Thyroid UK
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Genova Shock!

Firstly, some test results:

TSH 2.8 (0.4 - 4.0) High

T4 74 (58 - 154) Low

FT4 12 (12 - 22) Low

FT3 6.88 (2.8 - 6.5) High

FT4:FT3 ratio 1.8 (2.0 - 4.5) Low

RT3 0.30 (0.14 - 0.54) OK

Anti bods both less than 30.

I've read somewhere about the ratio of ft4 and ft3 but where? Can anyone help with this and why is it important?

Mostly though was the comment on the reverse of the page stating, 'Higher than optimal TSH. Suspect low grade/sub clinical hypothryoidism since 'TSH LEVEL IS THE MOST SENSITIVE INDICATOR OF THYROID FUNCTION'.

Really! Even Genova is using the TSH as a marker and noting it as the most sensitive indicator? This doesn't help us at all does it?

40 Replies

oh dear no, that's NOT good is it??

I think when I have finished my university work (have an essay to hand in soon) I will roll up my sleeves and write up something to send to them, they HAVE TO LEARN right?


yes i am shocke dtoo altho i have ha dthyroids done by them but it didnt dawn on me that tsh was GOD... YES EVERY ONE HAS TO LEARN IT IS SOOOOOOOOOOOOOOOOOO FRUSTRATING.


At least they mentioned it was high, most say in normal range! But agree that it being the most sensitive is misleading at the very least!


what's optimal? you look to be pretty much in the middle of the range, I'm confused


Optimal doesn't mean middle of the range, it means the dose you feel good on, the dose on which all your symptoms have disappeared. That's the problem with most doctors, they want to just get you 'in range' and they don't care where in the range. That's why so many people never get well. For most people 'optimal' is up near the top of the range - or even over the top.

Besides, the ranges are a nonsense! Have a look here :

'A standard thyroid panel usually includes TSH and T4 only. The ranges for these markers vary from lab to lab, which is one of two main problems with standard lab ranges. The other problem is that lab ranges are not based on research that tells us what a healthy range might be, but on a bell curve of values obtained from people who come to the labs for testing.

Now, follow me on this. Who goes to labs to get tested? Sick people. If a lab creates its “normal” range based on test results from sick people, is that really a normal range? Does that tell us anything about what the range should be for health? (For more on the problems with standard lab ranges, watch this great presentation by Dr. Bryan Walsh)'

Hope this helps, Grey


That is a good link, thanks.


You're welcome, cinnamon_girl, I aim to please!


Hi Sambonjela

Yes, the bloods were done privately as I could not get all done in one hit at the same time. Plus rt3 and ft3 are very hard to come by. These were sent off as I have been unable to get anywhere with my own NHS GP.

If Genova are happy to quote the TSH fugure alone as indicative then already there is a query. (Their range is not far from NHS in the area I am). Their 'assumptin' is that I am already sub clinical hypo).

If we ignore the note about this we can also still clearly see that both t4 and ft4 are very low creating red markers on the results sheet.

I also see that ft3 is shown in red as it is above range. Finally, the ratio between ft4 and ft3 is marked red as bwlow range.

I certainly could have sent off details of my general health but they do not requite this and I probably wouldn't be spending scare resources on private bloods if I were feeling fit and healthy.

So... it works for me as an additional source of evidence that there is something really not quite acceptable about the way my hypothalumus/pituitary/thyroid is actually working.

Indeed, I just wish I felt 'optimal'.

Hope this info helps your understanding.


Hi Tulula,

I know a blood test is simply a count of elements within a blood sample and they would not ask you to complete a questionnaire. A blood test doesn't assume anything, I'm not sure what you mean by their 'assumptin'?

I don't want to ignore the note, because that's what I'm curious about - why is it that they think the TSH is 'higher than optimal' when it's bang in the middle of the range?

It is not likely that there is a single number for optimal range (like 1 someone else suggested) given that there is natural variation between individuals, and given that the number a blood test finds will vary depending on the day/time etc. that the sample is taken.

If I were you I would want to understand why they feel its too high, given the range they have provided


I am pretty sure most endos consider optimal TSH to be 1. I've hear that a lot. Yettttt they won't diagnose hypo unless you go above the top of the range of the particular lab. Hmmmm do they teach logic at medical school?!

I prefer to use the term 'set point' when establishing where my TFTs need to be for me to feel well. Mine happen to be surpressed TSH and FT's in the upper range (I was under the impression that is the same for a lot of people too!).

Of course this is just IMHO!


Yes this is where I feel well too - or for me TSH suppressed, FT4 mid-range and FT3 near to top of the range :)


When the TSH is high, it IS a pretty good indicator and in their estimation, 2.8 IS too high so within your criteria, it seems all right to me. Perhaps these will help.


their estimation based on what?? within her criteria what seems all right to you?


I think she means that in their estimation TSH is too high - even though it is in the "flawed" normal range, as most healthy people have a TSH of under one. As Grey says the normal ranges are anything but for most people.


I think she should go back to them and ask them


I can only give you the information that is shown at the bottom of the page:

'Optimal Range' - The functional approach, orientated around changes in physiology and not pathology. This results in a tighter range, increasing the ability to detect patients with changes in physiological function'.

Their 'optimal' range for TSH is between 1.0 and 2.0. I hear what you are saying - on what do they base this decision?

Yes, maybe that would be an interesting question to pose to them at some point.

'Reference range' - The conventional or standard laboratory normal range designed to identify and diagnose disease states and pathology'.

Ft3 and ft4 - ft3 ratio are two readings that fall outside of both of these areas, whilst t4, TSH, and ft4 individually fall outside optimal but within reference.


No, you've answered the question - they give optimal range as being between 1 and 2 and not the range they provide next to your result.


Yes, apologies if my original question mis-led anyone. Genova work on the basis of breaking down the result into more than just 'normal' or not it seems.


My other 'evidence' is that my TSH reading has been rising continually from 1.54 to 2.8 now over the last 3 years whilst ft4 remains down at 11 or 12 at all times and I feel this must be indicative of something.

That is irrelevant of NHS or private testing.


I wasn't asking for 'evidence', I was just confused about the statement they'd put on the back - hence the question. I understand you may feel that I was questioning something, but as I said before that was actually a response to Greygooses post and nothing to do with your original post or my question in response to it.


sam, maybe this will help you see the difference between normal and optimal.

Do you see they calculate "optimal" by looking at all three readings. I'm just saying Genova says 2.8 is not optimal for her (in spite of being in the range) maybe because of her high FT3 reading.

Genova has been around for a long time being formerly known as Great Smokies Lab. It is good that they recognize the difference between being "in range" and "optimal".


Hi there

Genova consider 1.0 - 2.0 to be 'optimal' according to their information page. What exactly this is based on for them I don't know but by all the reading that I have done over the last 3 years I accept that they have good reason to do so.


I think quite a few people would find 2 to be too high for them - most people seem to feel well with a TSH under 1, but every one is different:) I am feeling well now that my TSH is 0.02 :D xx


I think I have read that a low FT4 and high FT3 can happen when hypothyroidism is taking hold - as the body detects the low F4 and ramps up conversion to T3. I think the high FT3 can then suppresss the TSH more than would otherwise be the case. Sorry not sure where I read this though. xx


I've read this too - lots!


That's interesting, Clarebear and if my recent experience is anything to go by, that makes sense. @ tulula, as you mentioned in the other thread yesterday, we've had quite similar results. My FT4 is 9.78 (L) and my FT3 is 7.46 (H) and although I haven't been well for a while, I've been feeling particularly bad for the past couple of months which may suggest it's getting its claws in. Yikes! xx


Tis a woory I must say but quite where to go now I don't know. I think I will add an adrenal test to this and I have found a great piece of info in an old book from 1980 of all times that I cannot copy and paste from so will try at some point to rewrite this.

It is only on google books and I cannot find a coopy anywhere.



Can you give details here of the book's author and title? You never know, there's always a remote chance someone reading here happens to have a copy!



ISBN : 0960590234

Clinical Nutrition--Seven Lines of Defense Against Disease

By Robert J. Peshek 1980

Would be really helpful if anyone could access this book. Page 9 - 15 is particularly interesting on FT4-FT3 ratio and menopause etc.


my tsh is 2.84 but wasn't marked high, how come geneova marks it high but blue horizon don't x


Hi Nicola

I'm not sure why they should be different.

Genova have a range of course but seem to divide this range into low, medium and high - within the actual 'range'.

i.e. their range is 0.4 - 4.0. if you score between 1.0 and 2.0 this is considered optimal (the best place you can be). Between 2.0 and 4.0 you are considered outside optimal range but still within range. The same is for a score of 0.4 - 1.0 but this would be low within the range.

They explain this as: 'Optiomal Range' - The functional approach, oreintated around changes in physiology and not pathology. This results in a tighter range, increasing the ability to detect patients with changes in physiological function'.

In other words I suppose they have realsied that many people can feel unwell physically between 2.0 annd 4.0 even though they may not be pathologically (medically deemed) ill.

Does this help at all?


Yes it do thanks, I wish I went with them so I could show my endo that, as my tsh last month was 2.84 x



I'm completely stuck right now as the high FT3 result with no antibodies etc tells my GP and the endo she spoke with that I'm actually doing fine as my body is converting T4 into T3 etc apparently very well.

So.... despite the news from Genova I can't really take it anywhere else unless I want to see someone privately which is not really possible right now.

Good luck though and let me know how it pans out for you over the coming weeks etc.

Gilly x


my ft3 was 5.3 and ft4 was 15.0 not sure if I will get help, im seeing dr p next Wednesday x


can I be cheeky and ask how much you paid for all that I want the thyroid one but also with the rt3 I haven't had that one done? x


Of course, I had T4, FT4, FT3, RT3, TSH and both antibodies done with them (the extra RT3 is an add-on to their slightly cheaper test) for £136.

The turn around time is about 10 days.

The reason I went with this is because I wanted to get everything done from 1 sample at the same time. Plus, I had the sample done at 8.45am as early as possible.

I was lucky to get it done by a phlebotomist that I know on the quiet.

Do let me know how you get on next week.


£1.36 for the lot? Do you remember the name of the test that's cheap, I would just have a problem getting someone to do the blood work that's why I done the bluehorizon one x


Hope you didn't misread that - £136 not £1.36. LOL

The one that didn't include RT3 was around £99 I think.

Yes, getting the test done is also a problem, there are Spire hosps that will take it for a fee (you can find out about these on the Genova website) and apparently some GP's surgerys will do it at a cost but I didn't want my GP to know so had to find some other way.

It's difficult - they don't make it easy for us do they!


Wouldn't it of been nice if it was that cheap lol no I used my phone and it got a habbit of putting the dots in lol x


Sorry for late reply, but if you can get to Genova (very close to Motspur Park railway station), they'll draw the blood for you, free of charge as far as I'm aware but check first.


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