TSH in range T4 below range

[Chalkie1965]

hi my private blood test revealed TSH 2.88 and T4 11 range being 12-22 my SHBG is also below range. I’ve been poorly for over 2yrs which initially started with digestive issues, neck and back pain, tingling and numbness etc. any idea why TSH is ok but T4 low? My T3 was in range too. Many thanks

[SlowDragon Administrator]

welcome to the forum

Just testing TSH and Ft4 is inadequate

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

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)

NHS only tests TG antibodies if TPO are high

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)

Essential to test vitamin D, folate, ferritin and B12

Lower vitamin levels more common as we get older

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels

What vitamin supplements are you taking ….if any?

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

thyroiduk.org/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...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endocrinenews.endocrine.org...

In days 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 if last test result serum B12 was below 500 or active B12 (private test) under 70

[Chalkie1965 in reply to SlowDragon]

Hi thanks for reply T3 was 5 range 3.1 - 6.8 I don’t take biotin. Many thanks

[Chalkie1965 in reply to Chalkie1965]

I’m not diagnosed

[SlowDragon Administrator in reply to Chalkie1965]

Ft3 looks good

Next step test full thyroid including both thyroid antibodies and all four vitamins

And an ultrasound scan of thyroid, especially if nether antibodies are not over range

[Sleepman]

Hi and welcome.

Do you take thyroid hormone or are you undiagnosed?

YourT4 should not be below range and needs doctors input.

What was your actual T3 number and range?

Ask doctor to measure for thyroid antibody.

Hi dose biotin( vit b7) can affect blood results. We stop supplementing a few days before tests.

[greygoose]

What time of day was the blood draw for this test? Was it fasting?

It rather looks like you have a pituitary problem and the TSH is not responding correctly to th low T4, what we call Central Hypo. But you'd need further testing to see if this was the case.

In any case, having an FT3 higher than the FT4 suggests that your thyroid is failing. Unfortunately, doctors don't know enough about thyroid to recognise the problem.

[Chalkie1965 in reply to greygoose]

It was took at around 9am and I had a cup of tea before test.

[greygoose in reply to Chalkie1965]

OK, so that could have lowered your TSH slightly, but even so, your TSH just does not correspond to your low FT4, it should be higher.