Thyroid UK

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Are my levels normal?

Mrs_Tumnus•

•25 Replies

Hi,

I apologise if I have posted this in the wrong place, but I am new here.

Could anyone possibly interpret my thyroid results?

Thyroid ranges -

Serum free T4 level - 11.0 pmol/L 7.0 - 17.0

Serum TSH level - 4.02 mu/L 0.20 - 4.50

I have all the symptoms of hypothyroidism, which my mum and aunt have, but my GP seems to think the reading is fine.

Over the past few years, my TSH has gone from 2.8 then 3.2 and now 4.02. My free T4 has gradually dropped too.

I would appreciate any advice.

Best wishes

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Mrs_Tumnus

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Of course you are hypothyroid and probably have been for years. It's a gradual process and your results are very typical. And with your relatives involved with it as well makes me wonder what is wrong with your GP. Does he offer any reason or advice? Is your FT4 IN the range at all? I'll assume he did not check for antibodies which would possibly provide more evidence. How do you feel? If he sees no symptoms he may think you would not want to be saddled with a daily hormone but sometimes there can be a subtle deterioration from untreated low metabolism. If you went to a functional endocrinologist, they might determine you have infections, or other hormone issues or leaky gut and also work on those. Even if it is genetic to a degree, there is usually a trigger. Unfortunately some won't even offer replacement hormone until patients are very ill.

I hope others here can offer some options for you as I'm not in the UK.

Thank you so much for taking the time to respond.

I am fatigued all the time, I have gained so much weight, my hair falls out by the handful in the shower, it's quite alarming how much hair I lose. My skin is dehydrated even though I have always taken good care of it. I am always cold when everyone else is warm. My hands are physically cold to touch. I don't have any energy at all. I'm 33 years old and yet feel like an old lady.

I have raised this with the GP three times and all he says is your results are in the normal range. Apparently, 5 TSH is the point where they decide it is hypothyroidism. My free T4 was at the lower end of the normal marker.

I have had full bloods taken and everything else is normal. However, the only thyroid markers her checked were TSH and free t4. I have B12 injections as I lack instrinsic factor but I don't think there's a link to thyroid issues?

I have read so much online regarding hypothyroidism and it seems 4.02 is too high, and given my family history, I would have thought it made sense to start me on medication. As well as my mother and aunt having thyroid issues, my dad's mother has an underactive thyroid too. My GP is aware of this.

I had more bloods taken today after kicking up a fuss so I should have the results by Monday.

Oh my, this is aggravating. Are you only able to see that GP? I hope someone who lives in your locale might be able to give you some advice. I'm so sorry they have allowed you to lose so much of your health, it's really unconscionable. I'm glad you put up a fuss, you need to do more of that in my opinion. I've been on this forum for many years and often thought there should be some sort of law suit over the lack of understanding and treatment. Synthetic T4 is very inexpensive and so was T3 although they are manipulating prices now. It's a shameful situation. I see many of my friends becoming obese simply because doctors will not prescribe T3. There is no reason for this.

Hi Mr_Tumnus,

Do you have the results for Vitamin D, folate, B12 and ferritin?

Low vitamin levels are common if you are hypothyroid.

Has your GP done an iron panel? This would include ferritin.

From my own experience if your ferritin is low you can lose a lot of hair.

With you having B12 injections you B12 levels should be good.

When your gp says your results are in range you need to know whereabouts in the range your levels are. They need to be optimum. If you read some of the posts you'll see this being mentioned regularly.

As Heloise says can you not see a different doctor in your practice?

My ferritin was 25ug/L Range 5 - 85B12 has been around for 100 for many years but I was then put on injections after tests showed lack of intrinsic factor. It was previously put down to my vegetarian diet. I have always taken vitamin B12 but I wasn't absorbing it. B12 is now normal after the shots.

Thyroid ranges -

Serum free T4 level - 11.0 pmol/L 7.0 - 17.0

Serum TSH level - 4.02 mu/L 0.20 - 4.50

I am waiting for blood results I had done yesterday, so I will ask to see a different GP for a second opinion once I get these.

Did you get new ferritin results

Ferritin is far too low - deficient

You need full iron panel test for anaemia

cks.nice.org.uk/topics/anae...

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency

Look at increasing iron rich foods in diet

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

An article that explains why Low ferritin and low thyroid levels are often linked

preventmiscarriage.com/iron...

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

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 disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron

Medichecks iron panel test

medichecks.com/products/iro...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good explanations of iron

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

My ferritin was 22 this time. 😐 Again, they said it was 'normal', so I didn't give it a second thought.

Folate was 3.7 last time, 9.2 this time. I was told this was normal too?

Hi Mr_Tumnus,

Welcome to the forum. The first question that is usually asked is can you add the ranges for those blood results? This will help other members who will comment on them for you.

Unfortunately with it being the early hours of the morning in the UK this may not happen till later on. It will also help if you put your location on your profile.

Please add ranges on these results (figures in brackets after each result)

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

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

As your Mum and Aunt have autoimmune thyroid disease it makes it more likely other family members might develop it

Looking at your forum name…..Are you male.

Autoimmune disease is less common in men

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

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)

Are you in the U.K.?

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...

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/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s.

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/wp-content/up...

Thank you for your response.

I am female, I just like the character Mr Tumnus (probably didn't think it through when choosing it as a username)!

I have added the ranges to the original post.

I agree with above comment, get your antibodies tested - then it’s proof of autoimmune and I think they have to treat. That’s what I did after suffering for years and being told guidelines were TSH 5 and above for treatment. Life changing to be medicated and feel well again! I use medichecks and continue to monitor my own results through them as NHS won’t test T3 and I take both T3 and T4, so need both tests.

Hello Mr_ Tumnus and welcome to the forum :

Yes you are hypothyroid but currently the NHS do not consider treatment until your TSH reaches over 5 and in some cases people are having to wait until their TSH reaches 10 :

If you go into Thyroid UK - thyroiduk.org this is the charity who support this forum.

There you will find all things thyroid plus a page of private companies who can run the necessary blood tests for you, if your doctor is unable to help.

This is where we all start off and just start a new post with the results and ranges once the results are back and you will be talked through what it all means and advised of your next best step forward.

We need to see results and ranges from a full thyroid blood panel which includes a TSH, T3, T4, antibodies, inflammation, plus ferritin, folate, B12 and vitamin D :

No thyroid hormone replacement works well until your vitamins and minerals are at optimal levels, hence the inclusion of these in this first blood test.

Welcome!

You have arrived at both the correct, and a safe place. The collective knowledge and experience of members here is greater than that of most medics.

Your experience proves the latter point...and it's appalling!

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

Your GP is following the current guidelines for hypothyroidism....and they are sadly lacking.

You haven't given reference ranges but it is not correct to say labs are " normal" if they fall within range

" Normal" means nothing!

Instead we aim for the specific point within the ref range where you feel well.

That point varies for each patient.

Medics focus on TSH which again is not helpful....this is the cause of misery for many hypothyroid patients because they are wrongly diagnosed

This might help ...

bmcendocrdisord.biomedcentr... "Time for a reassessment of the treatment of hypothyroidism"

thyroidpatients.ca/2021/07/...

TSH is a pituitary hormone, not a thyroid hormone...

It measures the combined level of thyroid hormones in the blood...

Low TSH suggests overmedication

High TSH suggests undermedication

BUT....what we need is the level of each hormone in order to extrapolate an accurate diagnosis

FT4 is the storage hormone which is converted by the body to FT3.

FT3 becomes the active hormone when it reaches the nuclei of the cells...

for good health T3 is required to flood almost every cell in the body and must be available in a constant and adequate supply

Low T3 = poor health

....and so the process continues, and can get more complicated for some.

Your thyroid is struggling....rising TSH and lowering FT4

Your family history screams hypothyroid and this GP should understand this

Glad you " kicked up a fuss" it sounds as if you know a lot more about hypo than this GP....

sadly not an unusual situation here.

SlowDragon has given you excellent advice, as always, I suggest you follow it

Starting with a full thyroid test as she describes

Hope something in this rant resonates

Come back with your new labs and members will help....

Good luck

Thank you for your response.

Thyroid ranges -

Serum free T4 level - 11.0 pmol/L 7.0 - 17.0

Serum TSH level - 4.02 mu/L 0.20 - 4.50

I may have to pay and go private if the GP won't treat me after I receive the latest results as I am getting really fed up of feeling this way. This forum has helped me immensely as I genuinely thought it was all in my head.

First step is getting full thyroid including thyroid antibodies and vitamin testing

Only do private testing early Monday or Tuesday morning.

Come back with new post once you get results

Low Ft3 ….leads to low vitamin levels….low vitamin levels leads to lower TSH

Frequently vitamin levels are rock bottom and over reliance on TSH means patients can’t get diagnosed

Are you vegetarian or vegan

Pre, peri or post menopause?

Helpful to add age and gender on profile please

And country

I am 33, so not pre, peri or post menopause.

I am vegetarian and have been for many years.

I think I will go private if the GP won't treat me once the results come back.

So as vegetarian what vitamin supplements are you normally taking

If not taking B12 and vitamin B complex daily it’s HIGHLY likely your B12 is far too low

academic.oup.com/nutritionr...

The present review of the literature regarding B12 status among vegetarians shows that the rates of B12 depletion and deficiency are high. It is, therefore, recommended that health professionals alert vegetarians about the risk of developing subnormal B12 status. Vegetarians should also take preventive measures to ensure adequate intake of this vitamin, including the regular intake of B12 supplements to prevent deficiency. Considering the low absorption rate of B12 from supplements, a dose of at least 250 μg should be ingested for the best results.3

Low iron/ferritin extremely common with plant based diet

NEVER supplement iron, unless tested and deficient

We see hundreds of vegetarian/vegan members with terrible vitamin levels

Thyroid can not work correctly if vitamin levels are low

First step is always to test …..then correct any low vitamin levels…..then retest again in 2-4 months

Low ferritin usually takes long time to improve…..3-6 months

Optimal vitamin levels are

Vitamin D at least over 75nmol

Serum B12 at least over 500

Active B12 at least over 70

Folate and ferritin at least half way through range

I lack intrinsic factor and have B12 injections as the supplements didn't up the levels despite taking super-strength vitamins for 4 years.

UPDATE -

My blood results just came back

Serum TSH level 4.81 mu/L 0.20 - 4.50 Now classed as abnormal

Serum free T4 level 10.0 pmol/L 7.0 - 17.0

Just 6 weeks ago my results were -

Serum free T4 level - 11.0 pmol/L 7.0 - 17.0

Serum TSH level - 4.02 mu/L 0.20 - 4.50

The GP is going to call shortly to discuss.

Report

Request full iron panel test for anaemia including ferritin

Vitamin D, folate and thyroid antibodies tested

Iron test should be done early morning and fasting

Once folate has been tested

As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels between injections too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Thorne Basic B or Jarrow B Right are recommended options that contains folate, but both are large capsules. (You can tip powder out if can’t swallow capsule)

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement

Hi Mr Tumnus. It was 5 years ago when my GP told me I was heading for Hypothyroidism as my TSH was increasing like yours is but they wont treat until TSH is over 10. Due to other medical complications my my GP forgot to test it for 3 years. I suddenly started with insomnia to which Gps gave me sleeping pills and sent me on courses. I said to them one day.....you havnt tested my thyroid for 3 years......blood result showed TSH at 11.1. I was started on Levo and sleep pattern returned to normal. These Drs just dont understand Thyroid disease.

GP could and should start treatment if had two blood tests with TSH over 5, if you have symptoms….and especially if high thyroid antibodies

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

UPDATE -

My blood results just came back

Serum TSH level 4.81 mu/L 0.20 - 4.50 Now classed as abnormal

Serum free T4 level 10.0 pmol/L 7.0 - 17.0

Just 6 weeks ago my results were -

Serum free T4 level - 11.0 pmol/L 7.0 - 17.0

Serum TSH level - 4.02 mu/L 0.20 - 4.50

The GP is going to call shortly to discuss.

So, the GP called. She has started me on thyroxin 25 given my family history and the fact my TSH is on an upward trajectory and the Free T4 is on a downward trajectory. I do feel relieved to finally have something that may help. Thank you to everyone who has taken the time to give me advice.

Pity she didn't start you on 50mcg levo, the usual adult starting dose!!

However it's still a welcome start

You will need to test again in 6/8 weeks with dose altered as necessary.

Repeat....test, increase, hold 6/8 weeks until you feel well

Be patient, it may take a little time

Don't be concerned if you feel a little worse shortly after an increase, it will pass

It's not because the levo isn't working...it's just the body adjusting to the new dose

Come back with any further queries you may have

Hi Mrs_Tumnus,

Good to hear that your GP has listened and taken everything into consideration and is now treating you. You must feel relieved.

I'm learning so much from joining this forum and you will get lots of helpful responses whenever you make a post.

Take care.

Thyroid UK

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