Hello
Your TSH level is OK, but your free T4 is very low. What time of day was the blood test taken? As ever, a doctor sees a result fall within the reference range and is happy. Thyroid patients know they need their free T4 and their free T3 to be towards the top of the reference range. Sadly then NHS never test T3 anymore unless the TSH is very high. But T3 is the most important hormone as it's active and the one the cells use for energy. We've gone backwards 200 years or more in thyroid treatment in the past 50 years.
T4 is the inactive storage hormone. Your body has to convert it to T3 for it to be of any use. You don't have much of it anyway so it's going to be vital that your body can convert and to do that it needs optimal levels of iron, folate and ferritin, Vitamin D, Vitamin B12 and decent sex hormones. So any one of those being low could cause your thyroid to slow you down. First port of call is to get those vitamin and iron levels up to optimal. Most thyroid patients know they have to do this for themselves, using private blood tests and their own research and supplements. GP's are clueless with most of this.
It is also vitally important to have your thyroid blood test taken first thing in the morning, preferably before 9am because that is when the circadian rhythm for TSH reaches it's peak. So you could be classed as a hypothyroid patient on a morning blood test, yet scrape through in the middle of the afternoon. Again, GP's don't understand this. Even my HRT hormone doctor who claims to treat thyroid doesn't know it (and what's worse won't listen!). It's even better not to eat anything or drink anything but water overnight before the blood draw.
So my suggestion to you would be to work at optimising your vital nutrients first. It takes 4-6 months of effort to raise levels. Retest to see where you are as you don't want too much iron or vitamin D, and then see how you feel. If you still feel tired all the time ask for another thyroid test and this time get that first thing in the morning blood draw and don't eat or drink anything other than water first. But do drink water. If we are dehydrated after a nights sleep our veins don't give up any blood.
