Can Someone be in the normal TSH range but still be suffering from Hypothyroidism

[thyreoidea]

My daughter has been suffering multiple symptoms, reoccurring urology issues, aches and pains, IBS to name but a few. Her GP’s have only ever tested for TSH which has always been in the middle of the range.

As I have autoimmune hypothyroidism as well as an autoimmune blood disorder should they be testing T4, T3 and the antibodies related to the thyroid as can they be identifiers of thyroid issues without the TSH being the sole marker.

TSH results range 0.3 - 4.20 NHS

Jan 2024 1.91 mu/L

Aug 2023 2.36 mu/L

Jan 2023 2.32 mu/L

Thank you in advance for any answers

[Buddy195 Administrator]

Ideally your daughter needs:

TSH

FT3

FT4

Plus any antibody and key vitamin tests (ferritin, folate, vitamins D and B12)

If her GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of her thyroid health:

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

I think Medichecks are offering 20% discount in Jan, so maybe worth investigating.

[thyreoidea in reply to Buddy195]

Thank you,

She has had Folate come back which is low, B12 in range but not the definitive answer, not sure about Vitamin D. I wanted her to be armed with more information to add other things to a blood test on Monday relating to her thyroid and the more sensitive testing for B12 deficiency if possible. If no joy at GP’s may have to go down the private testing route as long as the NHS recognise them and act accordingly if anything needs to be addressed.

[Buddy195 Administrator in reply to thyreoidea]

I would recommend sharing all results (with ranges in brackets as these can vary between laboratories). Please remember when GPs say normal/ within range, this may not be the same as optimal.

[thyreoidea in reply to Buddy195]

The only results so far taken last week

Folate 2.9 >3 was 3.8 in August 2023

B12 537 ng/l (200 - 771)

Ferritin 40 ug/l (13 - 150)

[Buddy195 Administrator in reply to thyreoidea]

I would push for a full iron panel as ferritin is low.

I managed to raise my folate with Thorne Basic B.

When your daughter has next thyroid blood test, ensure this is prior to 9am (this gives highest TSH)

[thyreoidea in reply to Buddy195]

Just added TSH results and rages to original post

[thyreoidea in reply to thyreoidea]

Thanks, her net one is 09:30 so fairly close

[Buddy195 Administrator in reply to thyreoidea]

TSH should always be under 2, with most members reporting feeling best when it falls below 1. However, GPs will not prescribe thyroid medication until 2 readings are significantly higher- that’s why early morning blood test can be helpful. As previously stated, a full thyroid panel is the next step, so we can offer better advice.

[DippyDame]

In a word...YES!

TSH is not a reliable marker. It's a pituitary, not a thyroid hormone and reflects high or low overall hormone level but gives no indication of individual FT4 and FT3 levels....but I guess you know that!

This should help.

thyroidpatients.ca/2021/07/...

FT3 is the most important result followed by FT4 but medics don't understand this

IBS and urology problems are symptoms of hypothyroidism/ undermedication....

Since every cell in the body needs to be flooded with an adequate and constant supply of T3, low cellular T3 can affect any part of the body.

thyroiduk.org/signs-and-sym...

A FULL thyroid test is required as explained below

Post any results she has and member will advise.

[greygoose]

Unless her TSH is around 1, it is not 'normal' (euthyroid). So, yes, she could very well have low FT4/3. And that is what makes you hypo, not any level of TSH. I'm afraid doctors have got it all wrong about the TSH. They do not understand what it is, nor what it does. Nor, more importantly, what it doesn't do!

Just going by the TSH assumes that everyone has a perfectly working pituitary. And that is just not true. Plus, all sorts of things can affect the TSH, like caffeine and the time of day. TSH is highest before 9 am, and drops to it's lowest around midday. But doctors just don't seem to understand that - or don't want to acknowledge it! And, if she does have Hashi's, the TSH can fluctuate even more.

So, yes, as the others have said, she needs full thyroid testing before any conclusions can be draw about her thyroid status.

[Bearo]

Just to add (hopefully, someone will correct me if I’m wrong) that because FT3 is the most important hormone the body will do its best to keep it high enough. So in the early days of failing thyroid TSH will (usually) gradually rise and FT4 will gradually fall but FT3 might maintain a level for a while, until it, too, falls.

It’s always good to know where FT3 is, but GPs rarely test it and it’s maybe not as essential as monitoring TSH and FT4 in the early days.

Happy to be corrected.