Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Why is my TSH and Free T4 BOTH low?
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Why is my TSH and Free T4 BOTH low?

On 4/18/08 I had blood work done because my hair started falling out like mad. I had been tired for years, and depressed. So here are the results. My question is 'why is both my TSH and Free T4 low?' I thought that your tsh was high when your free t4 was low?

4/18/08
Free T4 .6    range  .77 - 1.61
TSH .76   range  .34 - 4.82

On 4/19/08 I was retested because I was having terrible symptoms from 75 mcg of Synthroid. I had taken just 6 pills.

Free T4 1.0  range  .77 - 1.61
TSH  .36  range .34 - 4.82
Free T3 on 4/29/0 was  2.31  range 1.80 - 4.60

She then had me go off of Synthroid for a couple of days, then start 15 mg of Armour ( which I requested ). I then had my blood tested again yesterday ( since I seem to very touchy with meds.). 5/19/08

Free T4 .9  range  .77 - 1.61
TSH .46  range .34 - 4.82
5/19/08  Free T3 3.08  range  1.80 - 4.60
( I did take my Armour before the test... didn't know they were testing it that day!)

Also on my first initial work up there is a whole list of things they tested. Two of them show flags as low.

AST  13   range 15 - 37  ( I'm not even sure what these are.)
Hematocrit  36  range  37.0 - 47.0
Do these have any bearing?

I feel good in the morning... but by 2 pm or so, I'm back to being exhausted, crabby, and just don't feel good. I take my Armour at 6:30 am sublingual, only 15 mg. She suggested taking another 15 mg at 1 pm to fight the afternoon crabbies. She said she would like to see my Free T4 at 1.3. So I'm not sure quite what to do.


Any insight would be great.
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Your thyroid labs are normal.  A slightly low free T4 is not clinically significant if the TSH and T3 are normal.  The AST (liver test) and hematocrit (anemia test) levels are fine.

Does not look like you've had enough time on 15mg of armour for the labs to accurately reflect how this is working for you.  There is no data to support that Free T4 goal ("1.3") - or any specific free T4 goal for the typical hypothyroid situation.
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