Diagnosed as Hypo?

[97Gal]

For years (over a decade) I've been told I'm "borderline" hyperthyroidism.  I've always had more symptoms of hypo vs hyper (with exception of heart palpitations when drinking caffeine). Anyway, just got lab results below and doc wants to start me on meds for hypo (didn't say what meds/dosage yet, I go back in four weeks).  

T4  8.8  Range (4.9-12.9)
TSH  0.503  Range (0.178-4.53)
Free T3 2.7  Range (2.0-4.7)

I'm technically "normal" on all three, but have unexplained weight gain and serious fatigue.  Free T4 was not tested (is that typical, do you have to request that?).

Does the hypo diagnosis make sense from these numbers? I'm a 39 yr old female.  Should I request any other tests before starting meds?

Thanks

[97Gal]

Thanks for your time and insight.

[gimel]

Better when it is in the upper end of its range.

[97Gal]

B12 was 527 pg/mL.

[gimel]

Your B12 test result?

[gimel]

OTC is fine most of the time.  You could start with 2000 IU.  I expect that you may need to go up to 4000 IU.  

[97Gal]

Wow, I shouldn't type on an iPhone. Sorry for my poor grammar and autocorrects above.

[97Gal]

I will ask about the ferritin test as well. Are D3 supplants over the counter a good start or is their prescription strength I should be asking for? If OTC, then how much daily? Thanks.

[gimel]

I would go ahead and start with D3 supplements.  What was your B12 result?  Can you get the ferritin tested?  Very important.

[97Gal]

Thank you for your insight! It is greatly appreciated as I learn to navigate these lab results. My doctor did test B12 and Vitamin D and B12 was normal, but D was flagged as low (26.8 ng/mL). Should I work on the Vit D levels prior to starting T3 meds?  I will ask for a FreeT4 test on my next visit. Thanks again!

[gimel]

You were probably told you were borderline hyper due to your TSH level.  That diagnosis does not fit, however with your hypo symptoms and your Free T3 and Total T4 test results.  It is much more likely that you have central hypothyroidism, which is characterized by TSH that is well within its range, and  low levels of the actual thyroid hormones.  You can get some good insight about central hypothyroidism from this link written by a good thyroid doctor.  

http://hormonerestoration.com/Thyroid.html

I am happy to note that your current doctor recognized your need for thyroid med, based on your symptoms and your test results for Total T4 and Free T3.  I don't know why he chose Total T4 instead of Free T4.  The test for Free T4 would be my choice.  At any rate, the more important test is Free T3, and your level is much too low for many patients.  Many members say that relief from hypo symptoms required Free T4 at the middle of its range and Free T3 in the upper part of its range as necessary to relieve symptoms.  Before starting on meds, it would be a good idea to test for Free T4 and then make the decision about what type of med.  If your Free T4 is also at the  middle of its range you might want to ask the doctor about taking just a T3 med to raise your Free T3 level.  

When you go back for tests, I also suggest testing for Vitamin D, B12 and ferritin.  Hypo patients are frequently too low in the ranges for those, which can cause hypo like symptoms, as well as adversely affecting the metabolism of thyroid hormone.