Help! Hypo?! Total T3 low and Free T4 low?!

[andeflora1]

I just got test results back and I have many symptoms of hypo. I have horrible dry itchy skin, im always exhausted, hair is falling out, scalp is flaking and itchy all of the time, constipation and in the last 2 years I have gained 40lbs. Until I was 23 I was 106lbs and wore a size zero. No matter how many miles I run a day or how many salads I eat I keep gaining weight. Both sets of test were taken at the same time of day, if that matters. The endo I am seeing does not want to treat since the TSH is normal and the others are low but normal.

May 2014
TSH 0.93 range .5-4.5
Free T4 0.9 range .82-1.77
Total 82 range 71-180

August 2013
TSH 1.46 range .5-4.5
Free T4 1.0 range .82-1.77
T3 110 range 71-180
Also in August an ultrasound showed the left side of my thyroid was enlarged and very lumpy but the right side was normal.

Any help would be much appreciated!!!!!!!!!!!!
Thanks, 
Andrea

[Kenneth N. Woliner, MD]

You may need to find another doctor to treat you, but the first step that patients in your situation would do would be to:

1. Mention to the doctor that you could have "CENTRAL HYPOTHYROIDISM" and/or having another condition that falsely lowers the TSH (metformin is one drug that can do that), and that "empiric therapy" with thyroid hormone (I prefer using both T4 and T3, such as Natural Desiccated Thyroid) would be a reasonable thing to do.

2.  Mention to the doctor at the 2013 American Thyroid Association conference, a poster was presented showing that thyroid ultrasound (and eventual biopsy) did NOT line up with lab tests.  Patients with "normal (in-range) lab tests" often had lymphocytes and proof of Hashimoto's Thyroiditis on biopsy.

3.  Mention to the doctor that his goal as a physician is to alleviate symptoms (pain and suffering), prevent bad things from happening in the future, and not cause harm.  By not treating you, you remain to suffer, and bad things might happen in the future.  By treating you with the theory of "start low, go slow", his/her chance of hurting you is minimal.

But alas, many endocrinologists don't listen.  If that is the case, you need to find a new doctor.

[Barb135]

Just because labs fall into a "normal" range, doesn't mean they are normal for that person.  andeflora's symptoms are those of hypothyroidism and her FT4 levels are very low in the ranges, as are the Total T3 levels.  Those levels could very well cause hypothyroid symptoms.

[freakingoutinmichigan]

Sounds like your thyroid is normal. Why do you want to treat a normal thyroid? Where you diagnosed hashimotos? I wish I could get my levelsthat close to normal.

[vitapilat]

I'm not a pro at this but it looks like you are in the range.