TSH level? : Hi all, Haven't posted for a while... - Thyroid UK

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TSH level?

Kevz3016 profile image

Hi all,

Haven't posted for a while now, I have my annual thyroid review this week and need some help.

I am underactive/hashimoto, and still have symptoms, my last test results in October 2018 were as follows:

T4 20.1 (12.0-22.0)

TSH 3.32 (0.27-4.2)

My questions is do you think I need a slight increase in levo.

Also does anyone have the link/email from the top thyroid consultant

stating about getting your TSH below 1 for best results, I can't find it.

Cheers all.

13 Replies
SeasideSusie profile image


T4 20.1 (12.0-22.0)

TSH 3.32 (0.27-4.2)

It's a bit difficult because your TSH is too high, it should be 1 or below (for most hypo patients) but your FT4 is close to the top of the range and an increase in Levo will take it over the top. What you really need is FT3 testing at the same time as FT4, that would tell you how well you convert T4 to T3. If your conversion is poor then T3 added to your Levo would raise your FT3, very likely lower your FT4 (it tends to do that) and will very likely lower your TSH as well.

The article you are referring to is by Dr Anthony Toft, leading endocrinologist and past president of the British Thyroid Association, who said 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)."

He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at


print it and highlight question 6 to show your doctor.

He has recently written a new article which says that T3 may be helpful for many patients


Thank you for confirming that, it's exactly what I was thinking just need to Convince the doc to test T3 hahaha.

Well doctors refused T3 test again and I had to fight to get an in crease of levo from 100 to 112.5 they also will not do vit D. I wish doctors were better educated in this field.

SeasideSusie profile image
SeasideSusieAdministrator in reply to Kevz3016

No real surprise, I'm afraid. This is why hundreds of us here do private testing.

SlowDragon profile image

As you have Hashimotos low vitamins are extremely common

What supplements do you currently take?

When did you last test vitamin D, folate, B12 and ferritin?

Are you on strictly gluten free diet?

You definitely need FT3, FT4 and TSH tested together

Recommended that all thyroid tests should be done as early as possible in morning and fasting and no levothyroxine in the 24 hours prior to test

If GP won’t test vitamins or FT3 then you need to test privately via Medichecks or Blue Horizon

Likely to need addition of small dose of T3. But important to test everything FIRST

Email Dionne at Thyroid Uk for list of recommended thyroid specialists, some can and do prescribe T3. You may need to go privately initially but can then push for NHS care and prescription

Roughly where in the UK are you?

Kevz3016 profile image
Kevz3016 in reply to SlowDragon

Hi, I've been gluten free for a year now, and take selenium 200ug, B12 super B-complex igennus.

I had levels tested a while back all good at high levels, doctor refuses to test vit-D but I also take cod liver oil with it in and I exercise 4 times a week. I'm based in Northampton, can't afford private test at the moment as not working because of feeling unwell. Cheers

SlowDragon profile image
SlowDragonAdministrator in reply to Kevz3016

GP should test vitamin D, patients with Hashimoto's are known to be vitamin D deficient



If they won't test, could you afford NHS postal kit £29


Local CCG guidelines


Government recommends everyone supplement October to April


SlowDragon profile image

Guidelines on prescribing T3

On levothyroxine TSH should be between 0.4-1.5 to be adequately treated

See page 12

Page 13 box one - column 4 - vitamins that need testing

Print off pages 12&13 and give to GP highlighting relevant bits


Kevz3016 profile image
Kevz3016 in reply to SlowDragon

Thank you for this, I need to find out what's going on, this all started when I quit smoking 2 years ago now.

MaisieGray profile image
MaisieGray in reply to Kevz3016

That is not unknown, as smoking can mask the disease.

SlowDragon profile image

Common for Hashimoto's to be revealed/get worse after quitting smoking



SlowDragon profile image

Insist on being referred to NHS endocrinologist

Both Oxford and Cambridge centres of excellence endocrine departments are not too far away from Northampton

Kevz3016 profile image
Kevz3016 in reply to SlowDragon

I will do, oh and thanks for the links above great read and makes a lot of, sense. 👍

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