High TSH but ‘normal’ T4 and T3: Hey everyone, I... - Thyroid UK

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High TSH but ‘normal’ T4 and T3

Geraldine74 profile image

Hey everyone, I so hope someone can help me. I’ve thought for years I have an issue but doctors’ test (admittedly years ago) didn’t show anything. I’ve just done a LetsGetChecked test and shows high TSH but T4 and T3 as ‘normal’ (but not sure if optimal?) I realise I should go to a private consultation if I can and have the list of doctors from Thyroid Uk which is brilliant. My results are below. Any thoughts from this community? Please any advice would really help. I did test in the morning while fasted. My worse symptoms are joint pain, fatigue , sluggishness and slow weight loss...🥺😞

11 Replies
SeasideSusie profile image


I’ve just done a LetsGetChecked test and shows high TSH but T4 and T3 as ‘normal’ (but not sure if optimal?)

What are these "normal" FT4 and FT3 results (with reference ranges)?

Did you do vitamin tests as well? Joint pain is a common symptom of low Vit D. Fatigue can be hypothyroidism and low ferritin.

FT4 - 13.6 in range of 12 to 22 and FT3 - 4.5 in range of 3.1 to 6.8

Interesting about vit D and iron. I live by sea so always in the sun and do a green smoothie most days but guess could still be low??

Any thoughts on other results?

Thanks for the reply x

So your free T4 is very low - only 16% through range. Free T3 slightly better at 37.8% - but I need both to be much higher to feel tip-top and most hypos need them in the top third of the range ....

However you're unlikely to get treated until your TSH is waaay out of range - possibly as high as 10, or your free T4 drops below the bottom of the range.

It must be money (£££). If GPs had to prescribe thousands of prescriptions every week or month for T3 and T4 to bring optimal health/values, it would cost the NHS millions of pounds. I think that might be what it is all about.

I don't disagree - but at the same time, by making people so ill they can't work, just think of the income tax (and VAT etc) they're not getting ...

SeasideSusie profile image
SeasideSusieAdministrator in reply to Geraldine74


For a diagnosis of Primary Hypothyroidism you will need TSH to reach 10.

If FT4 goes below range with an over range TSH you may get a diagnosis then.

Very occasionally, although rare, you may get an enlightened doctor who will diagnose and prescribe Levo with your results if you present a large list of symptoms, but not many will because the guidelines say TSH must be 10.

If TSH is over range, but below 10, with raised thyroid antibodies, again an enlightened doctor should diagnose.

List of symptoms with a link at the bottom to print them off:


Not everyone makes Vit D well from the sun.

Assuming you are in UK;


All the rest of the latest guidelines about treating subclinical hypo, and every thing else are in here too.

PAGE 13.


1.5.4 Consider a 6-month trial of levothyroxine for adults under 65 with subclinical

hypothyroidism who have:

• a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions

3 months apart, and

• symptoms of hypothyroidism.

If symptoms do not improve after starting levothyroxine, re-measure TSH and if the

level remains raised, adjust the dose. If symptoms persist when serum TSH is within

the reference range, consider stopping levothyroxine and follow the recommendations

on monitoring untreated subclinical hypothyroidism and monitoring after stopping


Wetsuiter profile image
Wetsuiter in reply to tattybogle

i agree

SlowDragon profile image

Suggest you get further testing

TSH is far too high and Ft4 and Ft3 both low

Technically this called sub clinical hypothyroidism as Ft4 and Ft3 are within range )

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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

About 90% of primary hypothyroidism is due to autoimmune thyroid disease

Ask GP to test thyroid antibodies and all four vitamin levels

See flow chart at top of page two

(Suggest you print out and take along to consultation...Only give to GP if they won’t agree to test thyroid antibodies)


Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you did this test?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options


Medichecks Thyroid plus ultra vitamin


Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins


Blue Horizon Thyroid Premium Gold includes vitamins


Joint pain is common with low vitamin D

Come back with new post once you get results

Oh my gosh you guys are brilliant. Thanks for that info and thoughts. So should I ask for next steps to be antibody test? Will the GP do this do you think or will I have to use a private one and if so can anyone suggest where?

Also I’ve heard about reverse T3 mattering?

My GP tested TPOab (thyroid peroxidase) antibodies after i'd had 2 over-range TSH tests with in range T4's.

They were 2499[0-50], so he said "oh....." and gave me Levo.

I'd been in every few weeks for about 6months before that, and been offered antidepressants which i declined. But actually according to the Nice guidelines you don't have to have antibodies either, but im sure it helped.

The reverse T3 thing wont get you anywhere with a GP, in fact if you mention it they may assume you have been reading rubbish on the internet.

Also from what i have read from respected ones on here ,it doesn't tell you anything you cant work out from looking at FT4/FT3/TSH, it doesn't tell you why they are there, or what to do about them, and it cost's load's of money.

So i'd just try and get 2 over-range TSH's within 3 months and go from there.

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