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High T4 and low TSH
I am a 47 year-old female who was diagnosed with Hashimoto's in 1999. I have been taking 200mcg levothyroxin since my inital diagnosis. I recently (in June of 2011) had my thyroid panel ran. My Dr., a GP, wanted to reduce my dosage because of high T4 levels. I declined because with a lower dose I experience night sweats, the sensation of creatures crawling under my skin, and headaches. Today I received lab results conducted on 10-15-11. My concerns are multiple. My thyroid panel is: T3 uptake 29.5. Reference range 25.0-35.0%
T4. 12.6 Reference range 4.5-12.0. mcg/dL
FTI 3.72 Reference range 1.25-4.55
TSH, Ultrasensitive 0.04 Reference range 0.40-4.50 mIU/L
My fasting Lipid panel:
Cholesterol 199 Reference range 125-200 mg/dL
Triglycerides 153 Reference range 0-150 mg/dL
HDL 49 Reference range 46-199 mg/dL
LDL 119 Reference range 0-139 mg/dL
My sodium was low 137 RR 135-146 meq/L
CO2 was 22 RR 21-33 meq/L
I am not sure what is going on and these labs confuse me even more. The headaches I experienced at onset are reoccuring, my skin dryness is extreme again
T4. 12.6 Reference range 4.5-12.0. mcg/dL
FTI 3.72 Reference range 1.25-4.55
TSH, Ultrasensitive 0.04 Reference range 0.40-4.50 mIU/L
My fasting Lipid panel:
Cholesterol 199 Reference range 125-200 mg/dL
Triglycerides 153 Reference range 0-150 mg/dL
HDL 49 Reference range 46-199 mg/dL
LDL 119 Reference range 0-139 mg/dL
My sodium was low 137 RR 135-146 meq/L
CO2 was 22 RR 21-33 meq/L
I am not sure what is going on and these labs confuse me even more. The headaches I experienced at onset are reoccuring, my skin dryness is extreme again
Free thyroxine index (FTI) and T3 uptake are out of date lab tests. FTI became obsolete as soon as free T4 became available. T3 uptake does not measure T3 levels. The T3 Uptake test is actually an old, inaccurate way to measure T4 levels. Total T4 is also not an accurate measurement and does not give any information of how much T4 is free and available. Free T3 and free T4 labs are recommended.
As research goes on, it is becoming clear that inflammation and oxidation are the two primary causes of heart disease. Testing for inflammation - homocysteine (healthy is 6.3umol/L) and CRP (healthy is under 1mg/L) is highly recommended. Studies show inflammation is the leading predictor of heart attack risk.
Craving salt is a common sign of adrenal issues. When adrenal activity is low, less aldosterone is produced. This results in an excessive loss of sodium through the kidneys. Dysfunctional adrenal function can result in high amounts of thyroid hormones to build in the blood, making your labs in high range with continuing hypothyroid symptoms, or causing hyperthyroid like symptoms on doses which shouldn’t produce hyperthyroid symptoms.
Low carbon dioxide (CO2) in the body causes blood to be less acidic. This condition is caused by hyperventilation, or excessive ventilation which leads to a loss of carbon dioxide from the blood. Hyperthyroidism is one of the causes of low CO2 as more thyroid hormone causes hyperventilation by increasing ventilation hormones.
As research goes on, it is becoming clear that inflammation and oxidation are the two primary causes of heart disease. Testing for inflammation - homocysteine (healthy is 6.3umol/L) and CRP (healthy is under 1mg/L) is highly recommended. Studies show inflammation is the leading predictor of heart attack risk.
Craving salt is a common sign of adrenal issues. When adrenal activity is low, less aldosterone is produced. This results in an excessive loss of sodium through the kidneys. Dysfunctional adrenal function can result in high amounts of thyroid hormones to build in the blood, making your labs in high range with continuing hypothyroid symptoms, or causing hyperthyroid like symptoms on doses which shouldn’t produce hyperthyroid symptoms.
Low carbon dioxide (CO2) in the body causes blood to be less acidic. This condition is caused by hyperventilation, or excessive ventilation which leads to a loss of carbon dioxide from the blood. Hyperthyroidism is one of the causes of low CO2 as more thyroid hormone causes hyperventilation by increasing ventilation hormones.
Your lab results remind me of my own for over 25 years. I was taking 200 mcg of Synthroid, with a TSH of about .05, and FT4 at/over the high end of the range, yet I still had lingering hypo symptoms. After finding this Forum and learning about the importance of Free T3, I had mine tested and confirmed as low in the range. This condition is often associated with being hypo. After getting my med changed from T4 to a combo T4/T3, and tweaking the dosage, my Free T3 level is now 3.9 (range of 2.3 - 4.2), and I feel best ever. Many of our members also report that symptom relief for them required that FT3 was adjusted into the upper part of the range and fT4 adjusted to around the midpoint of its range.
Free T3 is the most important thyroid hormone because it largely regulates metabolism and many other body functions. Scientific studies have also shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate. So you should request to be tested for Free T3 and if the doctor resists, just insist on it and don't take no for an answer.
The low FT3/high FT4 is caused by inadequate conversion of T4 to T3. This is often the result of taking large doses of T4. Patients who are hypo frequently have low levels of vitamins and minerals that help in the conversion of T4 to T3. These include iron/ferritin, zinc, and selenium. So it is good to have these tested as well. Based on the experience of members, I would also suggest testing for B12 and RBC magnesium.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. I think you will get some good insight into clinical treatment from this link to a letter written by a good thyroid doctor for patients that he sometimes consults with from a distance. The letter is written for the PCP of the patient to help guide treatment.
http://hormonerestoration.com/files/ThyroidPMD.pdf
I also suggest that you might give a copy of this letter to your doctor and discuss your desire to be treated clinically as described. Even without seeing a test result for FT3 for you, I am sure that based on your symptoms, you will find that you need some T3 in your meds. If your doctor is resistant to testing and adjusting free T3, then you will need to find a good thyroid doctor that will do so.
Free T3 is the most important thyroid hormone because it largely regulates metabolism and many other body functions. Scientific studies have also shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate. So you should request to be tested for Free T3 and if the doctor resists, just insist on it and don't take no for an answer.
The low FT3/high FT4 is caused by inadequate conversion of T4 to T3. This is often the result of taking large doses of T4. Patients who are hypo frequently have low levels of vitamins and minerals that help in the conversion of T4 to T3. These include iron/ferritin, zinc, and selenium. So it is good to have these tested as well. Based on the experience of members, I would also suggest testing for B12 and RBC magnesium.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. I think you will get some good insight into clinical treatment from this link to a letter written by a good thyroid doctor for patients that he sometimes consults with from a distance. The letter is written for the PCP of the patient to help guide treatment.
http://hormonerestoration.com/files/ThyroidPMD.pdf
I also suggest that you might give a copy of this letter to your doctor and discuss your desire to be treated clinically as described. Even without seeing a test result for FT3 for you, I am sure that based on your symptoms, you will find that you need some T3 in your meds. If your doctor is resistant to testing and adjusting free T3, then you will need to find a good thyroid doctor that will do so.
COMMUNITY LEADER
I have a couple of questions I'd like to ask, if you don't mind.
# 1 is that T4 for Free T4 or Total T4? If it doesn't say "free" or FT on your lab report, then it will be "total", which is considered obsolete and not of much value.
# 2 is safe to assume, since you don't list it, that you have not had a free T3 done?
T3 and T4 are the actual thyroid hormones, with T3 being the "active" hormone, or the one that your body actually uses, while T4 is the storage form of hormone and must be converted to T3. Both T3 and T4 can become bound by proteins and can't be used or converted by the body. The amount of each hormone that's "free" - unbound and available for use, is the important one; the other is total, which tells you how much total hormone you have, but doesn't tell you how much is bound by protein and unusable.
Therefore, we always advise members to get tested for FREE T3 and FREE T4, not total T3 or total T4.
Studies have shown that Free T3 (FT3) correlates best with symptoms, which neither TSH nor Free T4 does.
TSH is a pituitary hormone and should be used alone, to diagnose or treat a thyroid disease.
Your symptoms certainly sound like you might still be hypo, but in order to determine that, we'd need to know what your Free T3 levels are, and whether or not the T4 you listed above is "free" or "total".
My suggestion would be to ask your doctor for another TSH, FREE T3 and FREE T4 (best if all run together), so we can get a better picture of what's going on. My first thought is that you might not be converting the T4 to the usable T3, but again, I'd need to know whether the T4 listed above is free or total, then see a Free T3 level. It's possible that you could benefit from a source of T3, such as cytomel, added to your levo.
Many doctors don't run FT3 and FT4, because they believe TSH is all that's necessary. If your doctor refuses to run the FT3 and FT4, I'd strongly suggest that you start looking for another one, because this one will keep you ill.
If you can't get your doctor to run the FT3 and FT4 tests, there are websites from which you can order these tests. One in particular is healthcheckusa; you order the tests online, they send you to a local laboratory to get the blood drawn and within a couple of days, you have results. I did this once and it cost $85 for TSH, FT3 and FT4; not covered by insurance.
# 1 is that T4 for Free T4 or Total T4? If it doesn't say "free" or FT on your lab report, then it will be "total", which is considered obsolete and not of much value.
# 2 is safe to assume, since you don't list it, that you have not had a free T3 done?
T3 and T4 are the actual thyroid hormones, with T3 being the "active" hormone, or the one that your body actually uses, while T4 is the storage form of hormone and must be converted to T3. Both T3 and T4 can become bound by proteins and can't be used or converted by the body. The amount of each hormone that's "free" - unbound and available for use, is the important one; the other is total, which tells you how much total hormone you have, but doesn't tell you how much is bound by protein and unusable.
Therefore, we always advise members to get tested for FREE T3 and FREE T4, not total T3 or total T4.
Studies have shown that Free T3 (FT3) correlates best with symptoms, which neither TSH nor Free T4 does.
TSH is a pituitary hormone and should be used alone, to diagnose or treat a thyroid disease.
Your symptoms certainly sound like you might still be hypo, but in order to determine that, we'd need to know what your Free T3 levels are, and whether or not the T4 you listed above is "free" or "total".
My suggestion would be to ask your doctor for another TSH, FREE T3 and FREE T4 (best if all run together), so we can get a better picture of what's going on. My first thought is that you might not be converting the T4 to the usable T3, but again, I'd need to know whether the T4 listed above is free or total, then see a Free T3 level. It's possible that you could benefit from a source of T3, such as cytomel, added to your levo.
Many doctors don't run FT3 and FT4, because they believe TSH is all that's necessary. If your doctor refuses to run the FT3 and FT4, I'd strongly suggest that you start looking for another one, because this one will keep you ill.
If you can't get your doctor to run the FT3 and FT4 tests, there are websites from which you can order these tests. One in particular is healthcheckusa; you order the tests online, they send you to a local laboratory to get the blood drawn and within a couple of days, you have results. I did this once and it cost $85 for TSH, FT3 and FT4; not covered by insurance.
Sorry hit post. I have concerns about the cholesterol as I have a family history of heart disease. It has never been high before. I am craving salt and can not drop weight. June of this year was 225 lbs started riding my bike getting in 3-5 miles a day 5 days a week. Lost 12 pounds quick then dropped another 10 Total time to lose six weeks. Now it us all back despite the continued exercise. I eat a diabetic/ cyliac diet due to having a son with both diseases. Getting frustrated as winter is coming, my bike riding will be comprised due to snow and I fight depression during winter months. My blood pressure is bouncing everytime I have a headache. Typical BP for me is 120/ 76. This last headache was 121/90.
Would love any input. I hate this feeling of being out of control.
Thank you,
Holly
Would love any input. I hate this feeling of being out of control.
Thank you,
Holly
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