TSH is "normal" but symptoms/fam history

[mg008]

46-yr-old female; TSH = 3.76 (May 2010); two (of four) sisters are hypothyroid (one confirmed that it is Hashimoto's,the other isn't sure) and my mom had part of her thyroid removed in the 1960s (not sure about the circumstances).

I went in for a routine physical because i hadn't been in several years and my pulse was 41.  My doctor ordered routine blood work, and I had to specifically request that she include TSH level.

Symptoms that I think may be attributable to hypothyroidism are low blood pressure/low pulse, low libido, sometimes itchy upper back, scaly spots above each ear, lack of motivation, insomnia, hives that come and go, slight intolerance of cold.  I am not fatigued--or at least don't think I am beyond what is normal for the working mother of a first-grader.  I also read that being prematurely gray (which I am) can be a risk factor.

My questions are:
1) Is it possible that I am hypothyroid even with a TSH of 3.76?  I know there is some controversy about the "normal" range for TSH.
2) If I am hypothyroid, could this be the cause of my PVCs, which I have had for at least 15 years?


Thanks in advance for any insight.

M.

[mg008]

For whatever reason my doctor ordered only a free T4 test.  It came back as 1.0 (0.8-1.7)

Should I push for a TPO antiblody test?

[mg008]

Thanks, Dr. Lupo.

[Mark Lupo, M.D.]

time of day does not matter that much.

[mg008]

Thanks for your response.  I have asked my PCP for a referral to an endocrinologist but she seems reluctant.  

I have a follow-up question -- I had my blood drawn for the TSH test late morning, and I read that TSH is generally lowest around 11:00 a.m.  Is that true?  How much does TSH vary over the course of a day?  

[Mark Lupo, M.D.]

Your TSH may be borderline high -- there is great debate on what normal is.
With this history and family history, would test TPO antibody, as this may be early Hashi -- and with symptoms, a trial of medication may be reasonable.

[Lesliean]

Of course you are hypo. Look for the AACE 2002 recommendations (they took it back the next year saying if they treated everyone over 2. it would mean treating 29% of the female population). The cut off now is 3. for TSH although many docs use 2.5 because 95% of the population without symptoms is below this number.

More importantly, what are your free T4 and free T3 numbers? Are they in the mid range? And here's one you won't hear from many docs but used to be the only test: How are you feeling?

You need a doc, or nurse practitioner who specializes in female issues and does not ignore symptoms of fatigue.
Good luck,
Leslie