Are conventional thyroid function tests as reliable as we’re led to believe?

This morning, I saw this piece of news on the BBC website which reports on the accusation some doctors (endocrinologists) have leveled that some doctors are misdiagnosing and mistreating thyroid disease. The main gripe appears to be the fact that some doctors are willing to entertain the diagnosis of low thyroid function (hypothyroidism), even when blood tests are normal. Moreover, thyroid hormone can be initiated in these patients, which may be harmful.

Key to understanding why some doctors do not put their full and utter faith in conventional blood tests when assessing thyroid function is a knowledge of the normal physiology of the thyroid. The thyroid is responsible for producing thyroid hormones which stimulate the metabolism and facilitate energy production in the body’s cells. The two main thyroid hormones are T4 and T3. A lack of thyroid hormone can lead to symptoms such as fatigue and lethargy, mental fatigue, low mood and/or depression, weight gain, sensitivity to cold, cold extremities, hair thinning and loss of eyebrow hair in the outer margins.

In an effort to stop this happening, thyroid hormone levels are monitored in the brain. If the levels of these fall, the pituitary gland (at the base of the brain) is instructed to secrete a hormone known as thyroid stimulating hormone (TSH) which is designed to instruct the thyroid to produce more thyroid hormone. As thyroid hormone levels go up, this is sensed by the brain, which then reduces its production of TSH. This mechanism is believed to maintain adequate thyroid hormone levels in the majority of individuals.

However, if for whatever reason the thyroid fails to produce sufficient thyroid hormone levels, TSH levels may continue to rise, to the point that they become higher than normal. This finding, coupled usually with a low T4 level in the blood, is used generally used to diagnose low thyroid function (hypothyroidism). Sounds good so far, except that there are a number of reasons for why someone’s TSH level may not always be relied upon to give a definitive measure of someone’s true thyroid status.

One reason concerns the ‘normal’ ranges of hormones themselves. Some individuals believe that these are simply set too wide. What is regarded as ‘normal’ is essentially arbitrarily set. Many labs here in the UK set an upper limit of normal of TSH of 4.0 mU/L. However, other labs, I have noticed, set an upper limit of more than 5. Last week I saw a patient who came with a previous blood result from last year that stated an upper limit of 5.6. And now consider this: some years ago the American Association of Clinical Endocrinologists recommended that the upper limit of TSH be lowered from 5.0 to 3.04. Overnight, as a result of this change, the number of individuals who could be classified as hypothyroid on the basis of their TSH level more than quadrupled.

Now, if assessing thyroid status with TSH levels is such a precise art, how is it that upper limits of TSH vary so widely?

Another reason why TSH may not reflect true thyroid status relates to the fact that the brain and peripheral tissues (outside the brain) can sense thyroid hormone levels different. Imagine, for a moment, that the tissues in the periphery are somewhat resistant or ‘numb’ to the effects of thyroid hormones (in a way similar to the situation when tissues become resistant to insulin). But let’s imagine there is no such problem in the brain. Then what can happen is the brain thinks there’s enough thyroid hormone around, while the rest of the body is in fact deficient in thyroid hormone and therefore exhibiting the symptoms and signs of hypothyroidism.

Even if the brain correctly senses a deficiency of thyroid hormone, that does not mean the pituitary will automatically respond appropriately. It is recognized that thyroid failure can be secondary to failure of the pituitary gland to produce sufficient TSH. This condition, known as secondary hypothyroidism, is traditionally characterized by low levels of TSH. However, it is possible that less severe failure of the pituitary may lead to ‘normal’ levels of TSH in individuals who have a genuine problem with hypothyroidism.

To my knowledge, none of these mechanisms have been nailed down. However, all of them, to my mind anyway, represent plausible explanations for how someone with signs and symptoms suggesting hypothyroidism can end up with ‘normal’ thyroid hormone test results.

Further doubt about the validity regarding ‘normal’ TSH levels comes from research which has linked higher TSH levels (though still within the ‘normal’ range) with an increased risk of weight gain and cardiac-related death. See the previous blog posts here and here for more about this.

So, bearing this in mind, I don’t think it’s too unreasonable that some practitioners do not to put their full and utter faith in conventional thyroid blood tests and their traditional interpretation when assessing thyroid status. It seems that some practitioners seem to be aware of the limitations of the traditional approach, and may prefer to treat the patient rather than the test results. It is, I believe, possible for individuals to present what looks, on the face of it, to be a clear case of hypothyroidism but, at the same time, yield ‘normal’ thyroid function tests. It is also possible for these individuals to find their health transformed on the initiation of thyroid hormone therapy.

Of course, there is a risk to treating with thyroid hormone, and they most certainly should not be doled out like sweeties. There is some thought, for instance, that thyroid hormone therapy can increase the risk of osteoporosis. However, if treatment is really surplus to requirement, then side effects such as a rapid pulse, undue anxiety and sleeplessness usually give this away.

And while there are risks to treating, what I think is sometimes forgotten is that there are risks associated with NOT treating too. Because if someone has genuine hypothyroidism (even if blood tests are normal), then not treating can consign them to a life of fatigue, low mood, depression and weight gain about which they often can do very little. Make no bones about it: undiagnosed and untreated hypothyroidism can have a devastating effect on health and quality of life.

Worse still, individuals with a genuine problem can end up being persuaded that, in the light of normal test results, their issues are all in their mind or perhaps simply due to ‘depression’. The suggestion appears to be that the tests can’t be wrong and that the doctors who treat such individuals must be. Are we to believe that individuals whose symptoms strongly point to low thyroid function improve out of sight on thyroid hormone therapy can only be exhibiting some glorified placebo response? Or perhaps their recovery was just a figment of their imagination. Or their doctor’s. Silly people.

50 Responses to Are conventional thyroid function tests as reliable as we’re led to believe?

  1. Hilda Glickman 28 March 2009 at 12:28 am #

    Dr Briffa- Any idea why I have high TSH, low T4 but when T3 was tested it was three times the normal amount?

  2. Janie Bowthorpe 28 March 2009 at 12:28 am #

    As author of the book Stop the Thyroid Madness: a Patient Revolution Against Decades of Inferior Treatment, and owner of the website……I am proud of you!

    I have a 45 year old niece who had a “normal” TSH for 15 years, yet we now see she had clear hypothyroidism with a variety of symptoms to match the entire 15 years! She was put on an anti-depressant, told to exercise more and eat less, and told that her fatigue is “simply” from being a mother of ONE child.


    As a result of being held hostage to the TSH “normal” range, and being forced to live with undiagnosed hypothyroidism, my niece also now has adrenal fatigue—another complicated condition to treat, and important to treat so she can tolerate T3 in Armour.

    And the above scenario has happened to MANY patients, even if they didn’t have to go so long. It has also happened to those on the inferior levothyroxine, which leaves most everyone with their own variety of lingering hypothyroid symptoms.

    Thank you for being open-minded, Dr. Briffa!

    p.s. Here’s my latest blog post about the idiocy of what’s going on in the UK:

  3. Joe 28 March 2009 at 8:20 am #

    Dr. Briffa,

    I have a family member whose hands can feel like icicles at some times and then be extremely warm at others, regardless of ambient temperature, and there seems to be little rhyme or reason to this.

    With hypothyroidism, would the hands almost invariably be cold or would there be wild unpredictable fluctuations like this? Or does this sound more likely to be auto-immune related? I realize you can’t determine much based upon so little info, but any input at all would be much appreciated.

  4. Dr John Briffa 28 March 2009 at 10:20 am #


    Anything’s possible, but it doesn’t sound much like hypothyroidism to me, especially if there are little or no other signs and symptoms of this condition. A more likely diagnosis, I think, is Raynaud’s phenomenon.

  5. Dr John Briffa 28 March 2009 at 10:24 am #


    I’ve not seen results like these before. One thing to consider is the possibility that much of your T3 is in the form of the inactive ‘reverse’ T3.

  6. Tony 28 March 2009 at 12:28 pm #

    Interesting. But how can you be sure that the diagnosis of hyperthyroidism without a positive test result is correct and that a response to THT is not a placebo response (it doesn’t have to be ‘glorified’)? After all, the symptoms could be symptomatic of something else.

  7. Tony 28 March 2009 at 12:30 pm #


  8. Tony 28 March 2009 at 3:17 pm #

    “Very clearly written John. Perhaps this should be circulated round GP practices or published in their journal.”

    But why would this article be more useful for GPs than the guidance from the Royal College of Physicians (which says the only accurate way to diagnose a thyroid disorder is via a blood test) or the British Thyroid Association (which says urine tests, saliva tests and measuring body temperature are not reliable ways of diagnosing the condition)?

    Diagnosis by the presentation of symptoms is also fraught with difficulties, as the BBC article says:

    Symptoms can include being very tired, feeling the cold, having difficulties with memory or concentration, weight gain and fertility problems. These are symptoms that can mimic other conditions, and experts warn an incorrect diagnosis could mean some patients could suffer harmful effects from excess thyroid hormones, while other serious conditions may go undiagnosed.

    The BTA is concerned about doctors outside the NHS and misnformation on the web, not GPs.

  9. Trinkwasser 28 March 2009 at 3:38 pm #

    Couldn’t agree more, over time I’ve met not a few people whose symptoms, including diabetes (both types) and “depression” especially treatment-resistant depressions, have resolved or improved from a geographical move from an area where TSH of 5 or even 10 was considered “not to be treated” to somewhere they are more aggressive. One person lost nearly half her body weight and improved her IQ back by 50 points

    Some people actually need TSH around unity to become “normal”. Others may have “normal” TSH but T3 or T4 is way out – hard to tell as many labs don’t do these tests, even one friend was unable to get hers tested privately as the lab didn’t have the kit. Sometimes a simple prescription like a brazil nut a day (for selenium) or iodised salt may help with the conversion.

    Our GP here are very proactive and find low thyroid not uncommonly, principally but not exclusively in post-menopausal women, with incidence increasing with age. Whether this is a local or general phenomenon is impossible to tell since so many other regions simply don’t look, or don’t treat.

    IMO this is a typical NICE/meeja scare story, it’s not implausible that some people are unneccessarily treated but the number of untreated cases which should be addressed is probably several orders of magnitude greater

  10. Tony 28 March 2009 at 3:59 pm #

    Is this really an issue with the reliability of the ‘conventional thyroid function tests?’ as the blog titles states or is about how the results of the test are interpreted?

    And now consider this: some years ago the American Association of Clinical Endocrinologists recommended that the upper limit of TSH be lowered from 5.0 to 3.04. Overnight, as a result of this change, the number of individuals who could be classified as hypothyroid on the basis of their TSH level more than quadrupled.

    I believe the estimate was in increase in the US was from 13m to 27m, not a quadrupling but in any event, what is the issue with this? The AACE changed their guidelines because data suggested that low-level thyroid problems were being missed and that a narrower TSH range would allow doctors to consider these cases more carefully. Here’s the press release:

    This does not cast doubt on the reliability of the test itself. Is this any reason to disregard it?

    Also isn’t it relatively simple to discount secondary hyperthyroidism during diagnosis since signs are very different?

    Hyperthyroidism – thyroid enlargement or goiter, increased heart rate, systolic blood pressure may be high

    Seconday hyperthyroidism – small thyroid gland, slow heart rate, low blood pressure, and low temperature

  11. Sylvie 28 March 2009 at 4:30 pm #

    Once again it takes John Briffa to get to the heart of a problem that affects so many people. To anyone who has an interest in this subject I would strongly recommend Broda Barnes’ book “Hypothyroidism, the Unsuspected Illness” as bedtime reading. Barnes main philosophy was “Health begins and ends with the proper balance of the endocrine system” and he also gave us these two key discoveries:

    1. The development and use of thyroid function blood tests left many patients with clinical symptoms of hypothyroidism undiagnosed and untreated.

    2. Patients taking thyroid replacement therapy have much better improvement of symptoms with natural desiccated thyroid hormone rather than synthetic thyroid hormones.

    Barnes also investigated the link between hypothyroidism and hypoglycaemia which links in with a whole range of issues that John Briffa discusses, and, I would suggest, is essential reading for diabetics.

    A final bit of info – just because you take thyroxine don’t think that that’s the problem solved. If you feel tired get your levels checked again. My sister has jus had her dose quadrupled and my mother’s dose has just been increased by 30% so it does need continuous monitoring and rechecking if symptoms reappear. Also if you’re tired still get your iron levels checked…..

  12. Sylvie 28 March 2009 at 5:11 pm #

    Oh yes, I also forgot to mention the Zone diet and it’s followers amongst those with inflammatory conditions, which is also, with a bit of tweaking, the diet recommended by Broda Barnes…..also don’t get put off by Barnes being a little out of date – the chap spent 50+ years studying this stuff – he knew what he was talking about!

  13. Hilda Glickman 28 March 2009 at 6:12 pm #

    Carol. I would get T3 tested, plus revers T3 ans antibodies, also candida and go to a naturopath or nutritional doctor to look at adrenal fatigue and diet especially essential fats as hormones have to lock on to cells which is affected by haning the right fats in the membrane. Hilda Glickman, nutritionist

  14. Roz Kadir 28 March 2009 at 9:19 pm #

    Very clearly written John. Perhaps this should be circulated round GP practices or published in their journal. As you say, sadly there are many people suffering with low thyroid who don’t get treatment because the blood tests are “normal”. Do you think any other tests are more useful such as looking at antibodies or the Broda Barnes test?

  15. Sassy 28 March 2009 at 9:48 pm #

    One of your readers from the USA. Found this interesting as I was treated with anti-depressants for a period of time — and then taken off them when physical symptoms got worse. Eventually, my doctor attended a lecture on thyroid developments, tested my free T4 and free T3 and began treatment with supplements of both. She determined that I should never have been on the anti-depressants. Since then I have begun to recognize when I need to be retested and the meds adjusted. As it turns out, a mid-range free T3 for me means I have symptoms; two days of increased T3 supplementation and I’m back to feeling like a normal person. I have been driving friends crazy suggesting that they get proper thyroid testing, since throughout the last three years, my TSH has remained “normal.” So anytime I see doctors considering that it is not the perfect test so many believe it to be, I want to applaud.

  16. Jenny 28 March 2009 at 10:20 pm #

    This re-enforces a feeling I have had for some time.
    I am a herbal practitioner of 22 years in practice and many a time I have had people (mainly women of a certain age), with glaringly obvious low thyroid symptoms, but a negative blood test.
    I have, in most cases, gone ahead and treated them as if they had low thyroid function, with a degree of success.
    Overall treatment invariably includes treatment for the pituitary gland, especially if distressing menopausal symptoms are part of the picture.
    One saving grace in this approach is that herbal medicine does not ‘replace’ thyroxine, but encourages the natural production of any needed hormones.
    Jenny Jones

  17. Katy 28 March 2009 at 10:38 pm #

    Thank you for this excellent article.

    I am interested to see that you don’t mention another increasingly common cause of hypothyroid symptoms alongside normal TFT results – the conversion from T4 to T3 within the body’s cells, for reasons such as low enzymatic function or hormone resistance in general.

    In my case, this was the problem, and my low thyroid function turned out to be secondary to Chronic Fatigue, and once I was treated with nutritional medicine over several months, my body started to function better, which had a knock-on effect on my conversion levels revealed in subsequent thyroid function blood tests. After over three years of taking natural thyroid hormone to support my low thyroid function, I’ve now been able to stop the supplementation. My eyebrows have returned and my body temperature is 98.4F for the first time in my adult life (I’m 49). Hopefully one of the steps towards full recovery!

  18. Dr John Briffa 28 March 2009 at 10:50 pm #


    You’re very right about this: It’s not that uncommon to find someone with ‘normal’ TSH and T4 levels to have low or low-normal T3 levels. I find that getting T3 levels up (treatment with T4 won’t always do this, as you suggest) is often key to resolving hypothyroid symptoms.

  19. Sally 29 March 2009 at 12:48 am #

    Thank you for this article – it is very timely.

    I was diagnosed as hypothyroid 5 years ago and have been very frustrated with the “treat-the-labs” approach, as a result of which I sought the guidance of a naturopath who immediately diagnosed adrenal fatigue, low iodine, low B12, and low iron to mention just a few items. As I have found out, these are all part of a classic constellation of symptoms/deficiencies that present with hypothyroidism and may actually cause hypothyroid symptoms OR be the result poor thyroid function, so I am particularly disappointed that my ‘tradtional’ PCP and endocrinologist didn’t test for these very basic items. Iodine especially seems to be key to optimum thyroid function, and to test for it is relatively simple and inexpensive (a 24-hour urine test), especially compared to some of the more ‘high tech’ tests such as radioactive iodine uptake studies which seem to be more popular among specialists.

    If we are going to use lab results, they should at least be scientifically standardized and should be regarded as PART of the diagnostic process. They should also include testing for the above mentioned minerals/vitamins in addition to relatively obscure but essential items such as reverse T3.

    Again, thanks for your articles on this. The more patients are aware, the more they can advocate for themselves and find doctors who are willing to work with them holistically instead of as lab data.

  20. Carol Homer 29 March 2009 at 2:18 am #


    I have been taking thyroxine for at least 8 years now and despite jogging and walking for 30 mins three times a day, eating a low carb diet I am so pooped at the end of the day I sometimes sleep for two hours before supper. I also am bi-polar (JUST CONFIRMED) and don’t seem to have the mental energy to keep fighting with my body. My weight has gone up from a consistent 9.5 stone to 12.5 and yes I am 53 but PLEASE don’t anyone tell me its my age or I’ll scream.

    Any suggestions – PLEASE

  21. Dr John Briffa 29 March 2009 at 10:53 pm #


    “But how can you be sure that the diagnosis of hyperthyroidism without a positive test result is correct and that a response to THT is not a placebo response (it doesn’t have to be ‘glorified’)? After all, the symptoms could be symptomatic of something else.”

    Many individuals with symptoms and signs of hypothyroidism see satisfying and lasting resolution of their symptoms when treated with thyroid hormone despite the fact that they have ‘normal’ thyroid functions. No-one can be absolutely certain that the underlying problem is hypothyroidism, but when individuals with clear signs and symptoms of this condition see resolution of these on initiation of thyroid hormone therapy, that does I think point strongly to the underlying problem being hypothyroidism.

    “After all, the symptoms could be symptomatic of something else.”

    Could you provide some example of conditions that closely mimic the signs and symptoms of hypothyroidism? Can you also list conditions that not only mimic the features of hypothyroidism, but also resolve on initiation of thyroid hormone therapy?

    “But why would this article be more useful for GPs than the guidance from the Royal College of Physicians (which says the only accurate way to diagnose a thyroid disorder is via a blood test) or the British Thyroid Association (which says urine tests, saliva tests and measuring body temperature are not reliable ways of diagnosing the condition)?”

    Because, for the reasons stated in the blog piece, conventional blood tests cannot be relied on to make a diagnosis of hypothyroidism. And as a result, many individuals seem to be going undiagnosed and untreated. Maybe some people would benefit from GPs being more aware of these issues.

    “Is this really an issue with the reliability of the ‘conventional thyroid function tests?’ as the blog titles states or is about how the results of the test are interpreted?”

    The blog questions the wisdom of relying on conventional blood tests in diagnosing hypothyroidism hence the use of the word ‘reliable’ in the blog title. I also refer to the interpretation of these tests in the blog.

    “I believe the estimate was in increase in the US was from 13m to 27m”

    Can you quote a source for this please?

    “The AACE changed their guidelines because data suggested that low-level thyroid problems were being missed and that a narrower TSH range would allow doctors to consider these cases more carefully.”

    Yes, precisely.

    “This does not cast doubt on the reliability of the test itself.”

    Well, if the test is so reliable, what do you make of the fact that there is such variance in terms of the acceptable upper limit of normal for TSH?

    “Also isn’t it relatively simple to discount secondary hyperthyroidism during diagnosis since signs are very different?”

    Here and elsewhere in your comments you’ve referred to “hyperthyroidism”? But my blog is clearly about hypothyroidism. Nowhere in my blog do I refer to hyperthyroidism. Neither do any of the commenters here. You do not refer to hypothyroidism once in your comments. Your comments refer only to hyperthyroidism.

    Tony, can you explain why you repeatedly refer to hyperthyroidism but not once to hypothyroidism? Could you explain your understanding of the terms ‘hypothyroidism’ and ‘hyperthyroidism’? Might you also give an account of what you understand to be the common underlying biochemical imbalances and features of these conditions?

    Can you perhaps tell us what experience you have of hypothyroidism and hyperthyroidism (either from an academic or clinical perspective) so that we can perhaps understand how you could possibly confuse these conditions?

  22. Jennifer Eloff 30 March 2009 at 10:45 pm #

    One of the best ways to test for hypothyroidism is still the basal temperature. Upon awakening 96.5 and below – good chance the person is hypothyroid. Follow-up tests (FT4, FT3, TSH), looking for a goiter and thyroid antibody tests, possibly a fine needle biopsy, etc. should then be done.

    Some doctors will say this is an old method (temperature taking) – but I believe it is tried and true and is a very good indicator of what is happening to the metabolism as well.

    Hashimoto’s Thyroiditis in 70% of cases is as the result of a mycoplasma infection – treated with doxycycline in small amounts, a remission of the disease could occur in some cases.

  23. L Vaughan 1 April 2009 at 11:18 am #

    Thank you, Dr Briffa, for speaking out once again on this issue. As a hypothyroid patient who has seen much better clinical results with combined T4/T3 treatment (specifically natural thyroid extract) than with T4 only, and with a treated TSH suppressed below the normal range, this reiteration of dogma by the Royal College of Physicians is both alarming and frustrating. One can only hope that dissenting voices like yours can help to balance the medical climate somewhat.

  24. Liz Smith 1 April 2009 at 11:36 am #

    Dr Broda Barnes years ago put forward the theory of basal temperatures showing suspect thyroid action. The only time I got my temp up to 38c was when I had terrible fever. When I first started taking it, it was normally 34c but was told that ‘no one took temperatures now to check thyroid problems. How many people are still using fluoride toothpaste, that is one aggravation – there are lots of toothpastes without it. The Australian Thyroid Association (?) had information questionaires to check symptoms and there are pages of symptoms. To tick more than about eight symptoms is asking to be called a hypocondriac by your GP. Good article about taking either natural or synthetic hormones. I have taken only natural, but my adrenal function is suspect too.

    I have done a ‘family tree’ of all my cousins and their children, as I’ve read its hereditary. Of the 16 of us, 12 have below normal temperature, weight problems, depression,constantly tired etc. Not being a doctor they dont take my advice and get their thyroid checked, even my sister who had goiter many years ago. Most of them have have been checked and told its not thryroid. The difference it makes to your life when you get the medication correct is just too good to be true.

  25. Dr John Briffa 3 April 2009 at 8:42 pm #


  26. Dr John Briffa 15 April 2009 at 9:31 am #



  27. Pamela 15 April 2009 at 5:17 pm #

    I have a referral letter from an osteopath to have tests for T3, T4 and Thyroid antibodies. My TSH level is “normal” at 2.9. My doctor says the lab wouldn’t do the other tests with a “normal” TSH. Where can I obtain private blood tests without a referral from my doctor for these in the North West of England?

  28. Jackie Bushell 16 June 2009 at 4:09 am #

    When will the ‘authorities’ realise that there is a lot of ‘self-treatment’ going on, and will continue to go on, in the area of hypothyroidism, whether they declare that treatment ‘wrong’ or ‘dangerous’ or not?

    Now that we underdiagnosed/undertreated hypothyroids can access information for ourselves via the internet, and more sources of information are becoming available (such as hypothyroid patient websites and books such as Dr Peatfield’s ‘Your Thyroid and How to Keep it Healthy’ and Janie Bowthorpe’s ‘Stop the Thyroid Madness’), we are no longer content to suffer with our symptoms just because the blood tests are so-called ‘normal’. We go to brave doctors like Dr Peatfield or we take our information from internet forums populated by other people who have consulted him or other like-minded medical professionals, and we order our natural desiccated thyroid, T3, adrenal supplements etc direct from online suppliers. So we’re ‘hidden’ from the official statistics.

    If the ‘authorities’ were bothered to find out how many hypothyroids are self treating, they would probably be aghast.
    But they should ask themselves why do so many people feel the need to do this, particularly in the UK where medical treatment is theoretically free.

    The ‘authorities’ simply have their heads in the sand over the diagnosis and treatment of hypothyroidism. In my blog at there’s a link to an excellent paper on the treatment of hypothyroidism by thyroid expert Dr John C Lowe. I hope one day the ‘authorities’ will recognise its value. Until then, those of us who need help will simply ignore GPs and endocrinologists who either believe or are forced to toe the official line, and continue to self treat.


  29. nikki 24 June 2009 at 9:20 am #

    please can you help me?my endocronologest will not give me thyroxine because he says my thyroid levels are IN MID RANGE! even though he knows im presenting ALL the symptoms of slow thyroid. my gp says im deprressed(surprise surprise!) i challenged him to put me on thyroxine for 4 months and if it didnt work id take all the anti depressents he could throw at me! for those 4 months i felt better than i have for 9 years. my hair started to grow as did my nails,eyebrows.cuticals ect i lost weight my bmi came down to normal my collesterall came down the list goes on and gp sent me to a so called specialist i have had no thyroxine for nearly 5 months now he says my throid levels are mid range even though he accepts the theory that MY thyroid might run at a much higher rate than mid range he refuses to give me thyroxine. i begged him in tears he has sighned me out of hospital care and told me hes just had the exact same conversation with the last 3 women patients hes had. they left crying too. please can you help me i can not live any longer like this. this is not liveing i just exist.iv tryed to keep it short as the list goes on and on. im so desperate im thinking of buying levothyroxine off the internet from the usa but im scared incase the place shuts leaveing me high and dry or i give myself to big a dose.i can not live much longer in this state nor do i want to.

  30. Claire 1 August 2009 at 1:58 pm #

    Nikki, you need to go private and see a Doctor such as Dr Briffa or Dr Skinner (Birmingham) who will be able to help you even though your blood test results are ‘normal’.

    You don’t have to live with depression and all the other symptoms but i would probably give your usual Dr and endocronologist a wide bearth…some people have their minds shut and it’s a waste of time trying to convince these people. Instead see someone who understands the problems with the blood tests results….get better and have the last laugh.

    Best of luck with everything,


  31. Kit 10 August 2009 at 11:19 pm #

    Dear Dr Briffa,

    I became depressed, sluggish, tired all the time and gained a lot of weight 17 years ago at the age of 13.

    My lab results for TSH and T4/T3 are normal according to my doctor, but I took my temperature on waking this morning and it was 34.6 degrees celsius.

    Could this be a case of hypothyroidism? And is it essential to use a mercury thermometer? I have been using a digital one as I find them less fiddly.

  32. Dr John Briffa 11 August 2009 at 6:02 am #


    “Could this be a case of hypothyroidism?”

    In a word, “yes”.

    “And is it essential to use a mercury thermometer? ”

    Don’t know. Unless your digital thermometer is wildly inaccurate, your body temp appears to be low.

  33. Kit 11 August 2009 at 9:29 pm #

    Many thanks for replying so soon. I much appreciate it.

    According to its manufacturer the digital thermometer I used had an accuracy range of +/- 0.2 degrees celsius, so I think the results are outside the margin of error.

    I also read somewhere that temperature readings below 97.6 degrees fahrenheit should be followed through with tests for the presence of both thyroid peroxidase and thyroglobulin antibodies. Do you think that this would be necessary or useful?


  34. Justine 30 October 2009 at 3:25 pm #

    Hi Dr Biffa – I find the whole hypothyroidism very interesting and you explain it so well. I too have a problem with my thyroid although my GP tells me I am perfectly normal and has done for the past 10 years. Last month my TSH measured 1.99 (GP blood test) but a private urine test revealed that I had very low T4 and T3. My GP has poo-pooed my results despite the test being from a reliable and professional laboratory. I have used thyroid supplements, nutritional glandulars and converters in the past plus iodine and selenium but am still not improving. Can you give me any guidance please?

  35. Chris 9 December 2009 at 1:26 pm #

    Dr Briffa,
    Are there any pointers to suggest that thyroid issues, hypothyroidism, arise from factors of the modern human habitat, perhaps including features of the modern diet?

  36. J franklin 26 March 2011 at 5:18 pm #

    their are different types of hashimoto`s disease.
    mine is postpartum thyroiditis or silent thyroiditis
    that means hormones are the trigger. my mums was triggered by meningitis.which is a virus.hashi`s and hypothyroidism are the same thing. doctor`s think it is two seperate things not so auto-antibodies can be in the gland it self but not detectable in the blood
    which gives the impresion of two seperate diseases.
    the TSH test is a pituatary one and can lag behind
    for many years before rising to a high not very accurate .

  37. Karen 12 August 2011 at 7:10 pm #

    I really don’t know where to turn anymore, I am 39 and feel my life is over as my quality of life has dropped so low. I cannot work anymore and even doing housework wipes me out. I have so many symptons of hypothyroidism and over the last 20 years they are slowly getting worse. I now sleep for about 16 hours a day after taking a sleepaid otherwise I’m awake all night, losing weight is impossible, feet, knees and fingers hurt so much and now lower back pain, I’m tatt, my eyelids are heavy and droopy, dark circles, dry skin, hair falling out and very dry. If I don’t put a handful of conditioner on every day it is like straw, I have very heavy and very painful periods, a lump in my neck, recurrent boils, recurrent colds and sore throats and so I go on. I went to see an endocrinologist and after talking to his student while he left the room I had blood tests. The result yet again ‘normal’ and he suggested I have sleep apnea (I don’t even snore) and depression. I went to the doctor who lost his temper with me telling me he can’t change blood results, although no one can actually tell me the numbers, just that they are normal. I asked him what the lump in my neck was and he said probably an enlarged thyroid gland??? I know something is seriously wrong, I used to be quick and intelligent but now I forget simple words and can’t do quizzes anymore. Takes me all my time to string a sentence together yet I used to have an IQ of 125. As I said I really don’t know what to do or where to turn now and my life is over, I never go out, never have the energy to do anything. Help me please

  38. John Briffa 12 August 2011 at 7:20 pm #


    Which country do you live in?

  39. Karen 13 August 2011 at 7:14 pm #

    I live in England. I know I have read that this is the worst country to live in when it comes to diagnosis.

  40. sarah 9 September 2011 at 10:45 pm #

    Hi my mum aunt and nan have thyroid problems. I am always tired, get emotional, can’t shift the weight, have a regular large lump in my throat which secretes white hard lumps, I am currently on day 6 of a period, I sweat profusely no matter what I am doing, even sitting, I am anxious have had constant verrucas for the past 6weeks and my hair has been thinning for the past 10years, I have had 2 tests in the past both normal and as I have been to the doctors for each of the above problems. Please help.

  41. judith 8 November 2011 at 12:39 am #

    Hi, I have been on levotyhroxine for 7 years.and i have never felt ok.I gain weight easily and cannot lose it even if i am calorie counting. My tabletshas been increased gradually from 25 to 50 to 75and i am now on 100mg.I am 48 years old and since taking thyroid tablets I have also been diagnoised with urticaria, and need antihistamines daily. My urticaria has got really bad this last6 months.could all this be linked. My tsh readings are 1.99.This rash is really making my life hell I have swollen eyes and lips from it. Please can you give me some advice please as doctors and dermatolagist have no idea. I live in the UK.

  42. catrin 22 November 2011 at 9:17 pm #

    I have just had routine blood tests done as part of an over age 40 MOT. they came back as hyperthyroid-T4 7.3 (3.1-6.8) TSH 0.04 (.27-4.2)

    I had the tests re done approx 2-3 weeks later and they have come back as hypothyroidism! T4 9.7 (11.8-24.6) TSH 32.5 (.27-4.20). my GP wanted to put me on thyroxine straight away but i have put it off as the two tests were so different and I have none of the symptoms of either hypo or hyperthyroidism. Im really not sure what to do. I have asked for the bloods to be repeated, i dont think my GP was very happy with me. I am due to have them done in two weeks time – TFT and thyroid autoantibodies. do you have any idea what may be going on in view of me having no symtoms, i am reluctant to go onto medication if i dont have to

  43. Fed up 30 March 2012 at 1:08 am #

    My wife has been showing hypothyroid symptoms ranging across the physical (sore limbs, tired all the time, cannot sleep, NO libido, brittle nails, swollen glands, weight gain) and the mental (depression, anxiety – although she wont admit these things) and it has been hell for me and my children for the last two years – putting massive strain on our family life and marriage (as she seems unable to show affection to me anymore which is really tough). She has finally gone to the doctor for blood tests – as the weight gain is making her unhappy (she wouldnt go for any other reason as she would see that as a weakness or just a fact of getting old). How reliable are these tests – and should I try to ensist she gets referred to a specialist? I am convinced that she has hypothyroidism but want it identified and fixed once and for all…..

    Many thanks

  44. Cat 18 March 2013 at 2:39 am #


    A few months ago i started feeling really hungry, but really hungry and I no matter what I ate it wouldn’t fill me up enough. I thought this was because sometimes i didnt eat much for lunch and breakfast and maybe my body just wanted to compensate later on. But then i started to have breakfast and eat a better lunch and trying to be more regular. My hunger gets a bit better when i try to have more regular meals. However, I have been putting on weight very quickly, about one kilo per week and i seem to be unable to stop this. I eat healthy, i exercise, i hardly eat sweets (maybe i treat myself once a week) and yet i keep on putting on weight. I mentioned this to my doctor, the hunger and the kilos piling up and he told me that my thyroid levels were ok (he did a blood test on me) and recommended that i see a dietitian. I just weighed myself again and i’ve put on another kilo in less than a week. I am getting really depressed. I am 5’4 and weighing 130lb (or 59 kg), so i am getting really chubby. If this is not my tyroid, i dont know what it is, all i know is that i was skinny before and now the kilos pile up and my body is always hungry. What could it be?

  45. Trish 1 May 2014 at 5:46 pm #

    I have all the classic symptoms that I know of. I have thin brittle nails as well as hair. Thank God that I have a lot of hair because I sure do lose a lot. I have an extreme sensitivity to cold under 73 and sometimes 75* I freeze and can not warm up without a HOT bath. I have dark circles under my eyes, tired, have major limb swelling discomfort etc., Body temp of 97.0 upon waking -97.2 thought the day.My weight is never stable just to name a few.Of course I was officially but unofficially diagnosed with depression years ago because they found that I was very lethargic and tired and weak years ago and never could find a reason. My dr did the TSH and the T4,free test a few days ago and that came back normal…tsh 1.752 and Free, T4 was .91. I have a brother and 2 aunts on my mothers side that had been diagnosed with some form of thyroid condition. What other tests can I ask for? I believe my dr is ready to give up on me, but I and people that know me are dead sure that something serious is wrong whether its thyroid or circulatory.


  1. Individuals with ‘normal’ thyroid function may still have symptoms of low thyroid function | Dr Briffa's Blog - 28 February 2011

    […] We doctors tend to rely quite heavily on TSH levels to make the diagnosis of low thyroid and monitor treatment. However, for a variety of reasons, I believe TSH is not to be utterly relied upon when making treatment decisions. I wrote about this a couple of years back here. […]

  2. The sometimes nonsense of ‘normal’ levels and ‘reference values’ | Dr Briffa's Blog - A Good Look at Good Health - 18 May 2011

    […] for a variety of reasons, some of which I detail here, TSH levels are utterly reliable for assessing thyroid function. For one thing, TSH references are […]

  3. Lab Values-The sometimes nonsense of ‘normal’ levels-May 2011 « Adjust2it's Blog - 20 May 2011

    […] for a variety of reasons, some of which I detail here, TSH levels are not utterly reliable for assessing thyroid […]

  4. More ‘aggressive’ thyroid management may help reduce risk of heart disease | Dr Briffa's Blog - A Good Look at Good Health - 27 April 2012

    […] My experience in practice tells me that the conventional way in which these blood tests are used to diagnose hypothyroidism is quite inadequate. The fact is, true hypothyroidism is not always reflected in a raised TSH and low thyroxine, and many individuals can suffer from hypothyroidism in the long term because their tests are ‘normal’. You can read about this here and here. […]

  5. Study finds thyroid extracts to be a viable treatment for some people with hypothyroidism | Dr Briffa's Blog - A Good Look at Good Health - 19 June 2013

    […] I’ve learned over the years that the diagnosis and management of hypothyroidism can be a controversial area. To begin with, there are reasons to believe that conventional medical tests are not the reliable indicator of thyroid function and status they are made out to be. I wrote about this issue here. […]

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