid disease aka Hashimoto's, there's no point in repeating the test. But because antibodies fluctuate, you could have had them tested when they were at a low level, another test might show them at a much higher level and be over range. The only way to rule out Hashi's is to have several negative results over a period of time. Yours at 19 (0-34) wouldn't convince me that you definitely don't have Hashi's.

I've had mine tested several times over the years (privately) and mine have always been between 6 and 10, that's both TPO and TG antibodies, so I'm happy that I don't have Hashi's. But with your result, one negative TPO result doesn't rule it out, and you could have positive TG antibodies.

1 like

Have you had vitamin D, folate, ferritin and B12 tested?

These are often too low. Can cause symptoms in own right or be affected by low thyroid, or cause thyroid issues

Add results and ranges if you have them

Push GP to test or private testing is next option

For full Thyroid evaluation you need TSH, FT4, Plus FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins


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 ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

1 like

hi i am writing from the states. here, the drs say the tsh has to be over 5 to be hypothyroid, but the alternative worls say anything over 3 along with sxs. you have hashimotos based on your tpo levels, and hypothyroidism. i have the same thing and have educated myself alot because i found that even endocrinologists dont understand hashimotos and the impact it has on left altering changes with how i feel now. my advise is to google, google on it and eat organic, gluten free, soy free to start with. it will decrease your attacks and muscle pains. also, taking armour , not levothyroxine will def help. the levothyroxine is a t4 med, but most people with hashi's cant convert t4 into t3. good luck


I'm still "Subclinical" in spite of various clinical symptoms (TSH over 5, T4 within range) and was advised by the folk on this forum to ask the doctor for a clinical trial of Levothyroxine.

Thankfully this was (eventually) granted and I've just had the first increase to 50 mcg.

Sometimes you have to push for things


Just a quick update.

I went to my GP appointment armed with all of the above in mind, ready to fight my case... but it seems I had a very understanding doctor!

With just looking at my previous levels and my symptoms he said he had no problem treating me as subclinical hypothyroidism. I'm having a blood test on Tuesday to check all levels and once they're back I've to see him to be prescribed levo. It's such a relief to be listened to.

1 like

Put up a new post once you get your results on the vitamin levels

You may need to supplement to improve


I had almost the same results a few months before my levels plummeted further and I felt terrible but the doctors said everything was fine. Even though everyone is different I think they should at least test again in a few months not a year!! :(

But as others have said, get your vitamins optimal and present them with the info on subclinical hypothyroidism :)

Hope you get some treatment soon.



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