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How would you feel with a TSH of 0.6 and a Free T4 of 1.1?

How would you feel with a TSH of 0.6 and a Free T4 of 1.1?

I still don't feel 100% well.

My story:

I was diagnosed August 1, 2010 with silent thyroiditis.

My stats are (Range: TSH 0.40 - 4.50 // Free T4 0.8 - 1.8)

08/01/10 TSH 0.03

08/09/10 TSH 0.01

09/23/10 TSH 0.41

10/28/10 TSH 1.36 -- T4 0.96

12/6/10 TSH 3.80 -- T4 0.92

12/28/10 TSH 0.99

02/11/11 TSH 2.45 -- Free T4 1.1
>>>>PUT ON 25 MCG of SYNTHROID<<<>>>PUT ON 50 MCG of SYNTHROID<<<<

04/28/11 TSH 0.6 -- Free T4 1.1

Can ANYONE tell me what they think about my situation? Is this as good as it gets? I frequently hear that people generally may feel best when the free T4 is in the upper two-thirds of the range, so will staying on this Synthroid help my FT4 to increase beyond 1.1? I worry my TSH may get too low now.

What is going on?
12 Responses
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Avatar universal
Thanks I would really appreciate the names of recommended doctors in the cleveland area. Thank you so much !!
Helpful - 0
Avatar universal
Id love to hear how you make out at the cleveland clinic. I went to their top endo 5 years ago. He dismissed all my systems and said my symptoms made no sense. I was so hurt and confused after my visit. All of my symptoms are common thyroid issues. Brittle nails/hair, tingling in fingers, sensitive to cold, fatigue, itchy, muscle spasms etc. He recommended I go on anti depressants and see a neuorologist for muscle spasms and tingling. I was out of his office within 5 minutes.. maybe less. I spent most of those 5 minutes explaining my frustration and my symptoms and he spent 1 minute making me feel silly for suggesting thyroid or menopause as source of my problems. I left the office, walked down the hall and fought off tears all the way to my car. That was the 4th doctor that has dimissed my symptoms as being nothing and suggesting anti depressants. My numbers were:
Free T4   .9
TSH         1.7   (past results  2011 3.6,  2013 3.1  2014  2.34  early 2015  2.80 and now dec 2015  1.7)
He didnt do any other testing.
I really feel terrible with the constant itching, brittle nails, dry skin, etc. I feel off and getting so frustrated. I also have cleveland clinic coverage.. really great for heart issues but bed side manner ***** with the doctors ive had. They are nice but do not listen. I understand that they are trained to know much more than patients but they need to listen and resolve issues. Blowing people off like they are crazy is so unprofessional !!
Helpful - 0
3 Comments
Unfortunately doctors are usually taught that TSH is all they really need to evaluate, which is wrong.  If they test beyond TSH then they use reference range endocrinology and tell you that a test result that falls anywhere within the range is adequate.  That is also wrong.  They don't want to take the time to evaluate and treat a patient clinically by testing and adjusting the biologically active thyroid hormones, Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  

If you are interested I have the names of a couple of doctors in the Cleveland area, that have been recommended by thyroid patients.  
I am very interested in doctors in the Cleveland area!
I just sent info by PM.   To access, just click on your name and then from your personal page, click on messages.  
Avatar universal
Hi,

Finally saw the endo and had blood work drawn, at my request.  She stated emphatically that she would test for reverse T3 but that it meant nothing.  She was very please during the visit and took her time, however, now follow up was done, tests were released via their on-line testing to me and I have not heard a peep from her or her office.  Here are my numbers:

TSH - 1.070                Standard:  0.5 - 5.0
Free T3 - 2.8               Standard:  1.8 - 4.6
Free T4 - 1.1               Standard:  0.7 - 1.8
Iron: 85                       Standard:  30-140
TIBC:  311                   Standard:  210-415
Transferrin:  27            Standard:  11-46
Microsomal Antibodies: _1.0  Standard:  -5.6
Thyroglobulin:  1.3        Standard:  -14.4

Reverse T3 takes about a week for test results to come back.  She was reluctant to test - however as I stated, I insisted, but she won't do anything about it.

Can anyone on here interpret what these mean.  How can I feel so sick and yet have good numbers?  or are these good.  

I am beyond disgusted with the entire Cleveland Clinic System however my insurance covers everything at 100% so I am stuck with them.  What do I do and where do I even go from her.

Other question - why does my TSH swing so widely from one blood test to the next.  5.9 all the way down to 0.6.
Helpful - 0
Avatar universal
A good thyroid doctor does not have to be an Endo.  In fact they are usually less receptive to clinical treatment than other doctors.  I do happen to know an Endo in your area that was recommended by a thyroid patient.  I just sent the info by PM.  Just click on your name and from your personal page click on messages.
Helpful - 0
Avatar universal
Thanks so much for your help.  I have been going to the doctors here at the Cleveland Clinic in Cleveland Ohio and they do not believe in T3 as an indicator of anything really so they don't treat and state that there is no thyroid problem.  Very frustrating trying to find a doctor that will take into consideration not just the numbers but the overall patient.  They are just so large and see so many patients that taking the time to work with a patient is low.  I am not saying that they are all that way but by in large - it's not an easy system to navigate to find that one doctor.  Any ideas as to how to find a good endocrinologist would be greatly appreciated!
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Avatar universal
That T3 test is for Total T3.  It would be much more revealing if it was a Free T3 test.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  So, in the future you should always make sure that they test for both Free T3 and Free T4.  Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you should get those tested as well.

Your Free T4 is below the recommended level of middle of the range, at minimum.  If your Free T3 is anywhere near as low as your Total T3, it is no wonder you have those symptoms.  Many of us say that relief from hypo symptoms required Free T4 at the middle of the range and Free T3 in the upper part of its range.  

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 test results.  Symptom relief should be all important, not just test results and especially not TSH results.  

Based on your experience to date with your doctors you need to find a good thyroid doctor that will treat clinically.  
Helpful - 0
Avatar universal
TSH   0.610      Standard Range:  0.400 - 5.500

Free T4 1.2      Standard Range:  0.7 - 1.8

T3  72             Standard Range:  94 - 170

Does this help?
Helpful - 0
Avatar universal
Thyroid test results should always be compared to their reference ranges to best assess the status.  Please post the reference ranges shown on your lab report for those tests.  
Helpful - 0
Avatar universal
I have been complaining for years about not feeling well, hair loss, fatigue, tingling in hands and feet, depression, brittle nails, constipation, swelling in hands and feet, shooting pains in my legs - just feeling exhausted.  Have gone from doc to doc who always test my thyroid which comes out perfect. They go no further. My mother, sister and brother all have thyroid disease and are being treated. Two docs stated that it was fibromyalgia with osteoarthritis.  One doc said it menopause!  I think I am sick of them all!

After much back and forth - went to a new doc who order a T3 and it came back low.  

Now I am not sure what to do:  my latest test results are as follows:

TSH - 0.610
T3 - 72 - low
T4 - 1.2

What do this test means and do I wait for the doc to follow-up with me or call the office?  I have a follow-up with him in March but should I wait that long.  

I am so sick of feeling awful and I am sick of going to the doctor.  It's ridiculous!
Helpful - 0
Avatar universal
With the half life of T4 med being about one week, if you make the change in meds it will take 4 weeks to reach 90% of the final effect on blood levels of T4.   Since symptom  changes also tend to lag behind changes in blood levels of the thyroid hormones, you really could not know the full effect when you went back for your appointment.  

If you are having symptoms severe enough to preclude waiting the four weeks, then I'd suggest that you call and talk with the doctor about a possible increase.  Otherwise I think I would wait and make sure the doctor is on board with testing for the most important thyroid hormone Free T3 and go from there after seeing the results.  I say this because FT3 largely regulates metabolism and many other body functions.  FT3 has also been shown in studies to correlate best with hypo symptoms, while FT4 and TSH correlated very poorly.  As FTB4 mentioned sometimes patients do not convert T4 to T3 very well and you really need to know the FT3 level, so insist on that test.  

As far as TSH, I would not be concerned if the TSH becomes suppressed below the range.  TSH causes no symptoms.  It is only an indicator of the levels of FT4 and FT3.  If TSH is suppressed that does not mean you have become hyper, unless you also have hyper symptoms due to excessive FT3 and FT4 levels.  My TSH has been about .05 for well over 25 years, without ever having hyper symptoms. In fact I had lingering hypo symptoms even though my FT4 was at the very high end of the range.  Only after learning about the importance of FT3 and testing and finding mine to be low in the range and getting a source of T3 added to my meds, did I finally get my FT3 into the upper part of the range.  Now I feel best ever.  

A good thyroid doctor treats a hypo patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief  is all important, not just test results.   You might get some good info about clinical treatment of hypothyroidism by reading this link written by a good thyroid doctor.  

http://hormonerestoration.com/files/ThyroidPMD.pdf
Helpful - 0
Avatar universal
I will request the T3 test, but I do not go back to the doctor for another 4 weeks.  Does anyone recommend going up to 75 mcg of the Synthroid (up from 50) in the meantime?  Good or bad idea?
Helpful - 0
Avatar universal
Don't be concerned about TSH, yours is low, but if you are Hypo, the thats were you would want it, the question is, has your MD ever done Free T3 tests? TSH is only a pituitary hormone, (Throid Stimulating Hormone) that stimulates the thyroid to produce and secrete more T4 into your system, you then convert this T4 to T3 and test is Free T3, this is the actual hormone your body needs to function. And most thyroid sufferers feel best when the FT4 is about mid range, the TSH is supressed and the Free T3 is higher than the T4 and about 2/3rds up in its range. The big problem we have is when MD's treat thyroid by TSH only and not the most important indicaters like Free T3 Free T4 and your symptoms, you go see them, tell them you feel terrible, they look at your TSH and T4 and because they are within a range, they say you are fine and send you home, When you have an MD with this tunnel vision, there is another factor that could exist in your case, and without a Free T3 test, there is no way to determine, and that is known as a Conversion Issue or Problem, this happens when you take a T4 Synthetic Hormone medication like Levothyroxine or Synthroid, and you body does not convert it to T3, The T4 could be perfect on the test, but you cpould be sorely lacking in Free T3, which would cause you to be symtomatic and feel terrible, If your MD does not perform a Free T3 test, how would he ever know where you stand in regards to your thyroid? Insist on this test, when the results are ready, request a copy, post them here and ask for help with your lab results, Free T3, Free T4, TSH and the reference ranges provided for each. With these results and ranges, members will be able to help and advise, also include your medication and dosage. Best Regards  FTB4
Helpful - 0
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