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HYPOTHYROIDISM

I have symptoms of hypothyroidism, but my test results are within a normal range. My TSH is 5.1 and my Free T3 is 3.1 pg/ml and Free T4 is 13 pg/ml

What does this mean please?
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Avatar universal
Have a look at this site and tell me which towns are close enough to you to consider as a better alternative than Washington.

http://www.healthgrades.com/diabetes-metabolism-endocrinology-directory/md-maryland
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Avatar universal
I agree with your post. Unfortunately, Medline (NIH) does not recognize these new ranges--perhaps because the AACE is funded by Abbott Labs?  What I do know is that I always feel much better when my TSH is around 1.0.  My new doctor (in the new community where I now live) has my TSH at 3.52.  I now have too many symptoms to begin listing here.  I may have to drive the 75 miles back to my old neighborhood to see my old doctor just to get this straightened out. (I am 65 years old, and do not know how long I can keep driving the Washington DC beltway to return to good doctors.) Too many doctors think that treating low thyroid is a science rather than an art.  It is up to us to listen to our bodies and try to find the energy to locate a physician who will treat us properly and listen respectfully to how we know we feel!
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Avatar universal
Reference ranges are specific to labs and vary in measurement units used and by country.  If you don't post your ranges, you are asking us to make assumptions that could very well cause us to give inappropriate advice.  That is an unfair position to put us in.  

None of us are medical professionals, but many of us have had to struggle with being hypo for so long and do so much research on our conditions that we've gathered a lot of knowledge along the way.  Furthermore, we are all volunteers.  Gimel is one of the best in interpreting thyroid labs.  He is trying to give you the best advice he can.  Is it so difficult to simply post your ranges?

Here's an article that I wrote explaining why just saying results are "normal" leaves so many people sick.  

Proper Use of Reference Ranges in Treating Hypothyroidism:  Some Ideas to Discuss with your Doctor

Many hypo patients or undiagnosed hypo patients have an array of hypo symptoms, yet their lab work (free T3, free T4 and TSH) indicate that they are within the reference ranges that doctors erroneously refer to as “normal”.  TSH is often high in the range (or maybe even above the range according to the latest standards of 0.3-3.0 which many labs and doctors still refuse use) and FT3 and/or FT4 are low in their ranges.  Many doctors think that if labs are anywhere within ranges, their job is done...patient is no longer hypo, any remaining symptoms are not thyroid related, patient is fat and lazy.  NOT TRUE.  

Please see illustration below.  Each of us has a personal reference range within the population reference range at which we are euthyroid (neither hypo nor hyper).  A shift in lab values of the individual outside of his or her individual reference range, but still within the population reference range, is not normal for that individual.  Many don't feel well until FT3 and FT4 are in the upper half of the ranges.  After all, the population ranges of FT3 and FT4 are statistically determined distributions of patient results; by definition, approximately half the population will be euthyroid in the top half of the range and approximately half in the bottom.  If you are one of the people whose personal range must be in the top of the ranges, and your doctor won’t treat you or won’t fine-tune your medication when your results are in the bottom of the range, you are left hypo.  Your doctor may tell you your labs are "normal", but they are NOT “normal” for you.

Reference ranges of test results do not imply that everyone is going to be well as long as they are anywhere in the ranges.  The ranges are broad (e.g. 0.6-2.0 for FT4).  If your personal FT4 reference range was 1.6-1.8 when your thyroid was functioning properly, does it really make any logical sense at all that now that you are on replacement hormones, you should feel comfortable with an FT4 of 1.0?  No, it doesn't.  We all have a set point that is optimal for us...doctors should be finding it and adjusting medication to it.

If labs are within ranges, it's time for fine-tuning (or initiating a low dose trial)...increasing meds slightly if hypo symptoms are still present.  This will move FT3 and FT4 up in the range and alleviate symptoms…that’s the goal.  The ranges define the universe in which we can freely adjust medication; its entire breadth from lower limit to upper should be used for this purpose.  The patient will still be in the reference ranges, but he or she will no longer be symptomatic.  

Illustration:
                                                 Personal
                Current                      Reference
                  Level                          Range
0.6               1.0                       [1.6……1.8]          2.0
|-----------------Population Reference Range-------------------|

With an FT4 of 1.0, patient is still hypo according to his/her personal reference range.
  
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Avatar universal

Knowing your lab's reference ranges is important because results and reference ranges vary from lab to lab.  If I compared your results to ranges that I am used to seeing, your results fall into the lower half of those ranges, which we see a lot from patients with hypothyroidism symptoms.  Symptoms are paramount in an evaluation of possible hypothyroidism.  Since you said that you have symptoms, with those lab results, and assuming the reference ranges are close to ones I am familiar with, there is every reason to think you would benefit from at least a therapeutic trial of meds.

You might get some useful info from this article written by Dr. Lindner.

http://www.hormonerestoration.com/Thyroid.html


Be aware that if you start trying to get treatment for being hypo, you will run into many roadblocks.  Frequently doctors have the "Immaculate TSH Belief" and don't want to treat a patient unless their TSH is beyond whatever range the doctor uses.  Others might medicate you, but only enough to get the TSH within their range, and nothing more, which frequently leaves patients with lingering hypo symptoms. Some may tell you that since the FT3 and FT4 is within range, that you are "normal" and nothing further is recommended.  

In order for you to get treatment you are going to have to search for a good thyroid doctor that will treat you for your symptoms by testing and adjusting FT3 and FT4 with whatever meds are required to alleviate those symptoms, without being constrained by resultant TSH results.  Not sure about Canada, but it is frequently difficult to find a good thyroid doctor here in the U. S.  

Here is a link that has been useful several times in locating a good thyroid doctor.  If interested you can search in your area and read patient feedback and see if any look promising.

http://www.thyroid-info.com/topdrs/canada.htm
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Avatar universal
I have seen many of Gimel's posts. She really does know a lot about hypothyroidism. This forum is the patient forum. Though we may not be endocrinologists, we suffer from thyroid disease, and have spent many hours researching. After seeing three endocrinologists who could not explain my ailments, I found this wonderful site, and the ladies told me which labs to order. I asked my endocrinologist for the TGab and TPOab tests, and it turns out I have Hashimoto's. I would still be suffering without diagnosis if it hadn't been for this forum.

Gimel is asking for reference ranges, because different labs, especially those in countries other than the US, use different ranges.

Example:

My FT3 was 250. Reference ranges that my labs used for FT3 were 230-420. Your FT3 is 3.1. I am assuming that your lab uses different measurements. Those measurements should be posted along with your lab results.

If your TSH uses the same reference ranges as mine, which I've seen so far that Canada and the US are the same, then you certainly look hypo.

In reality, TSH in a healthy thyroid should be around 1.1.

:) Tamra
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Avatar universal
I know about the TSH range. I know it is low. Hence my question.

If you will read my other results, you will see they are not in the low range. They are about in the middle.

I posted all my results. TSH, TF3 and TF4. They are all within normal range. In canada, we are still using the other range up to 7.00 and the doctors are sticking with it.

I wanted an opinion on the TF3 and TF4 and have already posted the results.

Thank you for tryng to help, but I was hoping that there might be some medical people on this site. It looks like there are none.
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Avatar universal
The easy answer to your question is yes.  The range for TSH was recommended to be changed from .5-5.0 down to .3-3.0, over 6 years ago by the Amer. Assn. of Clinical Endocrinologists.  The reference ranges for FT3 and FT4 are very broad and in need of similar correction.  For these reasons, FT3 and FT4 results in the low end of the range are very frequently consistent with having hypo symptoms.  That is why it is useful to know where within the ranges your test results fell.  That's why, with my lack of knowledge, I asked for a little more information--to give you the best possible response.  If you would spend just a few minutes reading posts from other members with hypo problems you might learn a lot.
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Avatar universal
They are within range. I am asking if I could still be subclinical hypothyroid, and hoping there might be someone with knowledge on this message board who would have known that without my saying.
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Avatar universal
Please post the reference ranges used by your lab for the free T3 and free T4 tests.
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