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Are the tsh and free t4 tests enough?
I have been having symptoms for the past year of muscle pains, trouble swallowing, lump in throat feeling, higher than normal anxiety, lightheadedness, palpitations, hot flashes, cold sweats, fatigue, nausea, digestive issues, headaches, feeling of irregular heartbeats, chest tightness.
I am 28 and I have had abnormal thyroid results in the past. I've been to the endocrinologist two times and they never thought it was bad enough to do anything about it at the time. But recently I went to my pcp, she checked my thyroid (not sure which tests she used) and the results were in the normal range. She sent me to the cardiologist for the palpitations and after a medical history and symptoms he thought my problems could be caused by thyroid. My ekg and Holter monitor results were normal.
Then I went to the gynecologist for cramping and irregular periods. She suspected a thyroid problem also. She did a tsh and free t4 test which came back normal.
It seems that everyone seems to suspect it's a thyroid problem but don't take it seriously when those tests are in the normal range. Yet no one has done a full thyroid screen. Should I just ask them if they will do a full screening, or are my current results good enough?
The only thing that came up on any of my blood work was low vitamin d.
I am 28 and I have had abnormal thyroid results in the past. I've been to the endocrinologist two times and they never thought it was bad enough to do anything about it at the time. But recently I went to my pcp, she checked my thyroid (not sure which tests she used) and the results were in the normal range. She sent me to the cardiologist for the palpitations and after a medical history and symptoms he thought my problems could be caused by thyroid. My ekg and Holter monitor results were normal.
Then I went to the gynecologist for cramping and irregular periods. She suspected a thyroid problem also. She did a tsh and free t4 test which came back normal.
It seems that everyone seems to suspect it's a thyroid problem but don't take it seriously when those tests are in the normal range. Yet no one has done a full thyroid screen. Should I just ask them if they will do a full screening, or are my current results good enough?
The only thing that came up on any of my blood work was low vitamin d.
I messed up that reference range on the tsh
My result was 0.887
Reference range (0.450-4.500)
My result was 0.887
Reference range (0.450-4.500)
Also one of the labs I got done at this time was Ra latex turbid. Which was 10.5 range (0.0-13.9)
Not sure if you have knowledge in Ra tests but was wondering if this was good or not so good.
Not sure if you have knowledge in Ra tests but was wondering if this was good or not so good.
I got the thyroid ultrasound done today. Should hear back about it tomorrow.
I also got my thyroid tests back today. The have changed since the last.
Free t4 direct 1.07 range (0.82-1.77)
Tsh 0.887 range (.0450-4.500)
T3 free 3.4 range (2.0-4.4)
I also got my thyroid tests back today. The have changed since the last.
Free t4 direct 1.07 range (0.82-1.77)
Tsh 0.887 range (.0450-4.500)
T3 free 3.4 range (2.0-4.4)
COMMUNITY LEADER
Central hypothyroidism is still hypothyroidism and must be treated the same as any other hypothyroidism - with replacement hormones, since your body must have thyroid hormones, no matter what the cause for the lack of them.
Central hypothyroidism is not "difficult" to diagnose; the problem is that many doctors miss it, because all they look at is TSH and not the actual thyroid hormones. If TSH is low in the range, they "assume" that all is well when it isn't. You may have to approach the subject of central hypothyroidism, instead of waiting for the doctor to get around to thinking of it.
It will be best if Free T3 and Free T4 were tested, but if they Totals, we'll make do with them and that will tell us that your doctor isn't real well versed in thyroid testing, so you'll have to specify "every" time that you want the "Frees" not the totals...
Central hypothyroidism is not "difficult" to diagnose; the problem is that many doctors miss it, because all they look at is TSH and not the actual thyroid hormones. If TSH is low in the range, they "assume" that all is well when it isn't. You may have to approach the subject of central hypothyroidism, instead of waiting for the doctor to get around to thinking of it.
It will be best if Free T3 and Free T4 were tested, but if they Totals, we'll make do with them and that will tell us that your doctor isn't real well versed in thyroid testing, so you'll have to specify "every" time that you want the "Frees" not the totals...
I am not sure if this time they tested the free t3 and free t4 or total. I should get my results back before Friday, and the ultrasound is scheduled for Thursday. I will post all the results.
So if it is central hyperthyroidism, and not a problem with the thyroid, how would that be treated and is it hard to get a diagnosis of that?
COMMUNITY LEADER
Sorry, I missed your posts from Jan 19 and 29...
Both, your TSH and Free T4 were both low in their ranges... this indicates central hypothyroidism, which is not a problem with the thyroid, but a pituitary issue in which the pituitary gland doesn't produce enough TSH to stimulate the thyroid to produce necessary thyroid hormones.
It's great that you're getting tested again. Do you know if the T3 and T4 your doctor is testing are Free T3 and Free T4 or are they just T3 and T4? Unfortunately, if you didn't specify Free T3 and Free T4, you'll get Total T3 and Total T4 which are considered obsolete and aren't as useful.
At any rate, you're getting tested again, so that will tell us "something". An ultrasound is also good, because that will tell us if you have nodules or if there are any unusual characteristics on your thyroid...
Please post the results as soon as you can and we can help you interpret them...
Both, your TSH and Free T4 were both low in their ranges... this indicates central hypothyroidism, which is not a problem with the thyroid, but a pituitary issue in which the pituitary gland doesn't produce enough TSH to stimulate the thyroid to produce necessary thyroid hormones.
It's great that you're getting tested again. Do you know if the T3 and T4 your doctor is testing are Free T3 and Free T4 or are they just T3 and T4? Unfortunately, if you didn't specify Free T3 and Free T4, you'll get Total T3 and Total T4 which are considered obsolete and aren't as useful.
At any rate, you're getting tested again, so that will tell us "something". An ultrasound is also good, because that will tell us if you have nodules or if there are any unusual characteristics on your thyroid...
Please post the results as soon as you can and we can help you interpret them...
I went back to the doctor a few days ago and got her to test the tsh, t3 and t4. Also going for a thyroid ultrasound next week.
I got my results back today from the cardiologist for the echo. It said that my heart muscle is slower to relax. He said it's minor right now and we're going to keep an eye on it. In extreme cases it can cause heart failure. After looking this up I found its called diastolic dysfunction. And looking at information about diastolic dysfunction I found that hypothyroidism can cause this. So I'm concerned that hypothyroidism may have caused this in me, and my thyroid results never seem to be bad enough for any doctor to take it seriously.
I do not. I'm working on getting those. They are at a doctor's office in the state I lived in a few years ago. But I just got a paper printed for my results from 11/13/2015.
Tsh 0.468 ref 0.450-4.500
And the vitamin d 18.7 ref 30.0-100.0
I did get vitamin d vitamins for that. Although they haven't helped with the tiredness and dizziness. It's actually gotten worse since.
Tsh 0.468 ref 0.450-4.500
And the vitamin d 18.7 ref 30.0-100.0
I did get vitamin d vitamins for that. Although they haven't helped with the tiredness and dizziness. It's actually gotten worse since.
COMMUNITY LEADER
Reference ranges vary from lab to lab, so there aren't any universal normal ranges for Free T4. Results have to be compared with the ranges used by the lab doing the tests.
ATA and AACE recommended that the reference range for TSH be changed to 0.3-3.0 approximately 12 yrs or so ago, but labs, therefore doctors have been slow to accept that change. I've read that they changed it back to 0.45-4.50, but haven't seen that, officially...
Your Free T4 is very low in its range... Most of us find that we need Free T4 to be about mid range; yours is only at 17% of the range, indicating that you're hypo, even though the results are in the range.
Do you have the results that are not within the ranges?
ATA and AACE recommended that the reference range for TSH be changed to 0.3-3.0 approximately 12 yrs or so ago, but labs, therefore doctors have been slow to accept that change. I've read that they changed it back to 0.45-4.50, but haven't seen that, officially...
Your Free T4 is very low in its range... Most of us find that we need Free T4 to be about mid range; yours is only at 17% of the range, indicating that you're hypo, even though the results are in the range.
Do you have the results that are not within the ranges?
I read that the normal range of tsh is 0.5-5. What is the normal range results for free t4?
COMMUNITY LEADER
If you had results that were not in the normal ranges, they were "abnormal"...
If you can get copies of any of those results, that would be helpful.
I agree with gimel that you should always get copies of all your labs and other diagnostic tests and keep them for your records. We often find that there were things the doctor should have followed up on, but didn't... I learned that the hard way, but of course, I didn't know then, what I know now, which is often the way it goes... if you have those labs in hand, you can go back and say "aha, this is *really* what was going on then"...
If you can get copies of any of those results, that would be helpful.
I agree with gimel that you should always get copies of all your labs and other diagnostic tests and keep them for your records. We often find that there were things the doctor should have followed up on, but didn't... I learned that the hard way, but of course, I didn't know then, what I know now, which is often the way it goes... if you have those labs in hand, you can go back and say "aha, this is *really* what was going on then"...
I wouldn't just ask about the results, I'd be sure to always get a copy of lab test results and then write on there how you were feeling at the time. These then become very useful for future comparison of results.
Well I didn't actually mean they were abnormal. But not in the "normal range". Couldn't remember if they were high or low. Those results were in 2006,2007,and 2010. I'll be seeing the doctor who did the latest tests tomorrow and I'll ask what the actual numbers were.
And yes the first time I seen an endocrinologist he did say I had symptoms of both hyper and hypo.
And yes the first time I seen an endocrinologist he did say I had symptoms of both hyper and hypo.
COMMUNITY LEADER
What were the actual results of your TSH and Free T4 tests? As Red_Star pointed out, we're all different, so what's good for one of us, may not be adequate, or may be too much, for someone else. Please include reference ranges with any results, since ranges vary lab to lab and have to come from your own report.
Also, what "abnormal" thyroid results did you have in the past?
Some of your symptoms sound like you've been hypo, but some sound hyper, which makes me wonder if you're flip flopping from one to the other, which is quite common with the early stages of Hashimoto's.
That brings me to the next question... have you ever been tested for thyroid antibodies to determine if you have an autoimmune thyroid condition? It's not unusual for symptoms to appear long before actual thyroid hormone levels actually go out of range far enough for many doctors to be willing to provide treatment. If you, actually, had abnormal results, you most likely, simply had a bad doctor...
In order to know what's going on, for sure, you need to be tested for, both Hashimoto's and Graves Disease. Hashimoto's is, ultimately, connected with hypothyroidism, but as I noted above, it's often characterized by periods of hyper in the beginning stages. Graves Disease is always associated with hyper.
The antibody tests you need to confirm Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). You need them both, since they are both markers for the disease and you could be misdiagnosed without them. The definitive test for Graves Disease is Thyroid Stimulating Immunoglobulin (TSI). It is possible, though rare, for one to have them both, with one dominating at a given time.
Next time you have thyroid testing done, be sure to insist that the doctor orders Free T3, along with the Free T4 and TSH tests. Antibody tests, typically, only need to be done once, unless they are negative, you might want to have confirmation tests done later; however, once you have the antibodies/autoimmune condition, you have it for life.
Also, what "abnormal" thyroid results did you have in the past?
Some of your symptoms sound like you've been hypo, but some sound hyper, which makes me wonder if you're flip flopping from one to the other, which is quite common with the early stages of Hashimoto's.
That brings me to the next question... have you ever been tested for thyroid antibodies to determine if you have an autoimmune thyroid condition? It's not unusual for symptoms to appear long before actual thyroid hormone levels actually go out of range far enough for many doctors to be willing to provide treatment. If you, actually, had abnormal results, you most likely, simply had a bad doctor...
In order to know what's going on, for sure, you need to be tested for, both Hashimoto's and Graves Disease. Hashimoto's is, ultimately, connected with hypothyroidism, but as I noted above, it's often characterized by periods of hyper in the beginning stages. Graves Disease is always associated with hyper.
The antibody tests you need to confirm Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). You need them both, since they are both markers for the disease and you could be misdiagnosed without them. The definitive test for Graves Disease is Thyroid Stimulating Immunoglobulin (TSI). It is possible, though rare, for one to have them both, with one dominating at a given time.
Next time you have thyroid testing done, be sure to insist that the doctor orders Free T3, along with the Free T4 and TSH tests. Antibody tests, typically, only need to be done once, unless they are negative, you might want to have confirmation tests done later; however, once you have the antibodies/autoimmune condition, you have it for life.
Excerpt from Hypothyroid Mom - Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism...
"Mary Shomon, author of the book that changed my life Living Well With Hypothyroidism, shared this important list of recommended lab tests.
Thyroid Tests "Normal" But You Don't Feel Well?
If you're undiagnosed, or a thyroid patient taking thyroid hormone replacement medications, being in the "normal" range does not mean you feel well, or that your treatment is optimized. What levels are considered "optimal*" by many integrative physicians?
~ TSH - Typically less than 2.0
~ Free T4 - Top half of the reference range
~ Free T3 - Top half - top 25th percentile of reference range
~ Reverse T3 - Lower end of normal range
~ Thyroid Peroxidase Antibodies (TPO) - Within reference range
~ Vitamin D - Above 50
~ Ferritin - Above 60 (Above 80 if experience hair loss)
* we are all different, one size doesn't fit all, so these are guidelines. Your optimal levels may vary."
Just to add to that, the vitamin D listed above is in ng/mL so above 50 ng/mL converts to above 125 nmol/L. Reading the latest studies on vitamin D, recommended currently (and may change as more research comes to light) - optimal is 40 - 60 ng/mL (100 - 150 nmol/L).
I believe ferritin (iron storage protein) is the same measurement worldwide but someone correct me if I'm wrong about that. Also another thyroid lab to look at - thyroglobulin antibody (TgAb).
"Mary Shomon, author of the book that changed my life Living Well With Hypothyroidism, shared this important list of recommended lab tests.
Thyroid Tests "Normal" But You Don't Feel Well?
If you're undiagnosed, or a thyroid patient taking thyroid hormone replacement medications, being in the "normal" range does not mean you feel well, or that your treatment is optimized. What levels are considered "optimal*" by many integrative physicians?
~ TSH - Typically less than 2.0
~ Free T4 - Top half of the reference range
~ Free T3 - Top half - top 25th percentile of reference range
~ Reverse T3 - Lower end of normal range
~ Thyroid Peroxidase Antibodies (TPO) - Within reference range
~ Vitamin D - Above 50
~ Ferritin - Above 60 (Above 80 if experience hair loss)
* we are all different, one size doesn't fit all, so these are guidelines. Your optimal levels may vary."
Just to add to that, the vitamin D listed above is in ng/mL so above 50 ng/mL converts to above 125 nmol/L. Reading the latest studies on vitamin D, recommended currently (and may change as more research comes to light) - optimal is 40 - 60 ng/mL (100 - 150 nmol/L).
I believe ferritin (iron storage protein) is the same measurement worldwide but someone correct me if I'm wrong about that. Also another thyroid lab to look at - thyroglobulin antibody (TgAb).
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