been showing signs for years of thyroid problems , never out of range (nhs) always on lowest marker
Just had these back last week nothing off doctor
Is it ok my tsh out but rest are in range ? Confused to how it works
Tsh 0.25
T4 15.3
T3 4.1
Thankyou
Hi! Can you provide the specific ranges for each of those?
Also, if you have your previous test results on hand, it would be great to see those and understand the trends. I’m curious, if your Free Ts have always been at the bottom of the range as you note… what has your TSH been?
hi there I have never had my t3 or t4 done before as I have never been out of range for tsh so docs won’t do them
The range for tsh is 0.27-4.2
Picture is of all past tsh over years
Hi Struggle 123, welcome to the forum. 
Difficult to interpret blood test results without the ranges, because they vary from lab to lab.
Although we don't need a range to see that that TSH is low. TSH varies thoughout the day with its highest point around midnight and lowest point around midday. So the time of day you have the blood draw is important. We always recommend just before 9 am and fasting. TSH can also be lowered by cafeine and certain foods. And, unfortunately, doctors only tend to look at the TSH. They have no idea what the other results mean. So, looking at yours, a doctor would be more inclined to diagnose you with subclinical hyper than hypo, even though your thyroid hormone levels are low - TSH is a pituitary hormone.
So, two more things we need to know before anyone can comment:
- The ranges for the FT4 and FT3
- the time of the blood draw
Oh! And have you ever had any antibodies tested? TPOab and TgAB.
The ranges are ft4 12.0-22.0
Ft3 3.1-6.8
Test was at 8.40 and hadn’t eaten
The tsh ranges are 0.27-4.2
Doesn't matter what the TSH range is, a TSH is always a TSH and should be around 1.
So, the TSH isn't reponding to the Free levels:
ft4 15.3 (12.0-22.0) 33.0%
Ft3 4.1 (3.1-6.8) 27.03%
which should both be around 50% through the range. So, that looks like a pituitary/hypothalamus problem - or what we call Central Hypo. And, by the look of your results going back to 2013, you've had it for some time.
The problem is, very few doctors have even heard of Central Hypo, let alone be capable of recognising it when they see it. They believe the TSH 'tells them all they need to know', which is patently not true. They don't understand the thyroid hormone levels themselves.
So, what you need is an endo that is well up on pituitary problems, but doubtful you'd get one on the NHS because your doctor is unlikely to refer you with those numbers. It's a bit like painting by numbers, the apple is n° 5, n° is red, so apples are red. What they don't understand is that sometimes apples are green, or russet colour. But as the intructions say red, red it is. They cannot, or will not, think outside the box.
Thankyou so much !
Least I am now armed with something I will find a endo and try to get this sorted. I will speak to my doctor as she has requested to see me because if these results so hopefully she will recognise there is a problem
You're welcome. Let us know how you get on.
Well went to the doctors … apparently all my levels are fine and I do not need to see a endo.
Even tho I have been going in for over 10 years with symptoms. She even drew me a diagram about the signalling. I said about the percentages t3&4 and that it’s not responding to these so perhaps a signalling issue.
Said she will email and ask if I could be seen but very doubtful . Also she will ask od there is any bloods that they can do now which may help.
So I have just ordered a blood test through blue horizon. I will now wait and hope the endo says they will see me.
Well, that doesn't surprise me. They're like robots, incapable of thinking outside the box. They've been taught that TSH 'tells them all they need to know' and they cannot - are not capable of - thinking otherwise.
I don't know what other blood tests there could be. Taken altogether, those results tell you all you need to know. Although, testing other pituitary hormones might open her eyes a little, but I don't know if she can do that. She could do an 8 am cortisol, though, but that doesn't prove anything except that further investigation into the adrenals might be useful.
I had a 8am cortisol done years ago and that was 354 doc at time said was ok . I will wait for the lab tests I ordered for my antibodies etc then go back armed lol
Well, what was done years ago is hardly relevant today. And although 354 was more than likely within the range, it sounds low to me. But, as long as a result is somewhere within a range, doctors think it has to be ok. They don't really know what they're doing.
hi there Thankyou for your response
T4 ranges are 12-22
T3 3.1-6.8
It was 8.40am and hadn’t eaten
I had a accp antibodies test that result was
1.3
Ranges 0.0 -7. 0
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once
Very important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
Low vitamin levels, especially low ferritin can cause fatigue
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG 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.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
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
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
Post all about what time of day to test
healthunlocked.com/thyroidu...
Testing options and includes money off codes for private testing
Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins
bluehorizonbloodtests.co.uk...
Only do private testing early Monday or Tuesday morning.
Link about thyroid blood tests
thyroiduk.org/testing/thyro...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
thyroiduk.org/signs-and-sym...
Tips on how to do DIY finger prick test
support.medichecks.com/hc/e...
Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee
thankyou I have low iron and they have issue folate
I will look at further testing see if doctors will do or I need to organise myself as I feel so crappy
You need to click on reply otherwise other poster doesn’t get notified
How old are you?
Pre or post menopause
what were most recent iron and ferritin results
Are you on iron supplements via GP
cks.nice.org.uk/topics/anae...
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
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
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Stop iron supplements 5-7 days before testing
Medichecks iron panel test
medichecks.com/products/iro...
Look at increasing iron rich foods in diet
Eating iron rich foods like liver or liver pate once a week plus other red meat, 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
Links about iron and ferritin
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.
healthunlocked.com/thyroidu...
Posts discussing Three Arrows as very effective supplement
Great replies from @FallingInReverse
re ferritin and Three arrows
healthunlocked.com/thyroidu......
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Great reply by @fallinginreverse
healthunlocked.com/thyroidu...
Iron patches
healthunlocked.com/thyroidu...
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...
Iron and thyroid link
healthunlocked.com/thyroidu...
Posts discussing why important to do full iron panel test
healthunlocked.com/thyroidu...
Good iron but low ferritin
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Chicken livers if iron is good, but ferritin low
healthunlocked.com/thyroidu...
Shellfish and Mussels are excellent source of iron
healthline.com/nutrition/he...
Iron deficiency without anaemia
healthunlocked.com/thyroidu...
Ferritin over 100 to alleviate symptoms
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Great research article discussing similar…..ferritin over 100 often necessary
ncbi.nlm.nih.gov/pmc/articl...
Low Iron implicated in hypothyroidism
healthunlocked.com/thyroidu...
Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue
healthunlocked.com/thyroidu...
Inflammation affecting ferritin
healthunlocked.com/thyroidu...
Updated reference ranges for top of ferritin range depending upon age
healthunlocked.com/thyroidu...
Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:
Females 18 ≤ age < 40. 30 to 180
Females 40 ≤ age < 50. 30 to 207
Females 50 ≤ age < 60. 30 to 264l
Females Age ≥ 60. 30 to 332
Males 18 ≤ age < 40 30 to 442
Males Age ≥ 40 30 to 518
The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.
what were last B12 and folate results
I’m 48 pre
Folate 2.6 docs given me tablets
B12 461
Ferritin 18
Yes I did get that in the end
Thankyou
So ferritin and folate deficient
Going to take months to improve low ferritin
What has GP prescribed
Are you vegetarian or vegan?
B12 too low
No vitamin D test result?
test via NHS private testing service
Aiming for vitamin D at least over 80nmol
Retest thyroid levels again 8 weeks time after starting folate
Recommend testing BOTH TPO and TG thyroid antibodies next test - would need to test privately
Gp prescribed folic acid 5mg for 3-4 months one a day
Didn’t do my vit d only ever had that done once in 2022 and was 64 and I do use supplement have done for years.
Ah ok I will look at the list of private labs you gave me then
Thankyou
vit d only ever had that done once in 2022 and was 64 and I do use supplement have done for years.
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But, improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly when supplementing
Can test via NHS private testing service
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Vitamin D and thyroid disease
grassrootshealth.net/blog/t...
Vitamin D may prevent Autoimmune disease
newscientist.com/article/23...
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Recipe ideas
bbc.co.uk/food/articles/mag...
Interesting article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
After you finish prescription folic acid suggest you look at adding a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Highly effective B12 drops
natureprovides.com/products...
Or
B12 sublingual lozenges
uk.iherb.com/pr/jarrow-form...
cytoplan.co.uk/shop-by-prod...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
Low folate
on going as maintenance dose
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
healthline.com/nutrition/fo...
Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements
thyroidpharmacist.com/artic...
B vitamins best taken after breakfast
Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose
Post discussing different B complex
healthunlocked.com/thyroidu...
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
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 folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
Your results are poor and I agree with others who have mentioned Central Hypothyroidism as a possible explanation for your results.
You might find these links helpful :
healthunlocked.com/thyroidu...
endocrinologyadvisor.com/dd...
Thankyou
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