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Can I still have a thyroid problem with normal TSH?
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Can I still have a thyroid problem with normal TSH?

Hello,

I've been searching for an answer to my problems for years and I have not yet found anything that can explain the reason why I feel the way I do.  I have often looked at Hypothyroidism as a possibility, but my doctor has ruled it out since my TSH is normal.

I have been suffering for close to 8 years with this constant spaced out/brain fog feeling, excessive yawning all day long, very low energy.  I feel like I'm dragging myself around all day long and it's to the point now where it's exhausting to even just stand still for more than a couple of minutes.

The only problem with weight that I have is it is very difficult for me to gain weight.  I have always seemed to have a fast metabolism, but I just can figure out why my body is so drained all the time.

I have been tested/treated for sleep apnea and the treatment has worked, however  I don't feel any different.

Does this sound like anything to do with thyroid?

Thanks in advance.
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11 Comments Post a Comment
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649848_tn?1357751184
Yes, it does sound like thyroid.  Is TSH the only thing your doctor is testing?  He also needs to be testing Free T3 and Free T4, which are the actual thyroid hormones, with FT3 being the active hormone.  We often see TSH in range, but either or both FT3 and FT4 either below range, or very low in their ranges, which can still cause hypo feelings.  

In addition, you need to be tested for thyroid antibodies to see if you have an autoimmune thyroid disease.  The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thryoglobulin Antibodies (TGab).  Positive results of either of these will indicate Hashimoto's Thyroiditis, which is an autoimmune, in which, for some reason, the body sees the thyroid as foreign and produces antibodies to attack it.  As the antibodies destroy the thyroid tissue, the thyroid produces less and less hormones, until eventually, it dies off completely and produces none at all, leaving you dependent on thyroid hormone supplementation.

Additionally, you should get your vitamin B12 levels tested.  Low levels will cause horrible exhaustion.  I have pernicious anemia, which is another autoimmune disease, in which my body does not absorb B12 from food, so I'm on weekly shots.

You should also get tested for calcium, selenium, magnesium and vitamin D. Low levels in any of these can cause symptoms.  

If your doctor refuses to test the FT3, FT4 and antibodies, you may have to find another doctor that will.  You won't be properly diagnosed and treated until you know those levels.  
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1569091_tn?1295812151
I would have said the same thing, but you said it first.

If your advice is followed, he/she will be feeling well in the future. The only other thing that I think he should be tested for is Potassium, and Sodium.
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Avatar_f_tn
Thank you very much for your responses.  Only TSH has been tested so I will certainly have a discussion with my doctor about testing the others.  Thanks again for your suggestions.
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Avatar_f_tn
Labs are back.

Cortisol   5.92 (Dr. said this was high)
Testosterone  8.8 (very low)
TSH 1.4
T4 19
T3 5.2

Do do these numbers look like?  Dr. is recommending testosterone therapy.
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Avatar_m_tn
Please post the reference ranges for the T4 and T3 tests, as shown on the lab report.  Test results and reference ranges vary from lab to lab, so we need to know where the results fall within the ranges.
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Avatar_f_tn
Fair enough.  I'm going to pickup the report tonight.  I will post back.

thanks.
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Avatar_m_tn
Those numbers also tend to look like TOTAL and not FREE T3 and FREE T4.

Please verify if they are total or free.

Total doesn't show much and are basically outdated tests.

Some people can be Hypo even with a TSH as "low" as 1.4.
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Avatar_f_tn
TSH 1.4 (0.35 - 5.00)
Free Triiodothyronine 5.2 (3.5 - 6.5)
Free T4 19 (9 - 23)
Anti-TPO <10 (<35)
Anti-TG <20 (<40)
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Avatar_m_tn
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.

If you would like to read more about clinical treatment, this is a good link.  

http://hormonerestoration.com/files/ThyroidPMD.pdf

In the letter, please note this statement.   "the ultimate
criterion for dose adjustment must always be the clinical response of the patient. I have prescribed natural dessicated thyroid for your patient (Armour, Nature-Throid) because it contains both T4 and T3 (40mcg and 9mcg respectively per 60mg). This assures sufficient T3 levels and thyroid effects in the body. Since NDT has more T3 than the human thyroid gland produces, the well- replaced patient’s FT4 will be below the middle of its range, and the FT3 will be high “normal” or slightly high before the next AM dose."


Your FT4 level is adequate.  If you are suffering with hypo symptoms, your free T3 level can be raised as necessary to relieve symptoms.  This can be done with a T3 med, such as Cytomel.  I think you should also get tested for reverse T3, as well as all the other tests recommended above..
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649848_tn?1357751184
Get your Vitamin B12 tested, along with Vitamin D.
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Avatar_m_tn
Thyroid point – press the fleshy bit on palm between  the base of thumb and wrist on both hands. If you feel pain when you press, then you have thyroid problem.
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