Can thyroid be low even if TSH is normal?

[lotus1970]

Hi my husband (49) has been experiencing extreme fatigue for a few weeks, (plus weight gain and low mood). He has hypothyroidism in his family and had his thyroid checked with GP and it came back apparently normal

serum TSH level 0.56 (normal range apparently 0.27-4.2)

serum free T4 level 13.3 (normal range 11.00-21.2)

should we get further tests done?

very grateful for any thoughts

[jimh111]

His TSH is low for his low normal free T4. You need to measure free T3 as well to see what is happening. If fT3 is high normal then the TSH is OK but if free T3 is also low normal it would explain his symptoms. Unfortunately, doctors tend to say low normal fT3 and fT4 is normal but it is not, normally TSH rises considerably as fT4 starts to fall and this keeps fT3 around midway.

[lotus1970 in reply to jimh111]

thank you so much - I'll get him to have his T3 checked.

[SlowDragon Administrator]

Ft4 is low

High Cholesterol is linked to being hypothyroid

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

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

Ask GP to test vitamin D, B12 and folate levels plus thyroid antibodies

Ferritin is good level

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)

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 antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

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 down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

List of hypothyroid symptoms

thyroiduk.org/if-you-are-un...

[lotus1970 in reply to SlowDragon]

great, thanks for all the helpful info