hello! I had a few blood tests at rheumatology recently, including a couple of thyroid tests for my gp. my tsh came back improved at 8.25 (obviously a ways still to go, but it was 22.5 at the beginning of the year), and my free t4 came back at 15. a combination of high tsh and a within range ft4 is not one I've run into before (I've been diagnosed actively hypothyroid since about 1996).
does anyone have a knowledge of this combination of levels? I know things aren't settled in general. currently battling with weight, tiredness, alopecia, no eyebrows, chest pains, and aching joints etc. fully symptomatic.
any help or suggestions greatly appreciated!
Written by
hazmatrec
To view profiles and participate in discussions please or .
Possibly it means that your FT3 is low, and that you're not converting very well. I know the NHS disagrees, but you should actually have all three tested every time, to know your exact thyroid status.
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH under one) and FT4 is in top third of range and FT3 at least half way in range
Most patients eventually need somewhere between 100mcg and 200mcg
TSH of 8.25 shows you are under medicated and need 25mcg dose increase in Levothyroxine
Bloods should be retested 6-8 weeks after each dose increase
Very important to test vitamin D, folate, ferritin and B12 too
These are frequently too low, especially if under treated for hypothyroidism , and may need virtually continuously supplementing to maintain optimal levels
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised or under treated
Recommended on here that all thyroid blood 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, best not mentioned to GP or phlebotomist)
Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).
Is this how you do your tests?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all 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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
Medichecks currently have an offer on until end of May - 20% off
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all hypothyroidism in Uk is due to Hashimoto's.
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .
hello! i appreciate this information from you, you've sent that before to me. i used to be on a hundred per day, then, seventy five because 'numbers were alright' and i was getting jittery. however, i went up to almost forty on my tsh last year, and we've now got the dang levo up to 275 per day, but still only the results as above. completely jittery now. and feeling differently bad to boot. that is how i do the tests. knowing it's hashimotos doesn't seem to be of much help, would that actually change the treatment? still no private testing as a possibility. i'm anemic and low in b12, but don't want to supplement that at the moment, as i've nearly gotten the gp to agree to test. vitamin d has been low since 2006, if not longer, and i'm taking 800 a day per prescription. both the blood sucker and the gp were interested in me telling them i fast and want the blood test early. it wa in the context of when i had the adrenals tested, that different times of day affect the results as does whether my body is trying to digest food or no. and that since they were testing my stores of things, there's no point in taking that morning's meds before the test.
i was mostly checking what it meant that the levels were giving confusing information about what's going on, and i had forgotten about the conversion ability issue. i'm going to follow up on what greygoose said, above. thank you!
I would say you need to systematically work through all the obvious things that are making you ill. If I were you I'd choose one at a time and spend a few weeks or months learning about it, finding the recommended treatment, and starting to take it. It sounds like you've got a lot going on, and it can be overwhelming.
One you mention for example is Vitamin D, you mention you've been deficient for over ten years, which is a long time! Taking 800iu from the doctor will make no dent in this. You probably need to be on 5 or 6,000 for a few months, and then once your levels are good something like 2000 as a maintainence dose. The Vitamin D Council and SeasideSusie and others on this forum give good advice. This will be causing you symptoms, and impairing your use of thyroid hormones, as will all the vitamins that are mentioned here a lot. Improving your levels will give you an improvement in how you feel, hopefully quite soon.
TSHs of 22 and 8.5 are outrageously high for someone taking thyroid hormone, and as soon as they were detected you should have had a raise of 25mcg, and the expectation of a few more raises after that. Retest every 6 weeks and a dose adjustment is best practice, on the NHS you will often wait a bit longer.
The freeT4 of 15 doesn't tell us much without the range. The ranges I get are 12-22, if yours are at all similar, 15 is a rock bottom result, 30% up the range. Usually we need to be at the top of the range, 75% and higher to feel well, so it isn't surprising you've got a high TSH. 22 may be a little surprisingly high with that TSH, but everyone is different. Some people have very responsive TSH, and also sometimes when we've been ill a long time the body can really panic and start pumping out TSH. It's also the case that conversion can get worse and worse over time.
A friend of mine has a pattern we see now and then on the forum, which is freeT4 at the top of the range with high TSH - this is caused by having poor conversion to T3, so the body doesn't have enough T3 to manage, and pumps out a high TSH. So there is nothing at all surprising about your own pattern. You may have been told by doctors that having a freeT4 anywhere in the range is fine, but this isn't true, where you are in the range is also very important.
Is there a particular reason you are desperately under medicated? I couldnt fully tell from your other responses, but is it because you get bad symptoms when you try to increase? It's very important to increase your thyroid hormone to reasonable levels, and you won't get better until you're able to do that. You'll keep developing other symptoms and illnesses, and your vitamins will be getting trashed.
If there's some reason you can't get your dose increased to what you need then that's the big puzzle you need to solve. I'd suggest making a brand new post so more people see it, explaining that you've been ill a long time and haven't been able to get your dose high enough to make you feel better. There are a few things you can try, depending on exactly what's going on.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Normal TSH, but High FT4?
Slightly high TSH
Falling normal range tsh ft4 
Elevated TSH, FT4 high, FT3 "out of range" any ideas????
High TSH and FT4
