Graves Disease Low TSH borderline T4: Can anyone... - Thyroid UK

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Graves Disease Low TSH borderline T4

Can anyone explain how my TSH of below 0.02 and T4 of 22.4 relate to each other? TSH is extremely low but T4 just above normal range so is this a mild or a severe relapse of my Graves Disease? (am back on Carbimazole). Appreciate any thoughts...

9 Replies

FT4 is only just above range

Have you had TSI or TRab antibodies tested to confirm this is definitely Graves?

Well really you need FT3, vitamin D, folate, ferritin and B12 tested as well

Are you on strictly gluten free diet? Many with Graves or Hashimoto's find it helps

Ideally ask GP for coeliac blood test first


Hi thanks for answering my query I’ve bought a blood test for all those , still in the post and am trying to eliminate gluten. I had an uptake test which apparently confirmed GD but can’t find any evidence of TRAB test from 5 years ago when first got diagnosis which a new Endo has just given me a form for. In the meantime they are recommending RAI!


Without a TRab test, you cannot be sure it is Graves.


That's a huge decision only to be taken once you have all the facts


Yes I’m terrified of RAI from what I’ve read I had a severe thyrotoxosis following the most severe tonsillitis I’ve ever had with a T4 of 53, and my first relapse was also post viral second one not so clear but Endos seems to think first T4 level shows it’s GD


Presumably you had antibiotics for tonsillitis?

This may have upset gut biome

Gut issues and thyroid disease go together


Do you know what reference range was used ? Depending on the range, 22.4 could be high, but nevertheless within range, just above range, or quite a bit above range !

TSH will normally be suppressed if FT3 and FT4 are high, because the pituitary dooesn;t need to signal the thyroid to produce more hormone. If FT3 and FT4 come down, TSH will normally come up (it can stay suppressed for a long time if you have Graves').

People here who have hust been diagnosed with Graves' often report thyroid levels arund double the reference range or even higher - if this is a relapse of Graves' , a 'severe' relapse might see FT3 or FT4 elevated to double the reference range - so you need to have FT3 tested.


So long as there is no reason why you cant take antihyroids (eh=g Carbimazole), you could say you'd like to try this approach first.


Thanks will check unfortunately my Gp doesn’t test for T3 or T4 and Just goes on TSH to prescribe carb so I never know what’s happening, by the time I get to the Endo (5 months later) all back to normal again so don’t have a clear picture of my history, frustrating!


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