Hi, I've had a diagnosis of mild Hypothyroxaemia as TSH has been normal but FT4 consistently low or low end of normal (usually 11 or 12). I just wondered if anyone knew anything about it at all? The little I can find out relates to the condition in pregnancy (I'm in my 50s and have had a hysterectomy so definitely not relevant!) I started seeing an endocrinologist after symptoms of hypothyroidism and I've had multiple blood tests together with a MRI scan which shows a benign pituitary microadenoma. In November I started a trial of Levothyroxine and now on 75mg/day and mentally feel better than I have done in years ...TSH currently at 1.19 and FT4 at 17.4 (12-22) Still have some physical symptoms of hypothyroidism such as aching joints, feeling cold etc but no more brain fog, anxiety, fatigue or mood swings. I'm not over keen on taking medication for the rest of my life and wondered if anyone knows if it's likely I will need to given that the condition is only mild? Any help gratefully received as I'm a complete novice to this and don't really understand it!
Mild Hypothyroxaemia: Hi, I've had a diagnosis of... - Thyroid UK
Mild Hypothyroxaemia
I am not medically qualified but it may be helpful to request a Free T4 and Free T3 blood test. I doubt GP will do so but you might be able to get a private on.
This is a link that may be helpful:-
frontiersin.org/articles/10...
Thank you Shaws...my last blood tests in December showed Free T4 at 17.4 (12-22) (prior to this it had always been around 11 sometimes 12) and Free T3 at 4.2 (3.1-6.8) so I'm guessing these are now normal levels. I'm just wondering if it's a condition that rectifies itself or whether it's going to be an ongoing issue...struggling to find any info at all! Thanks so much for responding 🙂
When we post results of blood tests we also have to put the ranges. Ranges are in brackets after the results.
The reason the ranges need to be stated is that they enable members to respond as labs may differ in their machines.
If you want to edit something in any your responses, click the down arrow next to More and select edit..
Thanks for the tip, now edited!
Never come across the term Hypothyroxaemia. At first I thought you had mixed up hypothyroid, thyrotoxic & anemia but having googled the term it does refer to low TSH & Frees in pregnancy.
Normally when free thyroxine (FT4) and free triiodothyronine (Ft3) are low the pituitary senses it and the Thyroid Stimulating hormone (TSH) rises. This signals the thyroid to make new hormone. When this mechanism isn’t working and the adenoma could very likely be causing it, it’s referred to as central or secondary hypothyroidism as opposed to the thyroid failing (primary hypothyroidism).
Usually it goes undetected as when TSH is normal it’s assumed so are FT4 & FT3 so they are not tested by lab.
Most feel well when TSH under 1. FT4 are top 3rd of range & FT3 at least half way through range. But you need to replace hormone so both in range & you feel well. If that happens to be lower end range then that’s what suits you.
Don’t think of it as medication, it’s a replacement hormone & you need it to stay well, and it is unlikely to resolve and you will alway have to take some level of levothyroxine.
I recommend you also test TPO & TG antibodies as it’s still possible the thyroid is affected not solely the pituitary.
When thyroid levels are low so are Folate, ferritin, B12 & Vitamin D. Low nutrients can also lower the TSH.
Test 6 weeks after starting & changing a dose. Best to test early morning after fasting only water & delay dose until after draw. For consistent results.
Avoid supplements biotin at least 3 days before as can interfere with testing process. If taking very high dose avoid longer.
Thank you so much, this is really helpful. When I was first tested I had low folate and B12 levels so currently taking multivitamins. I'll make a note of the tests you suggest and see if I can get them included next time.
Are the supplements enough to improve the low levels? Doctors often don’t check again and often refuse vitamin D testing. (There are private options, can be done at home via small finger prick sample via post )
Multivitamins often contain less absorbable cheaper versions and tiny doses (not enough to treat low levels).
Optimal levels is your aim, doctors ignore results if levels fall in range.
When you retested share result & lab reference range there are some extremely knowledgeable members on nutrients.
Ooh blimey I've no idea! I guess I could ask the endocrinologist to request tests...I'm seeing him privately so he's fairly happy for me to have multiple tests for obvious reasons! Okay I certainly will, thank you. I never expected such a helpful and comprehensive set of responses! 🙏
Likely save time (and added cost of endocrinologist arranging test) if you arrange test in advance and take results to appointment.
Medichecks & blue horizons (& others) offer packages including all the items recommended for full thyroid assessment - function - antibodies & main nutrients. Medichecks often do discounts for thyroid on Thursdays so wait & order when available. Links posted below by slow dragon.
Post on here & you will have all the Information & preparation possible to get the most benefit at further consults.
Fantastic, thanks so much!
It actually sounds like you have Secondary Hypothyroidism, where the problem lies with the pituitary, rather than the thyroid itself.
The pituitary is not secreting enough TSH to stimulate the thyroid to make enough thyroid hormone - I expect your FT3 is low, too. This will be caused by the pituitary microadenoma.
I'm not over keen on taking medication for the rest of my life and wondered if anyone knows if it's likely I will need to given that the condition is only mild?
You're not taking 'medication' in the normal sense of that word. You are taking thyroid hormone replacement. Levo is the thyroid hormone T4, not a drug.
And, yes, you will have to take it for life. Who said the condition is 'only mild'? If you don't have enough thyroid hormone to keep you well, then you have to replace it, you can't live without it. And your symptoms didn't sound in the least bit 'mild'. Being hypo is like being pregnant: either you are or you aren't. And, you are. (Hypo, I mean. 
)
Thank you so much, this makes perfect sense. I'm not sure what my FT3 levels were originally but they appear to be OK now at 4.2 (3.1-6.8). The endocrinologist has given me the diagnosis of mild Hypothyroxaemia (not to me directly - it was in a letter to my GP). As I didn't know what that meant I googled it and there's lots of references of links to pregnancy which thankfully there is no chance of 😆
Yes, I saw those links, too. And, frankly, I don't know what the difference is - or even if there is a difference!
But, your FT3 is not OK. It's too low. An OK (euthyroid) FT3 would be about 50% through the range. Your thyroid is knocking itself out to make more T3 than it normally would to compensate for the low T4. But it's not going to be able to do that forever. Especially not if your TSH drops even further. So, you do need constant testing.
Oh, and reading through your other replies:
* No, usually this is not a condition that will rectify itself. It's for life.
* We do not recommend multi-vits, for many, many reasons. For one thing, some supplements can be dangerous if you take too much so you always need your levels tested before taking supplements like iron, vit D, iodine, calcium. Secondly, all those supplements should not be taken at the same time because they tend to cancel each other out, so you're spending a lot of money and getting nothing for it. If you would like, I can elaborate further. 
Ah ok!! I think maybe I just get tested and start again then. As I said....complete novice 🙈
Well, we all have to start somewhere! Thank god for the internet!
Is it? Blimey, ok thank you, I have a lot to learn! I have another endocrinologist appointment in March to decide whether I continue with the trial of Levothyroxine so I'm guessing I should be saying that I want to continue!
You should, yes. Unfortunately, doctors know very little about thyroid, and even less about interpreting blood test results. For them, anything vaguely in-range - even scraping along at the bottom, just has to be 'fine' - which is patently not true, if you think about it logically.
Maybe this article would interest you:
Central hypothyroidism due to pituitary
So it’s ESSENTIAL to always test Ft4 and Ft3 as TSH is non responsive
Plus test vitamin D, folate, ferritin and B12 at least annually
What vitamin supplements are you currently taking, if any
Central hypothyroidism
bestpractice.bmj.com/topics...
ncbi.nlm.nih.gov/pmc/articl...
endocrinologyadvisor.com/ho...
academic.oup.com/jcem/artic...
ec.bioscientifica.com/view/...
As greygoose says ……levothyroxine is not a medication it’s a replacement thyroid hormone because you’re not making enough
if you were diabetic you wouldn’t expect to manage without insulin……
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 and last dose levothyroxine 24 hours before test
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 all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
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...
NHS easy postal kit vitamin D test £29 via
Thank you so much for all this information, I can't believe how helpful everyone is! I'm currently taking a multivitamin as my last tests showed low B12 and folate levels and prior to that low vitamin D. I'm not sure what levels they are currently at so will request these in my next tests. Thank you!
When hypothyroid we frequently develop LOW stomach acid, this leads to poor nutrient absorption and low vitamin levels as direct result
Common to need to supplement continuously to maintain OPTIMAL Vitamin Levels
Thousands of posts on here about low stomach acid
healthunlocked.com/search/p...
Web links re low stomach acid and reflux and hypothyroidism
nutritionjersey.com/high-or...
articles.mercola.com/sites/...
thyroidpharmacist.com/artic...
stopthethyroidmadness.com/s...
healthygut.com/articles/3-t...
naturalendocrinesolutions.c...
meraki-nutrition.co.uk/indi...
huffingtonpost.co.uk/laura-...
lispine.com/blog/10-telling...
Protect your teeth if using ACV with mother
healthunlocked.com/thyroidu...
That's great thank you. Interestingly I have the opposite... excess stomach acid with reflux. Whilst I've read that with hypothyroidism constipation is common, I suffer terribly from IBS whereby the main symptom is multiple bouts of diarrhoea on most days. (Sorry if that's too much info!) I tried a strict GF diet for around 6 months and whilst originally I had some success my IBS symptoms gradually returned so I guess this could contribute to poor absorption. Looks like I have a lot of reading to do! I'm very grateful for your help 🙂
Are you currently taking PPI like omeprazole or lansoprazole …..these tend to lower vitamin levels even further
High and low stomach acid have virtually identical symptoms
healthygut.com/articles/3-t...
Ppi like
Omeprazole will tend to lower vitamin levels even further
gov.uk/drug-safety-update/p...
webmd.com/heartburn-gerd/ne...
pharmacytimes.com/publicati...
PPI and increased risk T2 diabetes
gut.bmj.com/content/early/2...
Iron Deficiency and PPI
medpagetoday.com/resource-c...
futurity.org/anemia-proton-...
Wow, yes I do take PPIs and have done so for many years. I've had to change the way I take them as I'm aware of the interaction with levothyroxine. I've had an endoscopy for problems with my throat (hoarseness, sensation of lump in throat, difficulty swallowing ) which discovered excess stomach acid and I've been told that years of reflux is the root of these problems however due to the many other symptoms I have , I was aware it could be an indicator of hypothyroidism which led me to the endocrinologist. It seems that lots of symptoms seem to be interlinked...my head is spinning!!
New here, mystery symptoms -- wondering if it's thyroid?
Now not Hashi's?
T4 too high when TSH in range. Please can you look at my results?
Is it normal to have high rt4 and normal rt3?
Sub clinical hypothyroidism- how long can you have this before it gets worse?
