Free T4 TSH results in. Could I have been hypo all this time?

[Wtps]

Hi Everyone!
I'm new here and would appreciate any advice. Sorry for the long post I wanted to be as descriptive as I could be.

I saw my PCP and we found that my TSH was
6.94 (range:0.34-5.6) in August of this year (2009). This was after I complained of being tired. Feeling winded. Feeling extra heart beats and anxiety. Calf pain.  

My mother was either hypothyroid or hyper. She is deceased and I don't know how to find out if she was hypo or hyper? Does it matter in my case as of now since my TSH is high?

I then had my TSH rechecked by my new PCP in September this year 2009

TSH 10.570 (range:0.270-4.200)
Free T4 was also checked and was 1.02 (range:0.93-1.70)

The symptoms I've had are:
-fatigue(but I wasn't sure if this was just stress caused by going to school full time with a heavy course load
-my hair had become unlike my usual hair(it was dry, coarse, fell out somewhat easier)
-I noticed palpitations and heavy heart beats
-nausea
-decreased appetite
-no sex drive
-forgetful
-felt foggy
-eye floaters(had eye exam done recently and was given the all clear and that I only needed driving or reading glasses)
-short of breath and winded when going upstairs
-tightness in neck
-headaches that came often with neck pain
-3 sinus infections a year
-gums inflamed/front look receding
Lately I've noticed my period ending a few days early or being lighter when it was usually heavy and constant for years
I've also noticed some dizziness.

I also wanted to share my lab results from 2004 and 2006

2004:
TSH 4.43 (Range:0.5-5.0)

2006:
TSH 4.14 (Range:0.34-5.6)

Could I have been HYPO since 2004 and 2006? Even though the lab ranges were within range but according to the newer guidelines?
What questions should I ask my endo?
What tests should I have performed?
How do I know if I have hashi's?/How do I ask for this test?
Why is my Freet4 normal and TSH high?
ANYTHING ELSE/any other test that I should have?

My new PCP diagnosed me with hypo and prescribed 25 mcg of levothyroxine. I've yet to take it as I'm awaiting my endo appointment and rechecks. I waited because I wanted to be sure that going on medicine was indeed needed and I'm confused as to why my Free t4 was in normal range. Judging from what I've read I guess I'll be going on with it after the endo appt.. To be honest it's kind of disappointing and upsetting because I've never had health issues. Granted things could be worse and I'm grateful they aren't but I guess I'm just blue about having to take medicine forever. Also is there any chance that these readings could be caused by stress? I've been under really heavy stress with school and family life could that cause the TSH levels to rise?

[Wtps]

bump

[Wtps]

Hi Everyone. Hope you all are doing well. I went in to see my endo last week (2 months after my hypo diagnosis) for a retest. Here are the results:

TSH: 1.41 (0.40-4.00 range)
FT4: 2.0 (1.0-2.4 range)

Iron: 62 (35-170 range)
TIBC: 580 (250-450 range)
Ferritin: 13 (5-148 range)
Iron satuaration: 11 (20-55 range)

HCT: 40.4 (34.0-46.0 range)
Hgb: 13.5 (11.0-15.0 range)
WBC: 5.1 (3.9-11.0 range)
PLT: 311 (142-424 range)
MCV: 81 (80-100 range)

RBC: 4.99 (4.20-5.50 range)
MCH: 27 (27-33)
MCHC: 34 (31-36)
MPV: 8.7 (7.5-11.5)
Neutrophils(auto) 63 (48-75
Lymphs (auto) 26 (15-50
Monos (auto) 8 (0-10)
Eos (auto) 2 (0-7)
Basos (auto) 1 (0-2)
Neutrophil # (auto) 3.2 (2.0-6.9
Lymph# (auto) 1.4 (0.6-3.4
Mono# (auto) 0.4 (0.0-0.9

e=Eos# (aoto) 0.1 (0.0-0.7)
Baso# (auto) 0.1 (0.0-0.2

My endo said that my thyroid function was normal and to continue on my current levoxyl dose 75 mcg and to go back in 6 months for a retest. My iron has improved but I need additional iron to achieve full replacement so I'll be taking 1-2 pills a day for the next 3 months and iron testing will be done again in 6 months.

The iron pills upset my stomach. I think last night I didn't have enough food with them so I work up at 3 am vomiting and today I still feel queasy and upset stomach. It's so hard to take the iron. I have to eat tons of food so I don't get sick.

My endo and I talked about an ultrasound and he felt my thyroid twice and told me that it was very soft. I pressed him for an ultrasound and he told me that he didn't think it would be wise to get one because it can show false results and then I may be subjected to additional tests and things that I don't need. He said he's felt thyroid cancer(because that was my concern) and my thyroid is not presenting itself as such and that he wouldn't let me leave without one if he thought I was at risk.

He also told me that his mother recently had pneumonia and demanded a cat scan and they said they couldn't rule out lung cancer after seeing the results. She underwent a biopsy and nothing was found. After the pneumonia cleared up there was no evidence suggesting anything was going on. He said that she went through all of that for no reason. So what do you think?

I can relate because my sister also had unnecessary biopsies and tests etc. and opened a can of worms that wasn't warranted. He said my thyroid was very soft and he felt no nodules but I know all of you say that all nodules can't be felt. I'm feeling ok and have no new symptoms so should I just let the whole ultrasound request be and keep an eye on growths and symptoms?

Also what do you all think of my test results?

[Wtps]

Oh and I was just told by a new dentist that my gums are receding in places and she recommended root planing. She said the gums were at about 4. She also told me I might need a root canal on a tooth I just had filled by my other dentist 1-2 years ago who I went to for years. I can't go to him anymore because of insurance so I'm getting a second opinion because everything she told me I needed wasn't covered by my insurance. She said I needed a deep cleaning that would require a sep. appointment. This never happened with my last dentist. I have a friend who works in the dental field and they recommended going to see a Dr. who is well known in my area. My dental friend said they see this type of stuff happen all the time where offices will recommend treatments that aren't necessary and aren't covered by insurance.

So does having hashi's increase gum recession? Or does having hypo cause gum tooth issues? The dentist said autoimmune diseases can cause it and that she never saw it in someone my age unless they had one. I asked th endo about the chance of me having another autoimmune diseases like RA and he said my hands and feet would show symptoms which they do not. I asked about lupus and he didn't think so.

[Wtps]

Hi thanks for replying! The iron and I aren't working out. Even when I take it with food my stomach still gets sick. I'm going to try again today. I take it 5-6 hours after the levo.

I'm not sure I've had the hives before so maybe it was nerves or nerves and levo lol. I just thought it was odd because I haven't had hives in about 1-2 years.

Thank you for the info. about the FT3 I will def. bring that up next time.

I asked for an ultrasound and was told that I don't need one. I tried pushing and got nowhere somewhat. The Dr. seemed kind of 50/50 about needing an ultrasound then said I didn't need one. Any tips on what to say to get one? It scares me that I didn't get one although in the letter that was sent the endo said after 2 months on the levo we will check a number of studies then so maybe that means ultrasound I don't know?
Some good news is that I found my Dr. on the list of endos recommended by their patients link. So that's a good sign but I'm not sure it we are going to do further testing after I've been on the levo like he mentioned.

One thing I've noticed is headaches. I usually get bad headaches that time of the month and I noticed that once I started the levo. it was a bit worse. I brought the headaches up to my PCP and was basically told to take advil but this was before my hypo diagnosis. The advil barely work and I've tried a bunch of other OTC products that also don't work.

Thank you so much for all the info. again. I sincerely appreciate it! :)

[TamraW]

Welcome to the Hashi club!

First of all, do not take vitamins within four hours of taking your Levo. Iron pills should be taken at night due to the fact that they make many of us sick. Try starting out at half a pill and working up. Hashis are commonly B12 and D deficient. Get those levels checked, or get some B12 supplements and D or just get out in the sun for your D. I sunbathe every day for 1/2 hour, but I live in the land of sunshine!

Are you sure the Levo gave you hives? Hashis commonly have the hives, skin issues. I get it on the scalp, face, mouth ulcers, chest rash, lower leg rash, and right armpit.

Your TGab is used to confirm Hashi, but your TPOab did that already, so you don't need that result. FT3 is good to know and request that test every time. Eventually, once your T4 is in the upper end of the range by taking enough dose of Levo, you will need to make sure your body is converting enough of that T4 to T3. If not, then you may need a pill like Cytomel.

Uh, you should get your thyroid ultrasound. I can't believe the endo didn't run that. Many of us Hashis have nodules and those need to be biopsied just to be sure. I suggest getting a second opinion, especially since this doc doesn't test FT3 levels. Endos who don't test and treat T3 will only get the Hashi patient so far in recovery, unless you are one of the lucky Hashis whose body does a good enough job converting T4 to T3. Find a doctor who specializes in thyroid, not diabetes as so many endos do. I have interviewed six endos in my large city. Five of them were clueless when it came to testing and treating Hashi.

This website lists endos recommended by their patients: http://www.thyroid-info.com/topdrs/

Take care...
:) Tamra

[Wtps]

Hi All. Hope everyone had a Happy Thanksgiving. My most recent tests are in:

TSH:14.20 (range 0.40-4.00)

FT4 1.6 (range 1.0-2.4)

Iron:35 (range 35-170)

TIBC: 565 (range 250-450)

Ferritin: 17 (range 5-148)

TPO Ab: 201 (range 0-34)

Iron saturation: 6 (range 20-55)

So I'm hypo. and I have Hashi's and an iron deficiency and started Levoxyl on Friday at 1/2 a pill for the first week. I also started iron supplements but had to take 2 days off them due to vomiting. I asked the endo for FT3 and Tgab tests and when I got my results back they weren't on there so I called and was told I wasn't tested for those even though I asked for them.
Do I really need those tests?
Or are these results enough to confirm? I've been taking levoxyl 4 days and have been feeling a bit better strangely. My energy and mood seem up. The pills maee me feel a bit drugged the first few days but today I didn't feel like that much at all. The only weird thing was the vomiting but again I think that was from taking the iron too late at night with not enough food because since then I've had no vomiting. The levoxyl gave me hives slightly once and I kept feeling like there was dripping water on my wrist briefly. Other than that I'm doing ok. Thanksgiving was a little depressing because of all of this but I'm trying to cope.

I'm just wondering why the other tests I wanted weren't included? Am I reading too far between the lines wanting them? Sometimes I feel I should just stop trying to test more and accept what I have and deal. Thoughts? I go back to the endo in 2 months anything I should ask for? I asked for an ultra sound and was told that I don't need one. I also asked if I'm at an increased risk for thyroid cancer and he flat out told me hardly and that I'm not at any higher a risk than anyone else. I still wonder if I do really need an ultrasound though.

[Wtps]

Thank you again to everyone. Your responses have been extremely helpful in this journey to sort all this out. This forum has enabled me to know and ask the right questions and just to feel I'm not alone in this is really helpful.

I had my appointment and the endo was excellent. I had my FT3 and FT4 TSH and thyroid antibodies tested for Hashi's and I think one more thing but it slips my mind as of now. My endo think that I'm hypo and that it was a good idea to recheck and get the additional tests done before starting the pill. He stated had I started the replacement pill he would have no idea where I stand since we'd basically be testing the pill and not my function at that point. I was relieved at that. He was very down to earth and caring and took time and listened to me. I feel lucky that I was able to find a good endo right away. For those who are having trouble finding a good endo don't stop looking they are out there and you owe it to yourself and your health. He said once we know the results he will treat me based on those results.

My endo found I am also iron deficient and I'm starting supplements for 3 months. He also mentioned that the iron issue may also be having an impact on my tiredness as well. The brain fog he said is def. hypo. I'm not sure why my PCP didn't mention I was iron deficient to me. She drew blood and called me with the results. I specifically asked about anemia and she said I was fine. Yet the endo looked at my labs from October of this year and said I'm deficient. I knew just from googling my lab results that I was too but when my PCP told me I wasn't I thought she's the Dr. so I listened to her. Perhaps I should switch my PCP? Any opinions?


I did notice that after my blood was drawn that I kind of bled a lot. The person taking my blood was good and I barely felt anything and they told me to hold it down while they grabbed some tape and I maybe didn't put enough pressure? After a blood draw I usually get a few drops of blood on the gauze and it never bleeds through the gauze. This time it nearly bled through the gauze and it startled me when I look at it. Has this ever happened to anyone? Is this normal? I'm going to let the endo know just in case but thought I'd ask here to see others feedback. It scared me because I get woozy at the sight of blood.
It did stop bleeding and I have a little black and blue is that normal?

I don't have the results of my new blood testing yet but when I get them I will update. I also wanted to say that it's kind of depressing to have to go and get tested I feel kind of let down so to speak by my body. Also the thought of taking a pill every morning for the rest of my life is really bothering me still. When I was getting ready for my endo appointment I started crying and felt like this is the beginning of getting sick and older and it frightened me. Feels like the glory days are over and everything's going downhill from here. The reason I say this is because I have a family history of many medical issues one being hypo and I feel like now I'm going to get other things. My endo said "geez" when I was done answering his question about my family medical history. I feel like I can't win.

I also asked my endo about my bad sleeping patterns and being constantly stressed out and if that would affect my TSH and he said stress would lower my readings.
Take care everyone I will update as soon as I know the results.

[jokkejens]

I have experienced many of your symptoms, although I'm male, I guess being hypo can give same kind of symptoms male/female.
High level of family stress, kids, wife, work still going, more like an underlying stress there all the time...
I thought it was family stress, when I started to look pale, skinny face, half-opened eyes on all pics. I used to look healthy and good, but looking back on pics now, and it also struck me at the time they were taken, I looked like I was sick...Not good.

Then by coincidence I found out I was hypo excactly one year ago, october 08.
Still trying to adjust levothyroxin dose.
Now on 125 mg, that has taken my TSH down from 30 to 4.8, just above normal high range, Free T3 and T4 within normal range, but I am not finished adjusting. Still feel foggy on a daily basis and other symptoms.
Just wanted to let you kow, send me an message for more info.

[gimel]

Unfortunately, most doctors don't check FT3 unless you insist.  Many times they don't check FT4 either.  They rationalize  not testing for FT3 by saying that if they know the level of T4, then T3 will be comparable.  That's wrong if your body does not convert T4 to T3 very well.  Also it's wrong when a patient is on T4 thyroid meds, frequently the T3 level will remain in the low end of the range.  Since FT3 is the most biologically active thyroid hormone, that largely regulates metabolism and many other body functions, why not just run the test and be sure?  I don't understand it.

They check FT3 more frequently for possible hyperthyroidism because FT3 over the high end of the range is a good diagnostic for hyper.  They have the mistaken belief that they can diagnose hypothyroidism mainly by TSH, and if that is near the high end (probably the old reference range), then they might test FT4 also.  but if the FT4 is within even the very low limit, they frequently say that is "normal" and don't want to do anything further.


I wouldn't be overly worried about taking the T4 meds.  Most patients have no problem with them if they don't start out with too high a dose or increase it too fast.  Slow and steady is the best approach.  I'd be much more afraid of the symptoms than the meds.

Please make note of the last paragraph in my prior message and inquire whether your doctor is agreeable to treating you in this manner.  If he doesn't agree to treat your symptoms, you could end up in the large group of patients with FT3 and FT4 levels in the bottoms half of their ranges, and with lingering hypo symptoms.  Or else you will have to start looking for a good thyroid doctor, which might take a while.

[Wtps]

Thank you to both of you for the info. I sincerely appreciate it. I've been looking around on the boards but I'm new to this and confused and have a billion of new bookmarks to read.

I wasn't aware that my FT4 was still a low normal thanks for clearing that up and thanks again for helping me with finding out what tests I need done. I will be letting my endo. know during my appointment.

My PCP told me that checking my FreeT3 wouldn't matter?? PCP told me that they check Free T3 usually only for hyperthyroidism not hypo. I'm confused about why I was told that??

Also in 2004 and 2006 I did have some symptoms but never thought my thyroid was acting up since my PCP said my tests came back normal. Once I had this years results I requested my old labs and saw that my TSH was at the high end of normal. However in 2004 and 2006 I didn't have symptoms as bad as I do now but they were still def. present just not as bad.

I'm a bit worried about taking new meds since I can guarantee I'll end up on the levothyroxine. I asked my PCP about risks and was told that the birth control I'm taking has more risks/side effects. What do you all think about this?? In your experience was going on meds for the first time scary side effect wise or will I be ok? Worried.
Thanks

[gimel]

From your limited tests and you hypo symptoms, it was an easy call for your doctor to diagnose hypothyroidism and to prescribe meds.  Having a FT4 within range does not preclude being hypo at all, because the range is too broad and it has never been adjusted like was done for TSH 6 years ago..  And yes, you could have been hypo since 2004.  Were you having symptoms during this time as well?

Additional tests you should have done include free T3, which is the most biologically active thyroid hormone, as well as TPO ab, and TG ab. Free T3 is the most important thyroid hormone because it is four times as active as free T4 and free T3 correlates best with hypo symptoms.  Free T3 testing is frequently not done by doctors because they think that having free T4 test tells them all they need to know about the levels of free T3.  This is not always true because some patients do not convert T4 to T3 very well.  In view of the importance of FT3, why not check it also?  The latter two tests are to determine if thyroid antibodies are present, as in Hashi's.

Although many doctor rely almost completely on TSH to diagnose and medicate a patient, this is inadequate.  TSH is a pituitary hormone that is affected by many variables, including the time of day when blood is drawn.  At best it is only an indicator to be considered along with the more important  indicators, which are symptoms, as well as the levels of the actual, biologically active thryoid hormones which are free T3 and free T4.  

From my own experience and the feedback from the many patients on this Forum, I firmly believe that the best way to treat a thyroid patient is to test and adjust the levels of free 3 and free T4 with whatever meds are required to alleviate symptoms, without being constrained by resultant TSH level.  Symptom relief should be all important.  The most difficult part of all this is finding a good thyroid doctor that understands and will treat you in this manner.  So these really should be the questions to ask your new doctor about.  And if he doesn't agree with treating your symptoms by adjusting free T3 and free T4 levels, you'll likely end up looking for yet another doctor.  

[6hashi]

Hello ,
You should ask for Free T3 also ,"normal" FT4 with high TSH is because your Thyroid gland works over time and that causes your symptoms,however, your FT4 is still low normal !

In order for you to determine whether you have hashimoto , you need to ask for TGab and TPOab !

by the way ,normal TSH reference range is 0.3-3  .

feel well,

[Wtps]

I also wanted to add that I seem to be losing weight. Especially in the face around my temples are if that makes sense. I look skinnier in the face  I have changed my diet cut out most sweets but I haven't been exercising consistently. I hope nothing else is going on because looking in the mirror my face looks long and bony in areas to me. This is unusual for my because I looked healthy in the face before. Now it looks like I'm sick. Any thoughts? I've even had some family members say that I don't look like I usually do so I'm a bit concerned.