Please help! What does my free t4 level mean?

[Needhelp22]

Can someone please explain what my free t4 level means? It is 14.1 thanks in advance. My first time on here.

[PurpleNails Administrator]

Welcome to forum

Do you have a diagnosed thyroid condition? Take replacement hormone?

FT4 is free thyroxine, one of the main thyroid hormones.

Results have a range which can vary between labs, yours might be low but we need the lab range to interpret accurately. Eg (12-22) or (7-17)

Did you have TSH tested too the thyroid stimulating hormone, this is a pituitary hormone. If thyroid levels are low it rises to get the thyroid to “work harder”

GPs look at the TSH result to decide how your thyroid doing but it’s not totally reliable.

If levels are in range the lab doesn’t test a further hormone Free triiodothyronine. This is mostly converted from FT4 and is the most powerful hormone. So sometimes this can be abnormal but missed if TSH and or FT4 in range.

[Needhelp22 in reply to PurpleNails]

Hello, thank you for the reply, nothing diagnosed as yet. Serum free t4 (14.1 )12.00……22.00 pmol /LSerum TSH Level (2.4) 0.27 - 4.20mu/L

[PurpleNails Administrator in reply to Needhelp22]

With both results in range doctor will say euthyroid (normal).

Are you currently having any symptoms?

Your FT4 is on the lower side.

I suggest you monitor to see if levels drop further in future.

You might faster progress if you arrange a -full- test privately. (Postal kit & finger prick sample)

GP likely not able to retest and TSH & FT4 alone doesn’t give you all the information you need.

For full thyroid function you need

TSH

FT4

FT3

Thyroid antibodies. TPO & TG.

If antibodies are positive its evidence on you immune system attacking & damaging thyroid (most common cause of hypothyroidism). it could support treatment as level become borderline instead of waiting for abnormal level & worsening symptoms.

When thyroid levels low nutrient can be affected and this can worsen FT4 : FT3 conversion and lower TSH - making it appear ok when should be higher.

I’ll add a link for private companies and money off codes.

Medichecks thyroid advanced is popular option.

thyroiduk.org/help-and-supp...

[Needhelp22 in reply to PurpleNails]

Thank you again for your reply. My friend told me to come on here. I am new to here and all things thyroid. I have been retested and am waiting for the results. they think I have stone in my salivary glands but Is it possible to have lump do to thyroid issues? Should be in one week. Symptoms, tired all the time. I do believe now that I am very sensitive to the cold. That would be good if you could send me links to safe sites that I could pay for a private test.

[PurpleNails Administrator in reply to Needhelp22]

The links should be on the thyroid uk page of private companies. Perhaps it’s not working.

Here is one for medichecks -

medichecks.com

Blue horizons -

bluehorizonbloodtests.co.uk...

Codes are listed on thyroid uk link.

Thyroid is a base of neck. Salivary gland usually in part upper neck.

I have large thyroid nodule (just above collar bone) but I also had inflammation in submandibular gland which is under jaw.

* parotid glands, which sit below the ears on the inside of the cheeks

* sublingual glands, which are underneath the tongue

Doctors say it unrelated. I had 2 separate departments investigating thyroid nodule / gland inflammation (lumps were 4cm away from each other).

Do you have dry mouth, dry eyes?

[Needhelp22 in reply to PurpleNails]

Yes my eyes are dry. Have been for a while. Noticed it once while rubbing my eye. Lid got stuck. They don’t well up like they use to. My lump is under my jaw. She is sending me for a scan on it. I’m pretty sure I can feel a swelling in my neck too. Thank you. I actually feel heard.

[PurpleNails Administrator in reply to Needhelp22]

Sjogrens (pronounced show-grins) can cause dry eyes & mouth, salivary gland issues. It is often associated with underactive thyroid (both are autoimmune)

Do you ever have rashes especially after being in sun?

My advice for dry eyes is to use *Preservative free* eye drops & wipes. Rotating different brands seems to help. Liquid versions for daytime & gel versions at nighttime.

I found warm compresses (eg wheat bags, microwaveable gel masks) helped. Very gentle massage toward lash line. This “unclogs” the blocked Meibomian Gland & lipid oil layer protects eye and retains the water. Some find cold compresses more comforting.

If you like to moisturise near your eye area use water based clear gels not oil / cream. I did this as developed milia -white spots- round eye. I found the puffiness & swelling reduced when I switched.

[SlowDragon Administrator]

Welcome to the forum

What age are you approx

Are you vegetarian or vegan

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

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies

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.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Thyroid needs good vitamin levels to work well

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

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)

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...

Symptoms of hypothyroidism

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

Come back with new post once you get results

Only do private testing early Monday or Tuesday morning

Don’t test in heatwave

[Needhelp22 in reply to SlowDragon]

Thank you! I am 46 and a vegetarian. Thank you for the links and the advice.

[SlowDragon Administrator in reply to Needhelp22]

So as a vegetarian B12 and iron deficiency are extremely common

what vitamin supplements do you take regularly

Essential to test B12 before starting supplements

At least an annual full iron panel test for anaemia

All vegetarians need to supplement B12 daily

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

Many vegetarians need to work continuously on maintaining iron/ferritin

Might need iron supplements and if do it’s important to redo full iron panel 2-3 times a year …check iron not going too high. Iron is extremely toxic in excess

Thyroid can’t work well unless B12, ferritin, folate and vitamin D are at GOOD levels

Serum B12 at least over 500

Active B12 at least over 70

Ferritin and folate at least half way through range

Come back with new post once you get vitamin (and thyroid) results

Assuming vitamins are low - spend 2-4 months improving and then retest full thyroid and vitamins again

[Needhelp22 in reply to SlowDragon]

A lot to take in. New to this. Thank you so much for all the information. Truly an amazing site. Very responsive and informative.

[Needhelp22 in reply to SlowDragon]

This is further information on blood tests taken a few months ago. Serum tsh level (2.4)

Serum free t4 (14.1)

Serum fertitin 76

Serum b12 361

Serum folate 8.2

Age 46, female, vegetarian

Awaiting results for this month next week.

I purchased b12 today to get started on them.

[SlowDragon Administrator in reply to Needhelp22]

About 2 weeks after starting B12 add a separate vitamin B complex

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid). This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken immediately 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 and continue with separate B12

Low B12 symptoms

b12deficiency.info/signs-an...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

As vegetarian you may/likely need ongoing B12 supplement as well as vitamin B complex

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

[SlowDragon Administrator in reply to Needhelp22]

You need vitamin D test

vitamindtest.org.uk

Optimal vitamin D at least around 80nmol

Test twice yearly via NHS private testing service when supplementing

[Needhelp22 in reply to SlowDragon]

Does desogetral effect thyroid levels?

[SlowDragon Administrator in reply to Needhelp22]

Sorry don’t know

[Needhelp22 in reply to SlowDragon]

Thank you!

[SlowDragon Administrator in reply to Needhelp22]

Ferritin looks surprisingly good

Might want to get full iron panel test done after next test …..see what results are first

You can have high ferritin and low iron

Ferritin is storage form of iron…..often rises if there’s inflammation

[Needhelp22 in reply to SlowDragon]

Thank you! Ordered a a test from mecicheck for my thyroid.

[SlowDragon Administrator in reply to Needhelp22]

Suggest you wait 4-6 weeks after starting B12 and vitamin B complex before testing

Certainly don’t test in this sort of heat

[Needhelp22 in reply to SlowDragon]

Thanks for the reply. Best wishes. I will keep you posted and will likely have more questions.

[Needhelp22 in reply to SlowDragon]

In advance I would like to thank you for your help from previous posts. Here are my thyroid function tests for 14/7/221.5 THS Level. 0.27 - 4.20mu/L

FT4 level 11.3 12.00 - 22pmol/L

Female, 46

Doctor recommends retest in 12 months or 6 /12 if paitent symptomatic

I have been symptomatic for ages.

[SlowDragon Administrator in reply to Needhelp22]

What time of day was test done

Ft4 is BELOW RANGE

Book a repeat test via GP for 6 weeks time

Book early morning, ideally before 9am

Meanwhile working on improving low B12 and folate by supplementing

Remember to stop taking vitamin B complex 5-7 days before next test

[Needhelp22 in reply to SlowDragon]

I’m going to see if i have got an earlier sample of blood tests with thyroid on. This has already gone on to long. I’m booked in with him/her for 26/7/22 for an appointment. Any advice on what to say to him/her?

[SlowDragon Administrator in reply to Needhelp22]

Request repeat thyroid test, including thyroid antibodies, plus vitamin D

With low TSH and below range Ft4

Referral to thyroid specialist endocrinologist

See yellow box “secondary hypothyroidism “

gps.northcentrallondon.icb....

Explain you are vegetarian and are now working on improving very low B12 levels

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors

[e-mail]

If both antibodies are negative, you will need ultrasound scan of thyroid

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

[Needhelp22 in reply to SlowDragon]

Would you say with them results, doctor should start me on levothyroxine?

[SlowDragon Administrator in reply to Needhelp22]

Well….you really want to get a bit more testing done

Thyroid levels could be low because of your very low B12/folate

As vegetarian it’s always important to supplement B12

Improving low vitamin levels might help improve thyroid levels

If improving low vitamin levels doesn’t increase thyroid levels and/or test shows high thyroid antibodies…..then you should be started on levothyroxine

Personally I would get retested in 6-8 weeks