Does this TSH and T4 result have only one outcome? - Thyroid UK

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Does this TSH and T4 result have only one outcome?


I'd felt for years I had low thyroid issue. At last the result came back that agreed I had hypothyroidism : TSH 5.14 T4 11.8 (12-22). They phoned to tell me, and that they were sending me the pills the doctor prescribed, Teva 25g levathyroxine, and to come back in 6 weeks for a blood test. Can it do any harm to do this without further testing? Does this result rule out things like Hashimoto's, or other possible issues? Many thanks.

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You need to follow the normal protocol after starting Levo, that is retesting every 6 weeks with increases of 25mcg if necessary. The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well.

Why would you not want to do further testing? It will determine your optimal dose where you should feel well.

When having thyroid tests, always book the first appointment of the morning, fast overnight (just delay breakfast and drink water only until after the blood draw) and leave off Levo for 24 hours before the blood draw. This ensures the highest possible TSH which is needed when looking for an increase in dose or to avoid a reduction.

To know if you have Hashimoto's you need thyroid antibodies testing, thyroid peroxidase (TPO) and Thyroglobulin (TG).

Some people have adverse reactions to Teva levothyroxine, if you don't get on with it ask for a different brand.

It would be a good idea to test Vit D, B12, Folate and Ferritin as nutrient levels need to be optimal for thyroid hormone to work properly.

The doctor hasn't suggested further tests, just sent this prescription - which is why I wondered if she could just tell from the TSH/T4 result that it would clear up with the right level of levothyroxine. But I see from a comment below that the NHS won't do these other tests. Would it be a good idea to have these done privately before starting on the pills, in case another 'solution' would be better? Many thanks.

SeasideSusieAdministrator in reply to dinahnow


The NHS does test TPO if they feel the need, FT3 is determined by the lab and it's usually only when TSH is suppressed. TG antibodies can be done if an endo requests them.

Your results confirm hypothyroidism - over range TSH and below range FT4. It doesn't "clear up". Your thyroid isn't working properly, it isn't producing enough thyroid hormone, that hormone needs replacing (with Levo). There is no other solution. If you have Hashi's you can address that by helping to reduce the antibodies, but you'll still be hypothyroid because Hashi's eventually destroys the thyroid. If your vitamins and minerals are low or deficient they can be supplemented, but low levels cause symptoms, they don't make your FT4 go below range, too little thyroid hormone does that.

Once prescribed Levo your GP should follow NICE Clinical Knowledge Summary

Initiation and titration

•The dose of levothyroxine (LT4) should be individualized on the basis of clinical and biochemical (thyroid function tests) response. Treatment must be monitored regularly to determine an adequate dose and to avoid both under-treatment and over-treatment.

• The initial recommended dose is:

◦For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

◾This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

◦For people aged over 50 years and people with cardiac disease or severe hypothyroidism: 25 micrograms once daily, adjusted in increments of 25 micrograms every 4 weeks according to response.

•Once a stable thyroid-stimulating hormone (TSH) level is achieved and an adequate dose determined, arrange follow up to check thyroid function tests (TFTs) at 4–6 months and then annually.

If you want thyroid antibodies, FT3 and vitamins/minerals tested (advised) then do a private test and you'll get a complete picture and know exactly what you're dealing with.

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Thank you - I am newly diagnosed and this is very helpful.


Many, many patients react badly to Teva. Suggest you ask pharmacist for a different brand to start with, unless you have lactose intolerance

If you want to test antibodies and vitamins ask GP to do so, or get tested privately

For full Thyroid evaluation you need TSH, FT4, 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

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. When on Levothyroxine, take last dose 24 hours prior to test, and take next dose straight after test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

Thank you - v helpful to me too!


Usually, 50mcg is a starting dose with a 25mcg increase every six weeks until your TSH is 1 or lower. The test doesn't rule out hashimoto's and a Full Thyroid Blood Test should be:-

TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.

Thyroid hormones run our whole metabolism from head to toe and heart and brain have the most T3 receptor cells. T3 being the only active thyroid hormone and levothyroxine (also known as T4) is an inactive hormone and has to convert to T3.


The usual starting dose is 50mcg with 25mcg increases every six weeks, unless you are frail with a heart disease.

A Full Thyroid Function Test (rarely taken) is:

TSH, T4, T3, Free T4, Free T3 and thyroid antibodies. Antibodies are important as it distinguishes between hypothyroidism or hashimoto's. Hashi's being an Autoimmune Thyroid Disease.

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