Assistance with thyroid test results

[PJ12]

Hello. I am a 32y/o male (165#)and believe that I have some type of problem with my thyroid and am finally investigating this with an endo. All of my test results are not yet back, but what I have so far is: FT4 1.4 (.7-1.7 ref range), FT3 3.1 (2.5-3.9), TSH 1.48 (.5-5.00).  The tests that we are waiting on are the antibodies, metephrines, and some other hormone tests that he wanted ran.
My symptoms consist of: Anxiety for most of my life with a significant increase about 10 years ago, diagnosed hypertension at about the same time as increased anxiety, irritability, often sleep for many hours at night and am still tired the next day, apathy, easily 'stressed out', feeling of tightness in my upper chest/lower throat, decreased motivation, constipation, difficulty concentrating with forgetfullness, decreased libido, occassional blurred vision, often difficulty hearing (tv, radio, etc must be turned up louder than most people need).
SSRIs for anxiety and dep have done nothing but caused side effects. I am taking 37.5mg of Atenolol for the blood pressure and rapid heart rate.  When not on this I also have substantial anxious feelings (increased heart rate, tense muscles, blurred vision, etc).  I also get mild chest pains and headaches during exercise when not on the beta blocker. I take Klonipin occassionally for breakthrough anxiety.
My question is this: I seem to have both hyper and hypo symptoms mixed. My mother had thyroid problems. Based on my initial tests I appear to be within 'normal'. Do my symptoms sound indicative of hyper or hypo? What about the 'normal' tests?

[Mark Lupo, M.D.]

The problem with symptoms of thyroid disease is that they are non-specific and have many different etiologies besides thyroid. Certainly you describe symptoms of thyroid dysfunction (some sound hyper, some hypo) but the thyroid function tests are completely normal.  The antibodies will be interesting especially given the family history, but I would not imagine that the thyroid is the root of all your symptoms.

Checking metanephrines to screen for pheo is important.  Also consider testing testosterone levels.  The atenolol is good for many symtpoms, but some patients will get fatigue and sexual dysfunction with this type of medication.

[PJ12]

Forgot to mention...I also have a sensitivity to cold, but sweat significantly with physical exertion.  I exercise 3-4 times per week (cardio and weight training).  Thanks for any thoughts!

[mmfd]

You know, to me a lot of your symptoms sound like it could be sleep apnea.  I'm no doctor, but it is very common to have hypertension, decreased libido, forgetfulness, sleeping many hours without feeling rested, irritability etc.  You don't have to be overweight to have sleep apnea.  It might be worth asking your doctor for a sleep study.  On the other hand, maybe you do have thyroid problems.  I had more hypo symptoms than hyper and I am VERY hyper.  Good luck.

[ArmourGal]

but sleep apnea is associated with hypothyroidism...search the two terms together and you'll get some info.
cindi

[PJ12]

Thank you for the comments. I have never had a sleep study, but I really don't think many of my symptoms would be explained by this.  Specifically, symptoms such as intolerance to cold, headaches and excessive sweating with exertion and exercise, the vision and hearing insensitivity, etc.  However, I am not a doctor and am just trying to learn as much as I can about what may be causing my symptoms.  After my endo mentioning the possibility of thyroid problems I was surprised to find that many of my symptoms did match those that are often seen in hyper and hypo. Of course, many of the symptoms are vague and could be explained by any number of ailments. I am looking forward to getting all of the results back so that we can move forward with appropriate treatment or additional testing.

Thanks again for your time and comments.

Paul

[Mark Lupo, M.D.]

I thought briefly about sleep apnea but his age and weight suggest against it.

[PJ12]

Thank you for your response. They did test my testosterone as well, but I did not post this initially as I didn't know if it would be relevant. The results of these tests were: Free Testosterone 160.7 (range of 47.0-244.0), testosterone % free 1.4 (1.6-2.9), testosterone 1150 (400-1080).
I realize that the test % free is slightly low, the testosterone is slightly high, and the free testosterone is within the normal range. My endo did not seem concerned with the testosterone results. Would you see these as indicative of any specific conditions, or do they point to some other illnesses that should be considered as well?
I appreciate any additional information that you can provide.
Thanks,
Paul

[CATHYZOM]

i also received my thyroid results today and they were:
Free T3 2.74,  Free T4 1.52 and TSH 0.99.  I had posted my question on oct. 7th 05 saying i have muscle and joint pain in my arms and was told to run the Free T3 to see if it was low and as you can see that came back normal.   WHAT NOW????? Why am i still hurting so much and feeling sluggish.  please help.

[Pirategold]

I would like to post a question on this thread regarding Armour thyroid.  How important is it that this medication be taken w/o food?  I am attemption to adjust my medication to the optimum level and had my blood work done, results:  T3 Free  335 (230 – 420), T4 Free 1.0 (0.8 – 1.8), TSH – 2.7 (.40 – 5.5).  I plan to carefully take my thyroid twice each day and in six weeks retest.  Unfortunately for me I have not been consistent in dosage or even understanding the test results and overdosed for quite some time on Levoxil (sp?) to the point that my TSH was .05 and a little lower.  I was having anxiety attacks, my heart racing, nails cracking and splitting.  Another docter had me also on Indoral for 90 days, and I began growing hard skin on my calves and on the top of my head, had serious sinus issues and began to experience severe twitches in my eyelid.  My doctor apparently missed the low TSH readings for over a year and had me on an anti-depressant.  What is the ideal readings for T3 Free, T4 Free and TSH and do these numbers continue to be relevant when you are already taking Armour thyroid.  My dose is 32 mg in morning and 2 mg about 6 to 8 hours later.

Thank you,
Pirate

[ArmourGal]

I can only tell you the experience of me...and dozens of thyroid patients from my thyroid forum.  And that is...that to relieve hypo symptoms, a person needs their Free T4 over the midpt. of the range and their Free T3 at the top of the range or slightly over.  Your Free T3 is not there.

Most regular docs do not adhere to this, although there are a number of good thyroid docs who do.  Regular docs think you are fine if your TSH is "in range".  Other docs know that your actual thyroid hormone levels have to be high enough to eliminate hypo symptoms regardless of TSH.  

When one does research on the current TSH and Free ranges, one finds that these ranges are skewed towards hypo.  In other words, that the lower end of the the Free ranges actually indicate hypo...and that the higher end of the TSH range may in fact be hypo.  In fact there are those who propose having new ranges that have eliminated folks with antibodies for example.  Others have proposed different ranges for those on thyroid hormone replacement because of higher levels being needed for those folks.

These conflicts between the "standard" for thyroid treatment and the reality of so many thyroid patients being left with hypo symptoms is why so many say that thyroid disease is poorly treated in our country since the advent of the TSH test.  

[ArmourGal]

This is from my experience and research - i am not a doctor.  

It is very important that you don't take food with your ARmour as it will interfere with absorbtion.  I usually wait at least 30 minutes and sometimes an hour.  You can take your Armour sublingually (dissolve in your mouth) and then you avoid having to be concerned about food intake.  

On my regular thyroid forum, we use the recommendation of having Free T4 above the midpt of the range and Free T3 at the higher end of the range or slightly over - to relieve hypo symptoms.  I made some comments about this in the post above.  With Armour, it appears that at an optimal dose, many folks do have a suppressed TSH but are certainly not hyper.  I think perhaps that it has something to do with the T3 in Armour and it's effect on the pituitary.  Remember much of the research since the TSH test has been done with synthetics, and not with a desiccated thyroid extract.  

[Mark Lupo, M.D.]

Interesting - appears that you have elevated sex-hormone-binding-globulin (SHBG).  This would cause the elevated total testosterone and normal free T.  In men two common causes of this are hyperthyroidism and cirrhosis of the liver.  Ask to have the thyroid tests repeated and consider an antibody test for graves (TSI).  Also ask your doctor if there is any reason to suspect liver disease.