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Hypothyroid Symptoms with "NORMAL" test results. Need Help.
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Hypothyroid Symptoms with "NORMAL" test results. Need Help.

I am a 40 yr old female, in the past 2 months I have been feeling symptoms of hypothyroidism, and almost every symptom of Hashimoto. I have been to the ER, 2 doctors and no on will diagnose me or tell me what' s wrong. DR#1 prescribed 10mg of Lexapro because they said it was depression. DR #2 prescribed 25mg Savella because he said it was Fibromyalgia. They both refuse proper antibody  tests and is going off the TSH level. My results from my limited tests were:

Vitamin D:14
TSH: 1.8
T3: 0.47
Free T4: 0.9
Cholesterol: 135

I feel that I have been improperly diagnosed. Can someone help me? Am I truly just depressed?
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Avatar_m_tn
I agree to be careful.  Self medication is not recommended although some folks have to as a last resort.

You are taking about 1.5 grains which I think is fairly high for a starter dose.

With Thyroid it is almost always better to start out with a low dose and work up.  I think it is more common for people to start out at 0.5 to 1.0 grains.  So about 30 to 60 mg per day to start and then work up from there.

As I mentioned before and is mentioned above in others, the T4 takes several WEEKS to build up in the blood stream.  Maybe a quick Thyroid 101 would help you.

The thyroid gland produces both T4 and T3 hormones.  But dramatically more T4 than T3.  The T4 is a "storage" hormone or a "pre-hormone".  that is it is NOT directly used by the body.  It remains in the blood until the body senses the need for more thyroid. In which case the T4 is converted mostly in the liver into T3 hormone.

It is also important to understand that both T3 and T4 hormone molecules can become stuck or attached to a protein molecule. When that happens the hormone is useless.  That is your body does NOT use any hormone that has become attached. This is the importance of the "free" test when we refer to the Free T4 (FT4) and Free T3 (FT3).  This test measures only those hormones which are free from being attached to a protein and thus are available for the body to convert the FT4 into T3.  And again some of the T3 either made directly by your thyroid gland or by conversion from FT4 can become attached to a protein and also become useless.  YOUR BODY ONLY USES THE FREE T3 hormone at the cellular level.  SO this is why we stress the importance of the Free T3 test since ultimately that is the ONLY thing your body uses.

Armour Thyroid is made from pig thyroids. And pigs have a different ratio of T4 to T3 than do humans.  The fact is that pigs produce significantly more T3 than human thyroids do.  So when you are taking Armour or any natural dissected thyroid medication it has a bigger T3 kick to it than would be the output of your normal Thyroid gland.

Although nothing wrong with Natural Dissected Thyroid (NDT) and some people it is the only thing that works for them. The more common approach for most Dr.s is to use a synthetic T4 medication.  And let your body convert.  If you end up having an issue with converting which some people have.  Then they add in synthetic T3 medication.  This allows much more precise dosage control while still getting both T4 and T3 where as NDT is a "set" ratio based upon the pig T4:T3 amount.

Again there is really no right or wrong medication process other than the one that ultimately works for you as an individual. Some people have issues with certain manufacturers etc.

The warnings above are because the T4 takes up to 6 weeks to ramp up and stabilize in your blood stream. So it is possible that when the T4 levels rise and your body converts that into T3, that conversion amount combined with the T3 that is in Armour will cause you to have TOO much Thyroid and go Hyper.  Hyper you have to be more concerned about because that often leads to rapid heart rate and other symptoms.  You do not want to go on the roller coaster ride from hypo to Hyper like a yo-yo.  You think you feel bad now, trust me it can be worse.

Also understand to NOT get over confident just because you are seeing an Endo.  MANY people have found them to be  really not that  much better in treating Thyroid than a primary care physician.  That is because most endo's are concentrating on diabetes and do not deal with Thyroid issues so they are really not more knowledgeable than a "normal" Dr.

Be aware that an Endo can be just as reliant upon "immaculate TSH belief" as any other Dr.  If that is the case just run, do not walk but RUN away from AND Dr endo or otherwise who relies solely on TSH.  They will almost assuredly keep you feeling like crap or have you on a roller coaster ride of hell.

Hope this helps.
27 Comments Post a Comment
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Avatar_n_tn
Just an idea for your own comfort.  You can go online and pay for blood work to be done at a local.  Just Google 'blood tests' and you should be able to pull up a service that does it.   Order your own blood work and get your own results.  Discuss results with your doctor.  This way you're nor guessing and you're not feeling neglected.  Take charge of your own health.
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Avatar_f_tn
What are the ranges on your FT4 and T3.  Also, is that total T3 or FREE T3.  If "free" or "FT3" isn't specified, it's total.

Are you supplementing vitamin D?
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649848_tn?1357751184
Your vitamin D is way too low and you should be supplementing to bring it up.  Vitamin D deficiency can cause many of the same symptoms as hypothyroidism.

Is that T3, Free or Total?  If it's total, it's of little value; if the lab report doesn't specify "free", then it's total.  What's the reference range for the Free T4?  Ranges vary lab to lab and have to come from your own report. If your range is close to what we normally see, your FT4 would be in range, but just barely.  Depending on Free T3, low hormone levels could cause your symptoms, as well.

Symptoms of "fibromyalgia" are often alleviated once thyroid hormone replacement is started.  
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Avatar_f_tn
Here are the results of what he tested for. He did not test for antibodies and some of the needed tests. Here is all I have:

T4: 6.5  (4.5-10-9)
TSH; 1.837 (0.350-5.50)
FREE T4: 0.9 (0.6-1.8)
VITAMIN D: 14 (30-80):
FERRITIN :42 (10-291)
T3 TOTAL: 0.47 (0.60-1.81)

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Avatar_f_tn
He tried to call in a prescription for vitamin D,but he wrote it wrong so the pharmacy couldn't fill it. His office was closed so they could not verify.
So now I am sent home without medication but the Lexapro and Savella.
I feel terrible. I am trembling typing now, my head has massive pressure, my bones ache, my temperature has dropped to 96.5 on average, my blood pressure was low for months (90/60) then last week, it jumped to 160/100.
Meanwhile, my heart rate is at a constant 55 bpm. I can't walk properly, I shuffle. It feels like my body is about to stop. I even went to the ER, and because my vitals are non-emergency, and I am stable, I am sent home with advice to seek medical advice. Then I go to these 2 fine physicians to be told I am symptomatic because of depression. They look at my test results and told me I am "normal".
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Avatar_f_tn
Hi
Your levels are way to low. You can take over the counter vitamin d, but your thyroid levels are very low and you need to be on meds if you are not already. They gave me depression meds when my levels were off as well. I took them for two months and that was it. They didn't help because my thyroid meds were off. I know how you feel. I felt AWFUL. I started with 50 mcg of levoxyl and 15-20 of cytomel which helped so much. I'm currently on 88 mcg and about 12.5 of cytomel. My levels are still to low. I have to ride it out. It really *****, however when you get your meds you will feel a bit better.
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Avatar_f_tn
Thank You everyone for your help! It is relief to know that I am not insane. I was starting to believe it. I don't have any meds because no doctor will diagnose me with a thyroid problem. Any suggestions as to what I can do to get proper medicine?
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Avatar_f_tn
What would you recommend I start out with if I am to take Armour thyroid?
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Avatar_f_tn
Your doctor is ordering total T3, a test that is considered obsolete and of little usefulness.  He should be ordering FREE T3.  That being said, your FT3 is below range, and that should be getting your doctor's attention.  

You can order antibody tests online without a doctor's order.  They send the results directly to you.  If your doctor won't order antibody tests, that might be worthwhile doing.
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Avatar_f_tn
What are the tests you recommend I order?
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1756321_tn?1377771734
Ferritin is too low.  Some studies indicate you need a ferritin level of 70 or above for hair growth. The most common low/deficient nutrients found with hypothyroidism are vitamin D, iron, vitamin B12.

Labs recommended: TSH, Free T4, Free T3, thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TGAb), reverse T3, vitamin B12.
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Avatar_f_tn
As mentioned, your should insist on FREE T3 and FREE T4 in your next round of tests.  

Ideally, both TPOab and TGab should be tested to diagnose Hashi's.  However, if you order online, I'm not sure you'll find TGab.  By far, most of us with Hashi's have elevated TPOab, and a positive TPOab is considered sufficient for diagnosis of Hashi's.  However, if TPOab is negative, Hashi's can't be ruled out without TGab.

I think RT3 (reverse T3) would be of limited usefulness at this point when you haven't even been diagnosed with a thyroid condition, nor are you on meds.
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Avatar_n_tn
everything you showed is low----and your TSH is also at the lower end of the range---supposedly, if the TSH test were really accurate (I happen to believe it is not)  your TSH should be at the upper end of normal with how low your FreeT4 is and your Free T3 is---since he tested total T3, your Free T3 will be even lower.

I was within "lab ranges" for vit D---3 points above the bottom--and I had a lot of bone pain.  I finally figured out that even though it was within range---it was way too low for me.

I'm still working on my ferritin levels to get them up to a decent range.

With your TSH being low along with your Free T4 and Free T3 I am wondering if you might have central hypothyroidism---this is what I have and it comes from some sort of problem with the pituitary-----it also throws off a bunch of other things in your endocrine system.

I have had low ACTH, low cortisol---I have secondary adrenal insufficiency.  I have also had low DHEA, low testosterone, high sex hormone binding globulin, low p[rogesterone, high estradiol and I have a number of vitamin and minerals that are too low.

I have been working with a doctor since June to try and balance my endocrine system--but he is ill now--and I may need to find a new doctor-----that concerns me, since i flew across the country to see this guy.
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Avatar_n_tn
AnnNova-----if you want to try armour---I would suggest you try NP thyroid instead.  armour changed it's formula several years back and it gave a lot of people trouble.  NP thyroid is made by acella and it is very similar to what armour thyroid used to be before two formula changes.  it is sweet and you take it subligually--letting it disolve under your tongue.

My doc started my out at one gram for a month, then had me raise it by 1./2 grain every 10 days. If you start to feel crappy when the dosage goes up, you may need your cortisol checked.  He went by symptoms and not by blood tests.
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Avatar_f_tn
Thank You for all your good advice. I finally made an appointment to see an endo, but not until March 8th. The doctor finally called in the Vitamin D prescription (50,000 btu) taken twice a week for 3 months. I haven't started the Savella meds yet, but did start taking the Lexapro because I have been a ball of nerves lately. I broke down and took one of my in law's Armour 60 mg today. I can't tell you how much better I feel already. I would say my symptoms have lessen about 60% better. I hope to do the same until I see the doctor March 8th. Do you guys think this is a good idea? I just couldn't stand being in that state any longer, I was so desperate, well still am, but feel so much better already.
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Avatar_m_tn
When you change two things at the same time it is difficult if not impossible to determine what worked and what didn't.  You started the Lexapro at or near the same time you took an Armour pill.

Armour has BOTH a T4 and a T3 component.  The T3 portion is very fast acting as in hours.  So you might be able to feel a relatively quick response.
But the T4 portion is VERY slow acting. It takes up to 6 weeks to build up in your blood. So you would not have felt a thing from this with a single pill.

Hormones are very sensitive and need both time and some consistency to determine what the heck is going on in your body.

You definitely seem low thyroid to me as your symptoms also indicate. Many (not all) people who have depression and are Hypo (low thyroid) are able to not need any anti-depresants or anti anxiety medication once they get their thyroid levels optimized for them.

You need to find new doctors who will test you for the right things and also be willing to work with you.

While Total T3 is considered of little value, your Total shows it to be low. So you can almost be assured your "free T3" would also likely be low.

Many people find that in order to feel well they need to meet or generally be well up into the ranges for both Free T4 and Free T3.  In fact, the consensus seems to be a good target to work up towards is to have BOTH of the following;

1) Free T4 to be in the MIDDLE of the range (50%) if not slightly higher

AND- that means in addition to

2) Free T3 to be in the UPPER 1/3 of the range (66.7%)

It is also pretty common for people who are low thyroid to also be low in Vit D and B-12.  Both of which I think are already indicated in your case.  So you should always get those tested as well as Iron and ferritin which I think also was low in your case.  

many people have foun
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Avatar_f_tn
Bless this forum and the people on it. It is such a relief to know that I am not alone. I am still on my search to find the right doctor to properly diagnose and maintain me. I am hoping that the endo will do that on March 8th, but that is almost a month away still. I am still trying to find a GP though. Will order those tests that you all recommend and will post it here to see what you guys think. Thanks so much for your continued responses and help! Truly appreciate it.
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1139187_tn?1355710247
For what its worth, when i was first diagnosed with HORRIBLE symptoms everyone said there was nothing wrong with me because my blood work didnt look horrible.  In my opinion it takes just as long for your paper labs to go bad as it does for your labs to go good.  Another words, my body was under attack but at first my labs did not reflect this.  I still probably had plenty of hormone in my tissues.  But as time went on my labs continued to slide downhill.   It wasnt til i had tsh of 24 and frees of .5  (ranges 1.2 and up) til the Doctors finally took notice.
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Avatar_f_tn
That's just dreadful. I guess as long as I know I'm not going to drop dead tomorrow, I am a bit better about waiting for diagnosis. I was losing faith and hope as doctors after doctors told me I'm normal because my blood tests come out normal. I can't imagine how I would feel if I didn't take the armour and had to wait until 03/08. I still don't know if I'm taking the right dosage, currently taking Armour 60mg in morning and 30 mg at night. It's been a few days and I feel dramatically better, although I still notice symptoms but at a lower level. Am I taking the right dosage or is my body trying to adjust. This is plain terrible because i actually have really good insurance! I don't know know what else to do or how I'm supposed to find a doctor that is willing to help me.
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1139187_tn?1355710247
where are you located?
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Avatar_f_tn
I am in Northern Virginia.
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1139187_tn?1355710247
Did we talk yet?   I think i know a good doc there.  send me a PM if we didnt already discuss this.  My friend is there and sees one he likes.  
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Avatar_f_tn
Be very careful.  The T4 component in Armour takes 4-6 weeks to build in your blood.  So, if you take too much or increase too fast, you may start having hypER symptoms.  Taking thyroid meds is not like taking an aspirin...the relief of symptoms isn't immediate, but takes weeks to affect levels and stabilize.  

I don't advocate self medication, but just be conservative until you can see a doctor who can help you with this and monitor your progress via blood work.  
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1139187_tn?1355710247
Yes.   what she said.    and if you believe in that STTM wackyness you will find yourself overmedicated.
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Avatar_m_tn
I agree to be careful.  Self medication is not recommended although some folks have to as a last resort.

You are taking about 1.5 grains which I think is fairly high for a starter dose.

With Thyroid it is almost always better to start out with a low dose and work up.  I think it is more common for people to start out at 0.5 to 1.0 grains.  So about 30 to 60 mg per day to start and then work up from there.

As I mentioned before and is mentioned above in others, the T4 takes several WEEKS to build up in the blood stream.  Maybe a quick Thyroid 101 would help you.

The thyroid gland produces both T4 and T3 hormones.  But dramatically more T4 than T3.  The T4 is a "storage" hormone or a "pre-hormone".  that is it is NOT directly used by the body.  It remains in the blood until the body senses the need for more thyroid. In which case the T4 is converted mostly in the liver into T3 hormone.

It is also important to understand that both T3 and T4 hormone molecules can become stuck or attached to a protein molecule. When that happens the hormone is useless.  That is your body does NOT use any hormone that has become attached. This is the importance of the "free" test when we refer to the Free T4 (FT4) and Free T3 (FT3).  This test measures only those hormones which are free from being attached to a protein and thus are available for the body to convert the FT4 into T3.  And again some of the T3 either made directly by your thyroid gland or by conversion from FT4 can become attached to a protein and also become useless.  YOUR BODY ONLY USES THE FREE T3 hormone at the cellular level.  SO this is why we stress the importance of the Free T3 test since ultimately that is the ONLY thing your body uses.

Armour Thyroid is made from pig thyroids. And pigs have a different ratio of T4 to T3 than do humans.  The fact is that pigs produce significantly more T3 than human thyroids do.  So when you are taking Armour or any natural dissected thyroid medication it has a bigger T3 kick to it than would be the output of your normal Thyroid gland.

Although nothing wrong with Natural Dissected Thyroid (NDT) and some people it is the only thing that works for them. The more common approach for most Dr.s is to use a synthetic T4 medication.  And let your body convert.  If you end up having an issue with converting which some people have.  Then they add in synthetic T3 medication.  This allows much more precise dosage control while still getting both T4 and T3 where as NDT is a "set" ratio based upon the pig T4:T3 amount.

Again there is really no right or wrong medication process other than the one that ultimately works for you as an individual. Some people have issues with certain manufacturers etc.

The warnings above are because the T4 takes up to 6 weeks to ramp up and stabilize in your blood stream. So it is possible that when the T4 levels rise and your body converts that into T3, that conversion amount combined with the T3 that is in Armour will cause you to have TOO much Thyroid and go Hyper.  Hyper you have to be more concerned about because that often leads to rapid heart rate and other symptoms.  You do not want to go on the roller coaster ride from hypo to Hyper like a yo-yo.  You think you feel bad now, trust me it can be worse.

Also understand to NOT get over confident just because you are seeing an Endo.  MANY people have found them to be  really not that  much better in treating Thyroid than a primary care physician.  That is because most endo's are concentrating on diabetes and do not deal with Thyroid issues so they are really not more knowledgeable than a "normal" Dr.

Be aware that an Endo can be just as reliant upon "immaculate TSH belief" as any other Dr.  If that is the case just run, do not walk but RUN away from AND Dr endo or otherwise who relies solely on TSH.  They will almost assuredly keep you feeling like crap or have you on a roller coaster ride of hell.

Hope this helps.
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4939681_tn?1361302899
I am in the DC area and DESPERATE to find a doctor to help me!  Since you are so close, could you please respond or message me if you find a good doctor?  Thank you!  ... And vice versa... I'm trying to get in to see a specialist at Washington Hospital Center.  If they are helpful, I will let you know!
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Avatar_f_tn
Per your advice, I lowered my dosage of 60 mg Armour in morning, and 30 mg at night to 30 mg in morning and 30 mg at night. I was taking the 90mg dose for a week. I only started. I am still feeling tremendous bone ache and fluctuating weight. I will yo-you 5-8 lbs in a day, if not hours. I also seem to be urinating quite frequently. I am not pregnant, the hospital tested me. I pray that the endo on March 8th will help me. I am still by far feeling much better, I would say 70% better. I am still suffering symptoms and but at this point, it has become somewhat tolerable. I am so worried until I get diagnosed which I am sure is adding to my anxiety.
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Avatar_f_tn
It takes a while for symptoms to go away.  First, we have to get FT3 and FT4 levels to come up.  After that, the body still has to have time to heal after having been hypo for a while.  Patience!  

Glad to hear you are feeling better...
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