Hello everyone. I was hoping someone could help interpreting my daughter's recent thyroid function test please. TSH 3.83 mu/L range (0.25 - 4.20)
Free T4 9.4 pmol/L range (11.0 - 25.0)
The test was requested by Dermatology at the local hospital after i pushed my daughter to ask. (She's had a few thyroid tests over years by GP which always come back "normal"). She has shown symptoms for years ; weight gain, fatigue, skin problems (very slow to heal), low mood. She is now at the stage where she can go to bed at 8pm and sleep till 10 or 11 am and finds it very difficult to function normally.
By way of background, I was diagnosed with under active thyroid (and have been on levothyroxine) for over 10 years and my other daughter has Hashimotos.
Any advice would be gratefully received.
Many thanks.
Written by
Gertrude7
To view profiles and participate in discussions please or .
She needs to get retested including thyroid antibodies, vitamin D, folate, ferritin, B12
ALWAYS test early morning for highest TSH
Presumably you have Hashimoto’s too
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
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 that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
On T3 - day before test split T3 as 2 or 3 smaller doses spread through the day with last dose 8-12 hours before test
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options and money off codes
Hello SlowDragon and thanks for your reply and the information/links. My daughter is 38 . I should have said that the Dr said in his letter that TSH was "normal" and the T4 was "slightly below normal" and suggested re-testing in 3 to 4 months. Am I right in thinking that TSH although "in range" at 3.8 should really be under 2? Any suggestions on how to argue the case for a trial of thyroxine would be appreciated. As for myself, I've never been told I have Hashimotos, just underactive thyroid.
I'll ask her to get on to GP re vitamin testing. Also, we'll try the dermatologist who requested thyroid blood test (at daughter's request). Thanks for all the information. It really does help (and I'm sure others on here feel the same) give confidence to push against the system.
Strongly recommend you get FULL thyroid including antibodies and vitamins tested ……privately if necessary….8-10 weeks after increasing levothyroxine to 100mcg
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
So, what time of day was the blood draw for this test? That is very important, because doctors only tend to look at the TSH, they don't know any better. And TSH is highest before 9 am. It then drops sharply until midday, when it is at its lowest, and then slowly rises again in the afternoon. You want it as high as possible.
Unfortunately, doctors know very little about thyroid. They do not know that a euthyroid - i.e. without any thyroid problems - TSH is around 1, never over 2 and you are hypo when it gets to 3. But they like it to be at least over-range - preferably over 10!
As for the FT4, given that a euthyroid FT4 would be around mid-range - i.e. with that range, 18! - at 9.4 your daughter's is very low, not slightly below 'normal'. And that just goes to show how ignorant they can be! Your daughter is very hypo but the TSH is not reflecting that. Which, to my mind suggests a problem with the pituitar - TSH is a pituitary hormone, not a thyroid hormone - or the hyperthalamus. What we call Central Hypo. But, I doubt your doctor has ever heard of that. Sigh.
So, some mugging up to be done before the next test and confrontation with the doctor! At least one of you should know something about thyroid.
Thanks Greygoose. The blood draw was around 1.30pm (the appointment was with dermatology at the hospital). "suggests a problem with the pituitar - TSH is a pituitary hormone, not a thyroid hormone - or the hyperthalamus" - I'll have to do some reading up on this. Maybe we should push for a referral to endocrinology?
OK, so the TSH was at its lowest. It would have been higher before 9 am - possibly even over-range.
Even so, one would expect a TSH much higher than that, given that very low FT4. So, yes, I'm still thinking Central Hypo.
You should press for an endo appointment, but chose your endo carefully because they're not all created equal! Maybe ask on her for recommendations for an endo who knows about Central Hypo in your area - by PM, of course. We can't mention doctors' names on the open forum.
Thanks again for all the information SlowDragon. This is all a real learning curve and I wish I'd made more of an effort to understand it all years ago instead of just accepting the Dr receptionist's "normal" reply to my results enquiries.
That t4 is not “just below normal”.It’s not even inside the range,that Doctor is an idiot.Fatigue,weight gain and slow healing wounds all hypo symptoms.Gather all the information you can from the admins on here because what the GPs know about thyroid you could write on the back of a postage stamp.
Thanks for your reply. I do intend to use my day off tomorrow to look at the information everyone has been kind enough to give and put together a plan 🙂.
At next thyroid test…make sure to book early morning, ideally just before 9am, only drink water between waking and test and get thyroid antibodies tested as well
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Need help with my results please
Advice on my Daughter's results please...
Help Interpreting Results Please - Normal TSH, Low T4
Advice please on daughter's Medichecks results.
Test result help please?: Low TSH and Low T3
