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FT4 low but TSH usually normal
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FT4 low but TSH usually normal

I have been on a real roller coster ride in the last year or so.  It started with constant infections to the lung, throat ear, nose,etc.  Now after being on antibiotics 9 times and going through every test there is, they have been testing my TSH and FT4 levels to realize it was off.

Even if TSH is within normal range (most of the time), FT4 is  low 7.3 (8.5 - 15.2).  Symptoms include major night sweats, extreme fatigue, total lack of energy, chills during the day.  I cannot function for more than 2-3 hours during the day because i get exhausted and must sleep a few times a day.

Results are as follows:
May 14:  TSH 3.47 (0.3 - 4.2)
         FT4: 7.3 (8.5 - 15.2) LOW
         FT3 always normal
May 18:  TSH 6.04  HIGH
         FT4: 8.4
May 29:  TSH 3.78
         FT4: 7.4
Endocrinologist does not want to do anything even though i have many symptoms.  How many times do they need to test me?
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10 Comments Post a Comment
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Avatar_f_tn
Levels previous stated , are just a suggested level (and up to your doctor) and for treatment once diagnosed, not for a diagnose. Are you on thyroid meds.?

As far as I am concerned, when treated, TSH anywhere within the Labs reference range to where you feel your best, not someone else, is the correct level for you.
Symptoms thereafter should be that of other health conditions, which many share thyroid symptoms.  Therefore, other health avenues should be perused and treated accordingly.

AACE - American Association of Clinical Endocrinologists November 2002,
"Hypothyriodism treatment is indicated with TSH  10
In conjunction with a goiter or positive anti-thyroid peroxidase antibodies or both TSH between 5 and 10.
The target TSH level between 0.3 and 3.0" (for treatment after diagnosed)

US Goverenment  panel Jan 14, 2004, "defined the reference range of normal serum TSH concentration as 0.45 to 4.5 mIU/L . (for treatment after diagnosed).
No routine levothyroxine treatment for patients with TSH levels between 4.5 and 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level. Early levothyroxine therapy does not alter the natural history of the disease, it may prevent symptoms and signs of overt disease in those who do progress.
Levothyroxine therapy is reasonable for Overt - Subclinical Hypothyroidism - TSH Higher Than 10."

National Academy of Clinical Biochemistry (NACB); 2002 -  General "Guidelines for Laboratories and Physicians
When the serum FT4 is low and yet the serum TSH is only minimally elevated (<10 mIU/L), a diagnosis of central hypothyroidism should be considered"

Your FT-4 suggest primary hypothyroidism and relating to the other two suggest late Hashi.  However, your health condition and the medication/antibiotics can affect thyroid levels and do not reflect to thyroid symptoms. As well as, "US Government guidelines Jan 14, 2004:
A "TSH 2.5 - 4.5 May be due to minor technical problems in the TSH assay, circulating abnormal TSH isoforms, or heterophilic antibodies; normal individuals with serum TSH concentrations in this range would be misidentified as having hypothyroidism.  Antibody presence or absence does not change the diagnosis of  hypothyroidism (which is based on serum TSH measurements) or the expected efficacy of treatment".

You need to treat and heal from your other health issues, before thyroid. Then retest and go from there.  

GL


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201897_tn?1245845934
Sorry you're feeling so cruddy.

Your TSH is actually high according to the new range (.3-3.0).  Since it's fluctuating like that (along with your symptoms), I suggest you have your thyroid antibodies tested.  It could indicate an autoimmune thyroid disease.  If your endo won't test for these, then find another one who will.  Ummm... actually, since your endo has seen these #s and hasn't ordered the antibodies testing, you might want to look for another one anyway.

Also, if you have your numbers and ranges for the FT3, would you mind posting them?  A lot of times the dr'll tell you you're "normal", but the number should really be at the upper end of the range.
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Avatar_n_tn
FT3 level on May 14 was 4.6 (range is 3.5-6.5) and it was 4.4 on May 29.

They also did a battery of other test including ESR and both came at 1  (range 0-6).
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201897_tn?1245845934
Once again, your numbers are below midrange.  I'd push the doc, or any doc, to run thyroid-specific antibodies tests (TPOAb and TgAb).  If the test results are negative, then talk to them about starting a trial dose of Synthroid, Armour, or other thyroid med to see if that makes a difference.

You might as well throw the ESR test out the window.  It's a non-specific test and isn't much help unless they're looking for a chronic inflammatory disease.  If you've had an ANA done, the results of that would be interesting to see.

Hope this helps.  
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201897_tn?1245845934
Oh cool!  The anti-microsomal antibodies test is the same thing as the TPOAb test.  Would you mind posting your results when you get them?  Thanks! :)
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Avatar_n_tn
I am not on any meds either.
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Avatar_n_tn
All other issues have already been treated and resolved.

These blood results have been done after all respiratory and pulmonary problems have been cured.

Just got tested for anti-microsomal antibodies.  Waiting for results.  

It looks like my immune systems is weak.  Got tested for hormones. everything looks ok.

Looking forward to see the next results in a week.

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Avatar_f_tn
Another look at your May 14 Labs.


Your FT-4 suggest hypothyroid, possibly Hashi.

Did you get the Antimicrosomal antibody results yet.

GL
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Avatar_n_tn
My results just came in abnormal at 1:6400

Can someone tell me what it means?
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Avatar_n_tn
my tsh level was0.45 is this low?
i dont understand what it shoud be?
thanks heaps
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