Hi I'm new here.
I am perimenopausal and someone on menopause site told me to pop my thyroid results here for someone to determine if I have an underactive thyroid.
4th May blood test- TSH- 1.39 range 0.27- 4.2
Free T3- 5.08 range 3.1-, 6.8
Free thyroxine- 13.7 range 12- 22
24th May blood test
TSH- 1.16 (range as above)
Free T3- 4.61
Free thyroxine- 11.8
Hi Vicky567 and welcome to the forum.
Were both tests done under exact same conditions? We always advise:
* Test no later than 9am to give highest possible TSH, it's highest early morning and lowers throughout the day.
* Nothing to eat or drink except water before the test, this is because certain foods and drinks may affect TSH.
* No Biotin, B Complex or any supplement containing biotin for 3-7 days before test.
Primary hypothyroidism is diagnosed when TSH goes over range (most doctors wait until it reaches 10). If it's over range with low FT4 and symptoms a diagnosis may be made, or over range with raised antibodies then that should give a diagnosis of autoimmune thyroid disease (Hashimoto's).
However, another form of hypothyroidism is Central Hypothyroidism which is diagnosed when TSH is normal, low or minimally elevated with a below range FT4. This obviously fits with your second test.
I am not medically trained and I am not diagnosing, I am passing on information gained through my own research.
Central Hypothyroidism is where the problem lies with the hypothalamus or the pituitary rather than a problem with the thyroid gland.
TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). If there is enough hormone then there's no need for the pituitary to send the message to the thyroid so TSH remains low.
In Primary Hypothyroidism, which is where the thyroid fails, the TSH will be high.
However, with Central Hypothyroidism the signal isn't getting through for whatever reason so the message isn't getting through to the thyroid to produce hormone, hence low FT4. It could be due to a problem with the pituitary (Secondary Hypothyroidism) or the hypothalamus (Tertiary Hypothyroidism).
As Central Hypothyroidism isn't as common as Primary Hypothyroidism it's likely that your GP hasn't come across it before.
Your GP can look at BMJ Best Practice for information - here is something you can read without needing to be subscribed:
bestpractice.bmj.com/topics...
and another article which explains it:
ncbi.nlm.nih.gov/pmc/articl...
and another here:
endocrinologyadvisor.com/ho...
and another one:
academic.oup.com/jcem/artic...
You could do some more research, print out anything that may help and show your GP if you think this may be your problem.
You may need to be referred to an endocrinologist. If so then please make absolutely sure that it is a thyroid specialist that you see. Most endos are diabetes specialists and know little about the thyroid gland (they like to think they do and very often end up making us much more unwell that we were before seeing them). You can email ThyroidUK at
tukadmin@thyroiduk.org
for the list of thyroid friendly endos, both private and NHS. Then ask on the forum for feedback on any that you can get to. Then if your GP refers you, make sure it is to one recommended here. It's no guarantee that they will understand Central Hypothyroidism but it's better than seeing a diabetes specialist. You could also ask on the forum if anyone has been successful in getting a diagnosis of Central Hypothyroidism, possibly in your area which you'll have to mention of course.
Awwww thanks you so much! I will book a thyroid endo to look at it all properly xxx
My TSH was low but my others within range but GP said test results were high so until I saw the figures I had assumed my TSH was high. I'm waiting to see the endo but have seen ENT as have a 6x4cm nodule which has taken over my entire left lobe. I'm annoyed with the ENT doctor though because he wrote hypothyroidism when as haven't seen the endo yet to be diagnosed and don't think my results are typical of hypothyroidism
Just to add i found more results from my tests- 4th May
Thyroglobulin antibodies- 12 IU/ml
Thyroid peroxidase antibodies <9.0 IU/ml
24th may
Thyroglobulin antibodies- 13
Thyroid peroxidase- <9.0
Those results are negative for autoimmune thyroid disease assuming that the ranges are:
Thyroid Peroxidase Abs: <34
Thyroglobulin Abs: <115
If the ranges are different (occasionally they are) as long as you are below the stated number or within a range of, eg 0-34, then it's a negative result.
Hi Vicky, welcome to the forum.
We-ell, your results are a little unusual, and certainly wouldn't get you a diagnosis from a GP at this point.
But, your FT4 is very low, and getting lower - now under-range.
Your FT3 is higher - was mid-range, but is also dropping.
Usually, the FT4 is slightly higher than the FT3 in their respective ranges - to see this more clearly, we usually work out the percentages through the range. Handy percentage calculator here:
This unusual pattern often happens when the thyroid is failing, and the thyroid makes more T3 than T4 in order to maintain T3 levels, T3 being the active hormone - T4 is basically a storage hormone that doesn't do much until it is converted to T3.
However, the problem here is that your TSH is also low in-range. TSH is a pituitary hormone that stimulates the thyroid to make more hormone. So, it looks like either your pituitary or your hypothalamus isn't doing its job correctly - i.e. detect low thyroid hormone levels and stimulate the thyroid to make more. We call this Central Hypo. With your low T4/3, we would expect your TSH to be higher.
And, the great problem here is that doctors only look at the TSH in order to diagnose. This is what they learnt to do in med school, and they know next to nothing about T4 and T3 and their optimal levels. So, a GP would look at your TSH and pronounce it really good, and tell you there's nothing wrong with you. And, unfortunately, an endo would probably do the same!
So, what can you do? For a start, keep testing. At some point, the FT3 is also going to drop below range, and then you'll have a stronger case for a diagnosis. In the meantime, learn all you can about Central Hypo - all the information is out there, only doctors never look for it - so that you can better fight your corner. I'm sorry if you're feeling bad, at the moment, but there isn't a lot else you can do right now. Just keep an eye on levels and see how they develop. Note your symptoms, and keep your own records. And stick to your guns. Don't ever let a doctor tell you that under-range T4/3 is 'normal', just because your TSH isn't high. It doesn't always work that way, despite what they think. 
Thanks so much xxx
Could I ask. ..if found by the endo to have under active thyroid....who would give me the medication?, the endo?, as I dont want to be fighting hard to try and get it from here gp!! Xxx
Don't know if this was intended for me, but I'll reply anyway.
Are you in the UK? If so, it's usually the GP that does the prescribing once he has the go-ahead from the endo.
Are you planning to see a private endo? Because with your results, your GP might not be willing to refer you on the NHS. And, even if he did, the endo might refuse to see you. I have no idea where you would find an endo that specialises in thyroid. 99.9% of them are diabetes specialists with little knowledge of thyroid. So, you're probably going to have a battle on your hands, anyway. Which is why I suggested you research Central Hypo so that you know what you're talking about - one of you needs to! And it is unlikely to be the GP, I'm afraid.
Compare your results to these 10 healthy people on the graph below .
Your first set are fairly similar to healthy person '3' and healthy person'6' .. so it's quite possible that your first set are 'perfectly normal thyroid results'... and a GP will tell you there's nothing there to indicate a thyroid problem .
BUT as you can see.... people have different personal 'set points' for their thyroid hormone levels ... so while person 3 (or 6) will be perfectly fine and healthy with T4 at 10% , if person 8 or 9 (whose healthy set point for T4 is over 50%) suddenly found their T4 at 10% , they would probably feel horrible and for person 8 or 9 , T4 at only 10% would mean they had a thyroid problem and you would then expect their TSH to rise in response to the T4 being too low for them .
Your second set of results show that T4 has gone lower and is below range ... it's only a little below range (the '95% population range' does not include the lowest 2.5% of the healthy population ) so in theory, your second set of results could still be 'fine' and very slightly below range T4 is not always evidence of a thyroid problem .. but that only applies IF these levels are what is normal for you.
Again, a GP will not be concerned at this point, on the basis that IF these lowish levels of T4 were NOT 'normal for you' , then your TSH (Thyroid Stimulating Hormone) ought to have risen (asking for more T4 to be made) ..... but since your TSH is still looking totally normal at around 1, this suggests that these levels of T4/T3 are also normal for you .
I would hope that a GP seeing the T4 is now below range would continue testing over a few more months to see if this is the start of a trend of your T4 falling lower .
If it stays below range , or falls lower , or if your TSH doesn't rise higher to "ask" your thyroid to make some more T4.... then at that point they should be asking themselves "why isn't the TSH rising when T4 is so low ? " .. and 'Secondary /Central Hypothyroidism' ought to be considered as a possibility. ( they usually don't consider this unless you push them to )
~Primary Hypothyroidism is where thyroid can't make enough T4 because it's damaged,
~ Secondary / Central Hypothyroidism is where the thyroid itself is fine , but it's not being asked to make enough T4 because not enough TSH ~Thyroid stimulating Hormone is being made by the pituitary.
So basically its possible your results could just be 'your normal' , but the latest one where T4 has fallen under range raises suspicion that there is a problem developing, so your results need keeping an eye on to see what happens next.
But, be prepared ... it will be very difficult to get anyone to take the possibility of hypothyroidism seriously unless your T4 stays below range continuously/ or falls lower / or your TSH rises ~ and they will of course always suggest any symptoms you have are 'probably due to menopause'
( thyroid.dopiaza.org/ % calculator )
4th may:
TSH: 1.39( 0.27 - 4.2) 28%
FT4: 13.7 ( 12 - 22) 17%
FT3: 5.08 ( 3.1 - 6.8) 53%
24th may:
TSH: 1.16 (0.27 - 4.2) 22%
FT4: 11.8 (12 - 22) -2%below range
FT3: 4.61 ( 3.1 - 6.8) 41%
Grey goose and tatty- thank yiu so very much for taking your time out to reply! Very grateful indeed. I will keep my eye on my results as I intend to get it done frequently xx
Hi Vicky567,
You've been given great advice by SeasideSusie, SlowDragon, Greygoose and Tattybogle. My blood test results are similar to yours with TSH normal and below range FT4. It took some doing for me to get referred by my gp; hopefully yours will be more helpful?
My referral was accepted by the endo dept despite the gp telling me my symptoms were all in my head etc and yes to go away even though I was symptomatic and even more so now. I'm currently in the process of getting a possible diagnosis but it is time consuming.
As already mentioned read and learn as much as you can about central hypothyroidism. It's disappointing to be told by a consultant that all they are interested in is the TSH level. (Yes this has happened to me. My heart sunk when he said it!) Luckily he was an ENT surgeon and not the endocrinologist.
With TSH being in range you risk being told that all's ok despite being symptomatic. So you have to become knowledgeable about Central hypo and gently challenge them in a non threatening way with your newly acquired knowledge. If you find any particular research that is useful get a printout of it so you can refer them to it just in case.
It can be terrible when you're told 'it's all in your head/it's just your anxiety/you're menopausal' etc when you feel unwell. Hopefully your GP will be more understanding than most and you get a referral to an endo without much difficulty.
Best wishes.
Who shoukd I go to see? An ENT or endo? Xx
Tatty- what do you think I shoukd do next?,
Hi . if you can afford it i would test TSH /fT4 /fT3 again in a month ~ use same lab, and test at same time of day as you did for the previous tests so all results are properly comparable . Then you will have a much better idea than you do now of what's going on... . you will know for sure if there is a downward trend to your T4 results, which will make a much better case for seeing someone about them .... if you see anybody about it now , whether it's a GP or a private endo , the only thing they could reasonably do at this point is 'watch and wait' anyway... there's no way they'd prescribe anything yet , so there's no point paying just to be told that, when you can do it your self and test carefully, and gather better evidence than they will . (NHS GP will only test TSH and hopefully fT4 ,, but when TSH is in range it can be a real pain to get the NHS lab to do fT4 , and fT3 test is extremely unlikely )
During that month i would spend a bit of time regularly reading posts on here, and nosing around the 'related posts' section ..... because if you do eventually end up on thyroid hormone replacement at some point , learning to understand thyroid tests and conditions better than your doctor does is an investment you won't regret.
Look at SeasideSusie 's frequent posts on how to test Ferritin / Folate/ Vit B12 / Vit D, ..... might be worth getting them tested and seeing if any improvements can be made ... good levels of these help your body to use thyroid hormones properly ...... and it's always worth while seeing if they need improving anyway.
Also write a list of your symptoms and post it here ~even the ones you think can't possible have anything to to with your thyroid.
ps. to 'alert' somebody to your reply to them, or that you have mentioned them .. you need to either :
use the 'reply' button directly underneath their reply.
or,
type @before you type their name ( no space )
When you do that , a drop down list of similar names will appear underneath your reply , you need to click their name on this list... if you do it right their name will go blue in your reply and the @ will disappear , and they will get an 'alert' like you will when i do this Vicky567
Thank you so much tattybogle....that's very helpful....I will book again with medichecks for the same time xxx
What if they don't take blood test before 9am?, my regular test I go for is 10.30am....should I fast for this next one?,
The 9 am thing is just because, our TSH is highest in the middle of the night ,and falls to it's lowest at about 1-3pm .. then slowly rises again.
So for someone with primary hypothyroidism who's TSH was borderline eg. 4.4 [0.4-4.5] at 1 pm.. it would probably have been eg. 4.8 if they had tested earlier in the day , so they might have got a diagnosis with 4.8 , but at 1 pm the GP says "it's in range , go away."
But in your case.. your TSH is nowhere near the top end anyway .. so testing earlier to show it at it's highest isn't going to help you getting a diagnosis at the moment because yours still won't be much higher than 1.5 /2 ish even if you did test at 8 am.
So in this case , i think you should keep you test conditions consistent with whatever you did last time . that way you have the best chance of seeing if fT4 is really going down ~ fT4 may also be a bit higher before 9am , so if these test were 10.30am , and you do next one before 9am , then your fT4 might 'appear' to have gone back up , when it hasn't really .
Hi hun. So my last test was 23rd May. I'm buying the medichecks full thyroid test tomorrow. Shoukd I book the blood test for 24th June you think? So its exactly a month?
i would , yes .. i have read something somewhere which suggested that TSH levels are different at one point in the menstrual cycle .. it was only a case study on a couple of women , so it hardly counts as 'evidence' lol .. but just in case ... 'a month' might be wise for consistency rather than '6 weeks' which gives a different point in cycle
Before considering booking any consultation privately would recommend getting more detailed testing done including thyroid antibodies and vitamin levels
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
About 90% of primary hypothyroidism is autoimmune thyroid disease
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis) usually diagnosed by high thyroid antibodies
Recommended on here that all thyroid blood tests early morning, ideally before 9am
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 and money off codes
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
bluehorizonbloodtests.co.uk...
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...
With below range Ft4 a thyroid specialist endocrinologist should see you
Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors
tukadmin@thyroiduk.org
Thanks slowdragon very helpful info....I've noted it all down xx
Testing and improving low vitamin levels is essential
Optimal vitamin levels are
Vitamin D at least around 80nmol
Folate and ferritin at least half way through range
Serum B12 at least over 500
Active B12 at least over 70
If you are vegetarian or vegan……low vitamins highly likely
Ji hun my last vitamin D was 66 ??
Forgive me, but what does TPO and TG stand for hun? Xx
Re seeing an endocrinologist
Roughly where in U.K. are you
Some private endocrinologist are still doing consultations on zoom so distance no object
Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors
tukadmin@thyroiduk.org
Hi I've found more results on my paperwork-
4th May
Thyroglobulin antibodies- 12 IU/ml
Thyroid peroxidase- <9.0
24th may
Thyroglobulin antibodies- 13
Thyroid peroxidase <9.0
What’s the range on these
Usually
TPO is negative if below 34
Tag negative if below 115
But ranges vary according to the laboratory
Were either higher in the past
20% of Hashimoto's patients never have raised antibodies
Have you had ultrasound scan of thyroid
healthunlocked.com/thyroidu...
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about autoimmune thyroid disease
thyroiduk.org/hypothyroid-b...
List of hypothyroid symptoms
thyroiduk.org/if-you-are-un...
Sorry hun I dont understand as I'm new to all this! Do mine look dodgy?
There should be a number after these results….giving the range
These are the results
Is there a number after the results?
Eg most common is these ranges
Thyroglobulin antibodies- 12 IU/ml <115
Thyroid peroxidase- <9.0. <34
If the result is less than the range the result is negative.
If the result is more than the result is positive
Thyroglobulin Antibodies 12 IU/mL (Range: < 115)
Thyroid Peroxidase Antibodies <9.0 IU/mL (Range: < 34)
So results are negative
No significant antibodies
Sorry SlowDragon- what does that mean for me? Yes i am dozy! LOl does that mean nothing to worry about?
Most primary hypothyroidism is autoimmune thyroid disease diagnosed by high thyroid antibodies
However 20% of Autoimmune thyroid patients never have raised antibodies
An ultrasound scan of thyroid can be helpful
healthunlocked.com/thyroidu...
However at this stage I would get folate, ferritin and B12 levels tested next
Vitamin D
Is result 66nmol (U.K. units )
So you think at this stage i do not have underactive thyroid?
No….I think your antibodies result says you probably don’t have autoimmune thyroid disease
Your thyroid may be struggling because of low vitamin levels
First step is always to test vitamins and get all four improved to GOOD levels, if necessary
This should help improve thyroid levels and also improve how you feel
Vitamin D, if it’s 66nmol needs improving to at least around 80nmol
Are you in U.K.
Do you currently take any vitamin supplements
Come back with new post once you get vitamin results
Hi yes in the UK. Are you?
Yes i take Vitamin D every day and have done for years.
I will come back with new results here, thank you
Yes this is U.K. forum
Vitamin D in other countries is measured in ng/ml
It’s very important to confirm the unit in result
As shown in this post yesterday
healthunlocked.com/thyroidu...
How much vitamin D are you currently taking
nmol/L 50 - 200 (this what it says on my clinic letter)
I am not sure of the dosage i take...at work at the moment. What dose should i be taking?
Hi Vicky567I had to go to a private Endocrinologist to get a diagnosis of secondary hypothyroidism. GPs just do not understand it. Even now, after an official diagnosis my GP goes ‘oh but your TSH is low/surpressed’ and I have to remind her that that is normal for my condition…
If you can afford to, you want to see a private Endocrinologist. That was the game changer for me
You had some super advice on here about how to find one and how to test.
good luck & all the best
How much does it cost?
Hi pixie where did you go to?
Hope you don't mind me asking, but could you private message me the name of your private endo. Have the name of someone from McPammy who looks absolutely ideal in every way. Would just be my luck if I decided to see him and he has suddenly retired.
I don't want to comment on your labs, but as someone who was "Falsely" told I needed thyroid replacement I would tell you to be cautious. I didn't know what a hot flash was until I was put on thyroid replacement ! I was a little over weight, but really good + healthy and I soon knew what "Hyperthyroid " felt like and no one wants that. When I complained I was told I didn't know what it was like to feel normal. I trusted this doctor's advice for nearly 5 years and felt like hell and trashed my health generally. I am slowly undoing some of the damage, so that is why I caution you don't just rely on numbers. Here in the U.S.A. some internist are cavalier in their DX and treatment of thyroid issues. Make sure they rule out adrenal and or other issues first after all we are talking about hormones and a little can do a lot of harm. All my best on your journey!
Hi Vicky
Just as a piece of information, I will add the fact that the perimenopause can affect your thyroid.
I have had an underactive thyroid for around 8 years. Around two years ago I became slightly over medicated despite not changing anything and the doctor suggested slightly reducing my meds. I was surprised because your thyroid doesn't 'get better' of its own accord with what I've got (Hashimotos), it's being slowly destroyed.
A while later it became obvious that I was in perimenopause and was given HRT - cue change in thyroid again, then HRT was upped and the thyroid changed again and I am now back on almost my original, pre-menopause dose of thyroid meds.
The point of this long ramble is to ask if you are taking HRT, because if you aren't and start it, it may affect your thyroid results (or not - everyone is different).
Good luck whatever you do
Jennifer
See no evidence that you are hypothyroid. However you did not specify what the normal range is for FT3. You said your FT3 is 4.61. If that is pg/ml, then 4.61 is in the 2.77-5.27 pg/ml normal range which my lab uses.
Hi Eddie -
It says
TSH (Range: 0.27 - 4.2)
Free pmol/L (Range: 3.1 - 6.8)
Free Thyroxine pmol/L (Range: 12 - 22)
How do you feel? Any symptoms of over/ underactive thyroid? You haven’t said how you My TSH is way lower than 1 but I have hypo symptoms. You haven’t said or I can’t see anywhere how you feel!
Track your waking (in bed), 30-60 min. after breakfast, and mid-late afternoon body temperatures and pulses. YoNormal waking temp should be 97.8-98.2, it should rise after breakfast and hit normal (98.6+) by mid morning and stay there until dusk. Check your Vitamin D. I recommend Ray Peat, PhD's work on thyroid, light, diet and supplements..
Do I have a Thyroid problem?
Do I have a thyroid issue?
B12 deficient but could I have underactive thyroid too?
Do I have a thyroid problem? 
