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Confused over TSH w/reflex to FT4 results
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Confused over TSH w/reflex to FT4 results

So I finally have answers but am a little confused by the results.  Brief history, gained 25 lbs (despite training for and running a marathon....worst run I've ever had, it was my 4th marathon), deep purple bruising, unable to stay asleep despite being tired, etc.  Several
doctors said it was becauaw I am 44 amd have 4 kids...just accept it.  I saw an endocrinologist and talked about symptoms and showed him pictures of bruises, etc.  he agreed something had to be off.  I went in today and got the results of the lab work.

TSH w/ reflex to FT4 result was 3.34 mIU/L  the doctor said that is indicative that my thyroid is low and prescribed Synthroid 50 mcg.  I'm confused though because the range I see on the lab slip is 0.40-4.50, so wouldn't that be normal?  I've definitely had hypothyroid symptoms this past year (weight gain, bruising easily, tired, etc), just confused about the numbers.  My C-Peptide was also elevated and so I was also prescribed Byetta shots (twice a day) for insulin resistance.  He also said I am vitamin B deficient gave me a
shot amd said I nees to take supplements.  Does that all go hand in hand?  What about the thyrois redults?  Thanks!
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Vitamin B12 was 319 (200-1100 range)
Folate just made normal  5.5 (>5.4 normal)
Vitamin D 25 Hydroxy 40 (30-100)
C-Peptide 3.23 (0.80-3.10)
MCH 33.2 (27-33)
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I am noticing many comments about testing for T3..I see nothing in the blood work that mentions it.  How soon once one starts taking Synthroid do they notice anything? (50mcg). Thanks again!
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About 10 years ago, AACE recommended that TSH range be changed to 0.3-3.0.  As you can see, many labls, like your own, have been very slow to adopt the change.  Good doctors use the 0.3-3.0 range regardless of what's printed on the lab report.  So, two points for your doctor!

Niow, let's see how good he really is...did he also test FREE T3 and FREE T4?  If so, please post those results with reference ranges since they vary lab to lab and have to come from your own lab report.

B-12 defintitely needs work, and deficiency can indicate pernicious anemia.  PA is an autoimmune condition and is characterized by lack of ability to absorb B-12 through the gut.  If you have PA, you would have to supplement with injections rather than oral supplements.

Vitamin D is also extremely low.  Has he suggested supplementing that as well?

Not for all of us, but for many, B-12 and D deficiencies seem to come with thyroid dysfunction.

It takes 4-6 weeks for Synthroid to reach its full potential in your bolld.  It has to build your levels before you will feel much better.  Also, the initial dose is seldom the dose we end up on.  After starting meds, you thypically wait 4-5 weeks, retest, re-evaluate symptoms, adjust meds...and repeat until you feel well.  Labs often improve before symptoms are alleviated since there's a healing process that takes some time.
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Wow....the change was made 10 years ago and it's still not followed?  That's incredible!  With regards to the T3 and T4, no, the only testing done was the TSH w/reflex to FT4.

He gave me an injectible  vitamin B12 in his office and said to follow with sublingual B12  daily.  He said the D was fine, but I have had D deficiency before and have read that my level really is lower than is optimal so I've started taking a vitamin D supplement as well.  This all no doubt explains the horrible bruising I've been experiencing lately.  In fact I started documenting them by taking pictures with my phone and that really convinced him that things really needed further evaluation.  The C-Peptide confirmed insulin resistance, which I am now reading has a link to thyroid problems and I have started giving myself injectible Byetta twice a day for that.  

Another thing that got him to really listen was that I ran my 4th marathon in April (in memory of my dad) and it was brutal on me!  I could hardly train, had zero muscle gain, if anything it seemed like I lost muscle.  I showed him a picture of me at the end with my medal to show I wasn't lying about exercising because one doctor I saw several months ago actually told me they didn't think I was accurately gauging my miles, that certainly I was running less than I thought I was (despite the fact that I run with a GPS watch).  

Why won't these doctors listen?

With regards to the T3....how could that effect current treatment?  What other information would that provide?

Thanks so much for your information!  I feel like when I look online I get conflicting information.
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Well, if you think it's bad that the change was recommended 10 years ago and most labs haven't adjusted ranges, you'll love this...the ranges for FT3 and FT4 have NEVER been adjusted to reflect the TSH change.  We're still laboring under the same FT3 and FT4 ranges.

FT3 and FT4 should be tested every time you have thyroid labs.  TSH is a pituitary hormone and a very indirect measure of thyroid status.  Many things can influence it other than thyroid hormone levels.  FT3 and FT4 are direct measures.  

"TSH w/reflex to FT4" is just an order to the lab.  It means "test TSH, and if it's 'abnormal', test FT4".  Since your lab was using the old range, your TSH was 'normal', so they didn't test FT4.

Synopsis of Thyroid 101:  The two main thyroid hormones are T3 and T4.  All T4 is made in the thyroid, and it's the "storage" form of the thyroid hormones.  It has a long life and basically floats around in your blood stream until your cells need thyroid hormone.  T3 is the "active" form of the thyroid hormones.  It has a very short life and is quickly neutralized if not used promptly.  A very little percentage of T3 is made in the thyroid; most of it comes from our bodies  (mostly the liver) converting T4 to T3.  T3 is the only form your cells can use.

So, FT4 tells you just how much your thyroid is producing.  FT3 tells you how much your body is converting.  Many people are "slow" converters and don't feel well even with FT4 levels on the higher side.

Since you have been started on meds that are T4-only (the theory being that your body will convert that T4 to T3 when it's needed), FT3 is not a pressing issue at the moment.  However, I think it's invaluable to start establishing your own history (and getting results from your doctor and compiling them yourself).  If you have a complete set of labs (FT3, FT4 and TSH) every time, you get more than just a snapshot.  You can see trends developing that are often much more valuable than snapshot information.

You're right, your D is low.  Many with thyroid disorders find it has to be much higher in the range than that.  I think you're right to supplement it.  D deficiency can mimic thyroid symptoms.

Other info?  Your TSH is certainly "borderline".  It's a little elevated, but only slightly.  Just to give you some perspective, on diagnosis, my TSH as 60-something.  For all the reasons I stated above, I think it's very important to have FT3 and FT4 tested before starting meds.  It's the only way you'll really be able to evaluate the effects of the meds.  Bear in mind that since FT3 and FT4 ranges were never adjusted, FT4 often has to be midrange and FT3 upper half to upper third of range before symptoms are relieved.  You have both B-12 and D problems, both of which can mimic thyroid symptoms.  I'd request FT3 and FT4 as soon as possible (so that they'll be influenced as little as possible by the meds) to get a baseline from which to evaluate treatment.

BTW, your doctor just lost his two points by not testing FT3 and FT4!
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Sp could it be possible that I really don't have a thyroid issue after all?  I had another doctor test T3 and T4 months ago and it was "normal" (but i beloeve it was low range of normal).  He did it while I was on my second medrol dosepak and using a steroid inhaler for asthma issues I developed during the spring when the pollen was out of control, and I've often wondered if that would have altered the results at all.

I'm actually moving to another state next week, my doctor told me to follow up with a new doctor in 3 months for re-evaluation.
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I think it's possible you don't have a thyroid issue.  Without FT3 and FT4 to confirm it, TSH is really a very poor test.  You are deficient (or low) in both B-12 and D, each of which by itself can cause similar symptoms.    Also, steroids can affect thyroid levels.

If you think you already had low normal FT3 and FT4 results, a retest is definitely in ordfer.

Have you started taking your thyroid meds yet?  It might be worthwhile to see a doctor in your new state sooner than 3 months and get proper testing before doing so.  That way, you'll be able to better evaluate treatment.  I'm not suggesting you drop the ball on thyroid issues, but I do think some more testing would either confirm diagnosis or not.
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