Can someone help me understand my thyroid test results?

[sarahgrace93x]

Long story short, I've had an enlarged thyroid (goiter) since I was about 7-8 years old. I went to countless endocrinologists over the course of a few years and not one could find a problem with my thyroid. My tests always came back fine so they just wrote it off as a random goiter for no reason basically. Flash forward to about two years ago (i'm 24 now), I hadn't been to a real doctor in years due to no insurance and I had needed a physical for work. I go and she says the same thing my thyroid feels enlarged and sent me for an ultrasound and bloodwork. Bloodwork came back normal and ultrasound showed I had a nodule. She didn't seem too concerned. I went back a few weeks ago for a routine physical and she sent me again for more bloodwork and an ultrasound. She called and said my bloodwork was normal and was waiting on ultrasound results. She didn't seem too concerened once again, however my free t4 is low? I'm not too sure how to understand these if anyone can help
TSH 1.48 mcIU/mL
Free T4 0.83 ng/dL
Thyroid Microsomal Abs 10 IU/mL
Thyroglobulin Ab 11 IU/mL

She did not test t3 levels for some reason. I've been having a lot of symptoms of hypothyroidism and I'm wondering if that is what I have. Honestly I thought most of these symptoms were from a new birth control It tried, however now I'm starting to rethink that. Doctor doesn't seem to concerned though, should I seek out another endocrinologist? I've gained over 35 pounds in less than a year, despite normal exercise and semi decent diet. My skin is very dry, nails are brittle, I'm tired ALL the time no matter how much sleep I get, feet are always cold, hair is dry and dull, i go through randoms spurts of depression, low sex drive (not sure if this is related to birth control or not), trouble concentrating, etc. Any help or advice would be greatly appreciated

[flyingfool]

I agree completely with Barb135.

Below range FT4 combined with symptoms that both show hypothyroidism.

[Barb135]

Your antibody counts are both below the reference ranges, indicating that you don't have Hashimoto's, but your Free T4 is below the lowest reference point, indicating that you "do" have hypothyroidism.  I'll stand by my thought of Central hypothyroidism.  She's probably only looking at the TSH and assuming that since it's well within the range, everything is "fine"... it's not.  Regardless of the cause, hypothyroidism is hypothyroidism and needs to be treated.

If your doctor isn't concerned enough to treat your symptoms, I'd strongly suggest another doctor.

[Barb135]

Please post the reference ranges for the Free T4 and the antibody tests.  Ranges vary from lab to lab and have to come from your own reports for the best comparison.

Some of your symptoms are typical of some birth control medications, but they're also typical of hypothyroidism.  

The problem is that with low thyroid hormones, we would expect to see your TSH much higher than it is, and that's probably what your doctor is looking at the most.  Since you have, both, low TSH and low thyroid hormones, we would have to suspect Central, or Secondary, hypothyroidism.  This means that there's really nothing wrong with your thyroid, but there's a problem with the hypothalamus/pituitary axis in your brain, which causes a lack of TSH, so there isn't enough stimulation for the thyroid to produce thyroid hormones.

Many doctors miss Central hypothyroidism because they're so focused on TSH and expecting it to be elevated in order for one to be hypo.  You might ask your doctor about this and if s/he refuses to acknowledge the possibility, find another doctor immediately.  Central hypothyroidism, is still hypothyroidism and needs to be treated with replacement hormones.

[sarahgrace93x]

Hi, sorry here are the ranges that were listed!

Thyroglobulin Ab   0 - 115 IU/mL

Thyroid Microsomal Abs  <40 IU/mL

Free T4 0.90 - 1.80 ng/dL

TSH 0.35 - 5.50 mcIU/mL