Advice needed: I have Low TSH but normal T4. I... - Thyroid UK

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Advice needed

ExhaustedJane profile image

I have Low TSH but normal T4. I have a low platelet count and also B12 (injections monthly) and Vitimim D deficiency.

Had anyone heard of any links to the issues above. I’m exhausted and struggling to get through my day. It’s affecting my job and I have no social life. I have looked into the Hyperthyroidism but I am putting weight on not loosing it.

Anyone experienced or know of similar.

I have read up on pituitary tumours.

Hope to hear from you soon.


25 Replies

What do you call a 'normal' FT4? The word is pretty meaningless. Always better to give us the exact numbers - results and ranges. :)

My TSH levels are 0.23 which is very low but everything else is mid range

I do have thyroid nodules though

Most people do have thyroid nodules - even people with no thyroid problems.

0.23 is not very low for a TSH, but it's pretty meaningless on its own. Mid-range isn't always high enough for hypos. Perhaps you need an increase in dose.

Hi grey goose

Increase what dose?

Thank you

Sorry, this is an old post, and I didn't reread it. I just assumed that you were on thyroid hormone replacement, because that's what it sounds like, with a low TSH and mid-range Frees.

OK, so to be honest, you don't give us much to go on. As has been said several times in this thread, we need numbers: results and ranges. Just saying high and low - or even mid-range - doesn't tell us much. You need to be more precise and have the results for all the relevant tests. As I said, a TSH on its own doesn't tell us much. We need:




TPO antibodies

Tg antibodies

Unlikely you have Graves, if your FT4/T3 are mid-range, even though your TSH is low. Far more likely that you have Hashi's. But, you need the antibodies tested to know about that.

A pituitary or hypothalamus problem is a possibility, of course, but you would need further testing. Testing which can only be done by an endo, not a GP. Have you seen an endo to investigate that possibility?

Thank you

I’ve now been refered to endo

Good. Well, make sure he does all the tests mentioned above. No matter what he might tell you (out of laziness, perhaps) he cannot possibly know what's going on without all those results. :)

Thanks Greygoose

You're welcome. :)

Hi Jane, do you have the exact results for TSH and FT4? Low and normal are not good enough because ranges can have very wide margins. TSH ranges can vary widely and anything under 2.0 is preferable but unfortunately what is called "normal or even low" is anything under 4.0. To determine if it's a pituitary problem you need to see high FT3 which shows the active thyroid hormone.

You may need to take 8000 i.u. to raise vitamin d levels.

Thank you for your reply.

My TSH is 0.31

What is the range? That sounds "normal".

My TSH is 0.23 which is very low

Alll other results apart from vitamin D which is 30 without the mouth spray

I do have thyroid modules though

Hi Jane, are you improving at all? The nodules are suspicious but being anemic makes for terrible exhaustion, do you feel breathless or any other symptoms which might add to the puzzle. These are the blood tests which might be looked at and the levels you need. Have you had ALL the iron tests. You need to scroll down a ways to find all four of them.


All my other bloods come back normal and mid range

Only my TSH on the low side

Thank you

But, Jane, low tsh is good...usually. It means that your pituitary gland has decided your thyroid gland is producing plenty of hormone. Of course if there is something wrong with your pituitary gland and it is not sensing that you need more thyroid hormone then that is a problem.

This is why we need to see your FT4 and FT3 results exactly.

I’m going to ask for those tests


I agree with the other replies, you need exact figures. There are people on here who are a whizz with the figures and can interpret them in an easy to understand way.

The problem I've found is overlapping symptoms. Like you, I had B12 deficiency, symptoms improved with injections but start to return after about 8 weeks ( I s.i.) I've also been diagnosed with fibromyalgia but find the fatigue worse than the pain. I have a goitre that gets bigger and smaller depending on the fatigue and pain levels, though drs say all the figures are within range. So I never really know if it's one thing or the other that makes me feel so awful.

I'd suggest you put your blood results here so the experts can advise you, and look at all your vitamin levels to make sure they're as good as you can get them. And if you're having B12 injections, you know you need good folate levels as they work together ?

ExhaustedJane profile image
ExhaustedJane in reply to

Thank you for your reply

My folate is normal

My TSH is 0.31

Marz profile image
Marz in reply to ExhaustedJane

You also need the FT4 & FT3 tested along with thyroid anti- bodies TPO & Tg. How are your Folate levels ? - Folate/Folic Acid works with B12 in an important way ... Low Ferritin can cause fatigue. Has VitD been tested ?

Other than Vitamins D (which is really a hormone) and B12 are you taking any other supplements? Vitamin D is a bit useless a supplement on its own and requires cofactors to convert it into a usable hormone. It will rob the body of Magnesium if you're not supplementing and will increase Calcium levels that can create an electrolyte imbalance, so the Calcium is quickly deposited out of the bloodstream, but it may not make it to the bones where needed. Vitamin K2 is needed for this to work. Boron, Selenium, Iron and Zinc are also important - so it's worth having good stomach acid levels for these Minerals to get absorbed from food. If you have low T3 you are likely to have low stomach acid which would explain your low B12.

It sounds like you may need injections more often. B12 deficiency that is undertreated can have just as many symptoms. If your body is having trouble storing the B12, your body won’t be healing. Many people improve better on weekly or even daily injections- they just have to self inject.

Also, for the B12 to work properly, you need to make sure that your cofactors are plentiful. Iron/ferritin, folate, and potassium. B12 uses all of those to make new blood cells. Eat a lot more potassium - take iron supplements or get an iron infusion if your ferritin (stored iron) is low- and take folic acid or folate with each shot, 5mg at least.

This groups is extremely helpful if you want to pursue this route. 🙂

low tsh linked to high Adrenals and low D. Saw it last night on U tube with Dr. John Bergman . com. Sorry don't have the address.

Adrenals play a very big roll with our thyroid meds . Adrenals and thyroids work in unison .Testing Adrenals/Cortisol/DHEA-S . Adrenals/Cortisol is via 24 hour saliva collection . DHEA-S is via BW . Pain and achiness ,fatigue, allergies, skin breakouts ,moodiness , water retention, weight ,palpitations , blood pressure high/low may be related to adrenal insufficiencies .

I second jgelliss reply - as low DHEA mirrors hypothyroid symptoms... so worth getting this checked. Interestingly, the things that help raise DHEA also help convert T4 to the usable T3 hormone, so the connection is very strong indeed!

Given your low b12, you can make a start by taking betaine hcl with meals to get more minerals and vitamins from your food.. as I said earlier I suspect you have low stomach acid, but here are the symptoms to be sure...

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