please help with levels

[bri_b]

my tsh dropped to almost nothing. i was sent to an engocrinologyst and i called and these are the latest levels....please help me to make sense of what it could mean....free t3 3.1   free t4 1.3   and tsh 0.10. ps my previous tsh was less than 0.010. and previous free t4 was 1.5. the older ones were done on april 6th. the new ones on may 2nd. any input/info will help and be appreciated. i do have an enlargement on left side, but levels have always been normal in past. my t4 is in range. my tsh isnt and idk about the t3. thank you!!!!i

[bri_b]

i only have the report from april 6th 2012. tsh  expected range 0.400-5.500 mine was <0.010. units measured in miu/L.   free t4 expected range 0.9-1.8 mine was 1.5. units measured in ng/dL.  my free t3 was not tested at this time.  on may 2nd 2012 i got report over phone so i do not know what the lab range is for free t3 at this lab. but here are my results with the lab being the same (just so you know the range for free t4 and tsh)... tsh  0.10  free t4 1.3   and free t3 3.1.  since this was over the phone im really hoping i heard the lady correctly on the numbers. they were hesitant to give results over the phone. but i needed them for my psychiatrist. im having a lot of difficulty with these symptoms, and with having emotional problems, it seems that drs are not wanting to help me or take me seriously, but i am in a lot of discomfort and know that this is not right. i have lost almost 30lbs in approx 2 months without trying. my appetite has actually increased and seems that twenty minutes after eating a full meal, my body is physically hungry again. sorry so much info, just trying to give and get insight so somebody can help me to understand and advise me as what to do.

[Barb135]

Have you been tested for thyroid antibodies to see if you have an autoimmune thyroid disease?

We need to know the reference ranges for the FT3 and FT4. These ranges vary lab to lab, so must come from your own report, so we can see where your levels fall within them.

Hashimoto's Thyroiditis is noted for periods of hypo, then hyper.  You could be going through a hyper phase, even though your FT3 and FT4 may be in normal ranges.

Ask to get tested for thyroid antibodies: Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab) to test for Hashimoto's; and Thyroid Stimulating Immunoglobulin (TSI) to test for Graves.

[bri_b]

not on any thyroid medications. never have been. was never diagnosed as hypo only symptoms with normal tsh and regular/not free t4 in past (like a year ago). but recently started losing weight despite still eating same plus, my chest hurts, my head hurts, i have heat intolerance, diarrhea, irritable/manic while also exhausted feeling that i could fall to the floor at any minute. cant sleep!!! but get so tired that i could cry because i want to. when i do sleep, i hate hate hate to have to wake up bc idk when ill be able to fall asleep again. i feel so uncomfortable all the time. i have only seen my endo twice. once over a year ago, and then once on may 2nd. i see him again on the 31st. i dont know what his beliefs are really. ive noticed he likes to get me out asap. but that seems to be any dr. probably bc of my insurance. ps. i am on some psych meds . dont know if this means anything as far as my results. thank u.

[gimel]

Hard to comment knowledgeably on your Free T3 and Free T4 without knowing the specific ranges shown on the lab report.   I expect that if the FT4 range is close to many that I see, then your level is more than adequate.  For the FT3, it depends on the units of measurement.  If the FT3 result is in Pg/ml, then your result is likely just below the midpoint of the ranges I see most often.  If it is expressed in P mol/L, then it is most likely near the low end of the range.  More important is the question of how you are feeling with these test results.  Do you have any lingering hypo symptoms?

As for the TSH, don't be concerned with that result.  Hypo patients  frequently find that when taking thyroid meds their TSH is suppressed below the range.  This does not mean that you are automatically hyper, unless you do have hyper symptoms, due to excessive levels of Free T3 and Free T4, which you do not have.   Understand that TSH causes no symptoms.  It is only supposed to reflect the levels of the actual thyroid hormones.  In reality, it cannot be shown to correlate well with either Free T3 or Free T4, much less with symptoms, which are most important.  So please tell us whether or not you are having symptoms currently.  

Also, if the Endo is one that has the "Immaculate TSH Belief", then you are going to hear that you should be reducing your med, because you're hyper.   Wrong.  Don't accept that.  Patients taking significant dosages of thyroid meds often find that a dosage adequate to relieve symptoms results in TSH suppression.   My TSH has been about .05 for well over 25 years without ever having hyper symptoms.  In fact I continued to have hypo symptoms, while taking 200 mcg of Synthroid, until I learned about the importance of Free T3 here on this Forum.  I got mine tested and confirmed as low in the range.  My doctor switched my meds to a T4/T3 combo type.  After some tweaking of dosage, I now feel best ever.  

A good thyroid doctor will treat a hypo patient by testing and adjusting Free T3 and free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief is all important, not just test results.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is then sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

In the letter please note the following statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."