High T4 normal T3 and TSH - what does it mean? - Thyroid UK

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High T4 normal T3 and TSH - what does it mean?

GreyCatSix profile image

Hi, I’ve had a private blood test done, just got the results today. Extensive googling tells me that if T4 is high, then usually the TSH and / or T3 levels would be off as well but they’re fine. I can call my GP but she’s quite general and I expect she’ll say ‘your TSH levels are fine so there’s no issue’. And maybe she’s right, but I’d like to better understand my results.

Free thyroxine (T4?) 27 pmol/ L (12-22)

TSH 1.69 mIU/L (0.27-4.2)

Free T3 4.58 pmol/L (3.1-6.8)

Symptoms (some come and go)

Rapid heartbeat, thirsty, lack of appetite, hair loss, weak shaky legs.

Symptoms mainly appear just before and during period and I’m 48 so they could be caused by perimenopause but they’re quite extreme.

27 Replies
SlowDragon profile image
SlowDragonAdministrator

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

Ask GP to test vitamin levels and thyroid antibodies

Hairloss often linked to low ferritin

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)

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

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

Hi thanks for the reply. The test I did was Medicheck, the vitamin one, and all my vitamin levels are fine. It didn’t have the extensive thyroid tests you mention though, at least I don’t think so, I’ll look back at my results in case they’re not with the thyroid results on the page.

SlowDragon profile image
SlowDragonAdministrator in reply to GreyCatSix

Please add actual results and ranges on vitamins

Plus the Thyroid antibodies results

TPO and TG antibodies

Perhaps add photo to opening post ....like this

healthunlocked.com/thyroidu...

Thanks. I don’t think there were any TPO and TG antibody tests but will look tomorrow and post everything I have. Thanks again.

I have added those now (in the photo). The dr report with the test suggests testing again in 3 months time (Because of the raised T4) so that’s what I’ll do.

SlowDragon profile image
SlowDragonAdministrator in reply to GreyCatSix

So antibodies appear to be negative

Perhaps ask GP for thyroid ultrasound scan

You can have a “hot” nodule that is making extra Ft4 regardless of instructions from TSH

20% of Hashimoto's patients never have raised antibodies and ultrasound scan of thyroid can be helpful

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

What were ferritin (iron) results?

SlowDragon profile image
SlowDragonAdministrator in reply to GreyCatSix

Link about hot nodules

mythyroid.com/hotnodule.html

Thank you so much for your replies, I really appreciate it. I'll read all the links and talk to my GP.

Ferretin was 38.5 ug/L (13-150)

SlowDragon profile image
SlowDragonAdministrator in reply to GreyCatSix

Which is far too low

Are you vegetarian or vegan?

Never supplement iron without doing full iron panel test for anaemia first

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid problems are as much about optimising vitamins as thyroid hormones

Thank you for all this info, you are a goldmine! I'm mostly vegetarian, I eat a small amount of chicken or bacon very occasionally. I'd just started taking spatone iron but will look into a full iron panel test.

SlowDragon profile image
SlowDragonAdministrator in reply to GreyCatSix

Hundreds if not thousands of posts on here about low iron and ferritin

Many people day freeze dried liver capsules work well. Lots of different iron options

Personally I love liver ...but my ferritin always too high (Common Hashimoto’s problem too) ...so have to avoid eating too often

Hi GreyCatSix, welcome to the forum.

Do you have any sort of a diagnosis? Are you on thyroid hormone replacement? Knowing the answers to those questions will change interpretation of the results.

GreyCatSix profile image
GreyCatSix in reply to greygoose

No kind of diagnosis, no, and not taking anything.

greygoose profile image
greygoose in reply to GreyCatSix

OK, so your doctor would be right. Your TSH and FT3 are fine. It's your FT4 that is a bit odd.

Is this your first thyroid test? Have you had your antibodies tested?

GreyCatSix profile image
GreyCatSix in reply to greygoose

Yes this is my first test, I haven’t had my antibodies tested. Looking on the internet I suspect it’s fine because my TSH and T3 are ok I’m just being thorough using this forum to see if anyone knows whether there are any health implications if my T4 is high but everything else is fine.

greygoose profile image
greygoose in reply to GreyCatSix

Well, yes, I understand that. But, it's not normal, I don't think, to have such a high FT4 with that FT3 and TSH. And, just because they are ok, doesn't automatically mean all is fine. If you were on thyroid hormone replacement, I would say you have a conversion problem. But, I don't know if that's possible when you're not taking anything. I would urge you to get your antibodies tested.

GreyCatSix profile image
GreyCatSix in reply to greygoose

I'll look into a test with antibodies. I obviously chose the wrong test as I thought I *was* getting the full thyroid test! Annoying to have to spend more money but no doubt worth it to get checked out fully.

Marymary7 profile image
Marymary7 in reply to GreyCatSix

Are you sure you don't just need to click on the bottom of that result where it says autoimmunity? Which test did you ask for...

GreyCatSix profile image
GreyCatSix in reply to Marymary7

Thnaks Marymary7, I've now done that and edited the post. I'm not sure if they're the right antibody tests compared to the ones mentioned by SlowDragon above.

Marymary7 profile image
Marymary7 in reply to GreyCatSix

They are the correct antibodies tests. Were you taking any Biotin or B complex before you took your bloods. They need to be left off for one week or they effect the results.

It's helpful to copy out your vitamin test results as often being in the bottom of the range is not good enough particularly with B12 and D3.

GreyCatSix profile image
GreyCatSix in reply to Marymary7

Hi, I'd stopped taking B12 complex for a week before the test so should be accurate.

GreyCatSix profile image
GreyCatSix in reply to greygoose

Ps Hi and thanks for the welcome!

If you click on the “printable page” somewhere near the top right of the report, you will see all of the tests listed in a more readable form, as you haven’t shown your ferritin or CRP

Thanks for suggesting that, I gave it a try and unfortunately got an error message!

🤔

Hi,

I have a high t4 and was taking 125 mcg- they just dropped to 100 mcg, but my TSH WILL GO UP. DID THEY DROP YOUR DOSAGE?

GreyCatSix profile image
GreyCatSix in reply to Caper12

I don't have any dosage I haven't been diagnosed with anything! Because it's only high T4 and all my other tests were normal, my GP just said test again in future.

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