Hi. Feeling totally confused by all I have read so hoping for some help please
I have not felt ‘well’ since Jan 2020 and had borderline TSH results of 4.15 and then 4.17 that year, I have since gained 2 stones in weight, feel tired all the time, dry/itchy skin and cracked heels. I took a private blood test and my TSH is now 5.06, free T3 5.09 and free thyrox 13.3 plus high prolactin. GP has said to try me on meds as I am getting worse. She also want to do extra blood tests, what should I make sure she checks please?
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BethH77
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Please can you tell us the ranges for your results. Ranges vary between labs & to interpret your results accurately we need to know what’s the range for your tests.
What meds & dose have you been started on? How long have you been taking them?
For full thyroid function you need TSH, FT4, FT3. Antibodies TG & TPO.
Nutrients need to be optimal for replace hormone to work well. Testing Vitamin D. B12. Ferritin & folate important.
Different brands levothyroxine are often not interchangeable. Unless lactose intolerant, best to avoid Teva brand levothyroxine as it’s the least tolerated
Your ft3 the active hormone is a good level, but your ft4 is extremely low.
50mgc per day standard starter dose (unless young, elderly or have heart issues). You’ll need retesting in 6 weeks and dose increases until TSH below 2 & ft4 & ft3 in upper part or range.
Dear Beth you are not alone I had all those symptoms for years until I could no longer live like it so after asking the doctor for a full blood test not knowing what was wrong not only did I have UAT I also had very low iron levels.Little did I know I would have to take a little white tablet for the rest of my life .Been on Levo 25mg for a month now and it’s too early to tell if it’s working yet but my symptoms are maybe slightly alleviated although I have goodish days I still have really bad ones as well .Trying to get my head round the plethora of symptoms is there any wonder it’s so hard to detect but we are on the right road now hopefully and have this wonderful group for support
Sorry you have felt this way for so long too, I hope you can find the right dose. I have a friend and her iron was very low too along with UAT, I will ask them to check mine. Thanks for replying x 😊
Hi. I have more results now after 7 weeks on 25mcg and feel more tired than ever! I am worried about the inflammation marker too ......CRP inflammation 7.1 (range 0 to 5)
Contact GP for next 25mcg dose increase in levothyroxine up to 50mcg per day
Bloods should be retested 6-8 weeks time
Standard starter dose of levothyroxine is 50mcg, being on only 25mcg frequently causes worse symptoms
Likely to need several further increases in levothyroxine over coming months
Which brand of levothyroxine are you currently taking
Approx how much do you weigh in kilo
guidelines on dose levothyroxine by weight
Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
Thank you, these were private bloods I did in advance of my GP tests this week (TSH and FT4 only)...... both antibodies were tested and are super low. I am worried she will just say TSH is 4.2 so all is good......as in range.....I had to twist her arm to start my on 25. .. will show her this anyway, thank you.
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states 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)."
(That’s Ft3 at 58% minimum through range)
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor please email Dionne at
I did a finger prick sample and folate came back invalid sadly.I am only taking Vit D currently and GP says B12 is 'in range' so no further tests needed! Medichecks have suggested a further test so might do that myself? I have been referred for scan as have lump and always have sore throat/hoarse voice which worries me with the inflammation marker too now.
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