Help! (maybe no one saw my post?) high t4 + Normal TSH + Low D

[snookerbear]

Please help me.... I am reposting this in hopes that someone out there has a similar story...
Back in November, I told my Primary I was really fatigued.  I also told him I had a sore throat/ difficulty swallowing .  He looked and said there was nothing wrong with me.  
I went to my OBGYN two days later, for my yearly exam.  He asked if I had seen the GP lately, and if I had told the Primary that my throat hurt!  I said yes, and asked how he had preumed as much.  He could feel an obvious goiter.  He also said that he felt something was going awry with my metabolism, because I keep putting on weight even though I abstain from carbs, and consume fewer than 1500 cals every day.  I have mentioned this to my Primary, but I suspect he doesn't believe me.  So; I digress, the OBGYN ordered labs (tsh) and they came back NORMAL (0.7) (Aaagh!).
I had my first visit with the Endo, and he seemed curious to know why I still sought aftter him, given that the labs had come back ok.  I told him I'm really not sure what drove me to stick up for myself (I usually don't!), but that the bottom line was that whether the labs were normal or not, I was still exhausted, and my neck still hurt.  I also have many symptoms of hypo.  I can't grow my nails, I am always cold, weak, sore, and I struggle with constipation.  I have severe chronic headaches and my brain functions at a really pitiful level these days.   etc, etc... So he humored me and ordered more labs, but he did also mention that he didn't think he'd be seeing me again; lol.
So here we are in the present.  The labs have come back, and they're even more frustrating.

TSH range: 0.550-4.780...........(mine:1.054)Normal
B12 range: 211-911.................(mine: 375)Normal
FREE T3 ................................Not Ordered
T3 total range:  60-181 ng/dL....(mine: 156)Normal
T3 uptake range:  22-35 units...(mine: 23)Normal
T4 range: 4.5-10.9 ug/dL..........(mine:11.7) HIGH
T4 free range: 0.89-1.76...........(mine:1.19) Normal
thyroglobulin antibody <20.......(Normal)
Thyroid Perioxidase Ab <10.....(Normal)
Vitamin D...............................15.7 (LOW)

ok; so one would think hyperparathyoidism becuse of my low d, but i have hpothyroidism symptoms with goiter, low-normal tsh, and high t4.....    WHAT THE HECK IS WRONG WITH ME!????

I can't find a single incidence online whith the same Normal TSH + High T4 + Low D combination.  Could anyone enlighten me?  

[gimel]

This is a very old thread and I seriously doubt that you will get a reply from the prior posters.  If you would please post your thyroid related test results and their reference ranges shown on the lab report, we will be glad to help assess your status.  Also, please tell us about symptoms you have.  Also, have you been diagnosed as hypothyroid or not?  If so, what med and dosage are you taking?

[Jtodaro]

Hey my problem is identical! All the hypo symptoms but everythings normal but he said my total t4 was 11.5, pretty close to yours! I had my ultrasound and its normal and im so exhausted and fed up!
Did you get any answers yet?

[snookerbear]

Fred Siegel, MD OBGYN (Middlesex Obgyn)
Middletown, CT

[ThyroidHunter]

Thanks for sharing one of the best physician comments I have ever heard in:

"Do your patients appreciate their normal lab results when they're dead?"

If you could share this physician's name so I can credit him for it when I use it I would really be grateful.

Best in Health - You're on the road now

[Barb135]

A lot of the T4 you have "floating around" is bound by proteins, therefore is unusable.  That's why we say you need to test for Free T4, not total.  Total T4 testing is pretty much obsolete and really isn't of much value, so you need to forget about the total T4 being high and concentrate on the Free T4 being low in its range.  

T4 must be converted to T3 before it can be used.  The only T4 that can be converted is that which is "free".

Free T3 correlates best with hypo symptoms, therefore, if you were to take a T3 med, such as cytomel, it would raise your FT3 levels, which could help alleviate symptoms.  Adding a T4 med, would provide additional T4 to be converted to T3.

[snookerbear]

I will push for an FT3.  Thank you for the PDF... The part about treating the Thyroid as a whole, and using hormones that include T3 was very helpful to me; but I was wondering, with my T4 so high, are there risks with taking T4 supps? if I take T3 alone, would it worsen my hypo symptoms?  Frankly, I agree with the possibility that my pituitary gland is not doing its job very well.  I have an awful lot of T4 floating around, and not much being done with it!  

I'm so sorry to innundate you with all of these questions, but I am absolutely desperate to feel better.  

Thanks :)

[Barb135]

I had posted on your original thread, but you hadn't included some of the test results.  

While your vitamin B12 is "in range", it's way too low; if mine were that low, I'd be very ill...I take weekly shots to get keep it up in the 700 area, and if it falls much below that, I can tell.  I'd like to get it even higher, but it just won't go up for me.

As everyone as has already said, you need to be treating your low vitamin D.  Talk to the your endo about that.

The total T4 doesn't tell much because a lot of that is bound by protein and is, therefore, unusable.  I agree with gimel, that IF there had been an FT3 done, it, too, would probably be in the low normal range.  You should insist that FT3 be done on every round of tests.

You should ask to have pituitary function tested, since your TSH is low, along with the low FT4.

It will be interesting to see if you have nodules on your thyroid - this will show up on the ultra sound.  If so, you might want to have antibodies retested in a few months, as you could be in the beginning stages of Hashimoto's, and it's just not all showing up on the labs yet.  It's not uncommon for symptoms to show up first.

Lab errors do happen, but I don't know that's real common.  We do see a lot of people with symptoms, long before anything shows on the labs, and we also know that there can be quite a bit of fluctuation; particularly with TSH, so the way things are today, may not be the way they will be in a couple days or a week.

Talk to your endo regarding the low B12 and D levels.  If he tells you the B12 is fine because it's in range, you might need to look elsewhere for help.

[snookerbear]

" RE:  Physicians who only diagnose by "test results", not by patient "symptoms" or "observations", (the OB that found your goiter by "observing" it) are not a good option for those with known or potential thyroid problems. "

My OBGYN; who is a great, funny guy, (and brilliant to boot) said essentially the same thing when I told him the GP had blown me off when I told him about my pain...

He said that one of his closest friend is a GP; and they are taught to read and treat labs.  He said that he tells his friend often that he is a surgeon, and thus taught to treat symptoms and make physical observations to make a diagnosis.  He said that his friend once rebutted; explaining how efficiently he analyzed labs, and how good he must be (therefore) at diagnostics.

So my OB says: "Do your patients appreciate their normal lab results when they're dead?"

...ok I know its a bit of a morbid anecdote, but i totally appreciated it because the GP never listens to me.  I have a lump big enough to impede my ability to swallow (and a sinus infection that isnt a sinus infection?) and he says "are you using your neti-pot?"  (really.)

[snookerbear]

I have already had an ultrasound.  My Endo has scheduled me to come in tomorrow and discuss the results of the US and Labs.

Thank you, thank you, thank you... and thanks to barb; who was very helpful to me the first time i posted.

[gimel]

The most important thyroid test, FT3,  was not run.  I say this because FT3 is the most biologically active thyroid hormone.  It largely regulates metabolism and many other body functions.  Your symptoms sound like you are hypo and your FT4 is low in the range.  I suspect that if FT3 were tested it would also show low in the range.  FT4 and FT3 levels that are in the lower end of their ranges are consistent with being hypo.   This is because the ranges are too broad.  They have never been corrected as was done for TSH over 8 years ago.  Note that your lab is still using the old range.  This is not relevant to your situation because your TSH was in the lower part of its range.  When I see a patient having concurrent low TSH, and FT4 (and probably FT3 as well), then I suspect that there may be a pituitary function issue as well.  

Low Vitamin D, low B12. iron/ferritin, and selenium are also consistent with being hypo.  You really need to get your Vitamin D level increased and get tested for these others.  

A good thyroid doctor will treat a patient clinically by adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.    Symptom relief should be all important, not test results.  If your doctor is unwilling to treat you clinically in this manner, then you will need to find one that will do so.  

I think you might like to read this link.  It is a letter written by a good thyroid doctor to the PCP of patients that the author is consulting with from a distance.  It is provided to the PCP to help with treatment.

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

[jenniferk86]

Also, low vitamin d can cause fatigue, joint and muscle pain, depression, hair loss, look up symptoms of low vitamin D, that is a pretty low Vitamin D too, so you need to start treating that in the least

[ThyroidHunter]

ANY goiter is a sign of possible thyroid malfunction, and most every member of the Thyroid Board will tell you mistakes with blood work are a virtual routine.

Physicians who only diagnose by "test results", not by patient "symptoms" or "observations", (the OB that found your goiter by "observing" it) are not a good option for those with known or potential thyroid problems.

I wish I could tell you more, but thyroid blood testing has been a great failure to a great many around the world since it became somewhat common in the early 1990's. The instrument's suffer from accuracy problems, technician error, and sensitivity. It depends a great deal on the type of lab your blood tests were done at to even have a hope of knowing they are correct. You should note, I came back with a perfect thyroid panel less than 48 hours before I nearly died from a thyroidic storm. There are hundreds, if not thousands, of similar stories on the Board.

You must have an ultrasound/sonogram on your gland. There is no way to tell if it's just a simple goiter, or a combination of tumors, cysts, and goiters that could mark much worse trouble. This was my case.

Get back to your GP for an ultrasound order and with a written list of symptoms you want treatment for. If you are unable to obtain this from the GP, go to your OB and ask for it, then immediately begin looking for another GP.

Patients have a "right" to have their symptoms treated, if such treatment exists (and it does) regardless of blood test results. Also, a low Vitamin D suggests other vitamin deficiencies that are common in those with thyroid disease, including Vitamin A (why you may be gaining weight - metabolic malfunction), Vitamin B-6, C, D, & Zinc.

Hope this helps and best in your health.