Hypothyroid??? Wish I knew WHAT I have...

[caphill]

I am a 48 year old male. I have not felt well since the winter of 2007.  Tired, sleeping lots, 2 hour naps after work, feeling "dazed" at times. Enthusiasm for all things gone.  Libido has dropped to near zero.  In May 2008, I had an impacted kidney stones which had to be removed. When the stones arrived, I said "Ahhhh...THAT'S why I've been feeling so crappy.  Unfortunately, I slept that summer away, had a miserable winter, and slept a good portion of Summer 2009 away.  It is not "depression"- I have experienced that and this isn't it. I have a wonderful life and MANY goals that I can't accomplish due to fatigue.

My primary Dr. has tested a few times but has not been receptive to thyroid issues being the problem. She wants me tested for sleep apnea. I had a sleep study done several years ago and was told I have moderate SA. I could not wear the CPAP mask.

I finally have found an endocrinologist but have to wait 4 weeks to consult on my lab results. Here they are- I'd love an opinion:

CALCIUM    9.4
PHOSPHORUS    2.7
FSH   3.7
LH   3.6
T3 Free    2.8
Free T4    0.9
CORTISOL    16
TESTOSTERONE    225
PROLACTIN 7.2
GROWTH HORMONE,SERUM   >0.1
ACTH,PLASMA     19
ANTITHYROID PEROXIDASE <1
TSH, SENSITIVE     1.55   (earlier readings over the past 15 months have been: 2.28, 2.33, and 1.93

[gimel]

I'm not familiar with some of the tests you listed, so I'll confine my comments to mostly the thyroid area.  It would be helpful if you would list the reference ranges that go with the test results.  The reason for this is that labs get slightly different results and accordingly use somewhat different reference ranges.
If the reference ranges for the FT3 and FT4 tests are what I am used to seeing then your hypo symptoms are consistent with having a FT3 in the low end of its range and a FT4 below the midpoint of its range.  Although the TSH results do not signal the same thing, TSH is a pituitary hormone that is affected by many variables, including the time of day when blood is drawn.  It is inadequate as a diagnostic.  
At best it is an indicator, to be considered along with the more important indicators, which are symptoms and the levels of the actual, biologically active thyroid hormones, FT3 and FT4.  TSH does not correlate very well at all with hypo symptoms.  FT3 correlates best with hypo symptoms.  We'll probably need to discuss further why levels of the "Frees" in the lower half of their range are frequently an indicator of hypothyroidism.  Also I noticed no test for vitamind or B12.  Have you ever had those done?

In the interim, I think you wil find this article to be very worthwhile reading.

http://www.hormonerestoration.com/Thyroid.html  

[caphill]

I've listed the reference ranges my lab is using for the following test:

TSH, SENSITIVE 1.55 (standard range 0.5 to 5.0) [earlier readings over the past 15 months have been: 2.28, 2.33, and 1.93]

T3 Free 2.8 (standard range: 2.3 - 4.2 pg/ml)

Free T4 0.9 (standard range: 0.9 - 1.8 ng/dl)

CORTISOL 16 (standard range: not given- _____mcg/dl)

Testosterone 225 (standard range: 240 - 830 ng/dl)

I have been tested for Vitamin D in the past and have shown to be deficient. This was attributed to the long Minnesota winters and I was given prescription supplements. It didn't help.

[gimel]

You didn't mention vitamin B12.  That might be a good test to have done also.  Vitamin D deficiency seems to frequently accompany being hypo.  And your symptoms along with your FT3 and FT4 levels point to hypothyroidism.  Doctors, even Endos, are usually of the "Immaculate TSH Belief", and they would have a hard time getting past your TSH being within range.   However, as I outlined above symptoms and the levels of the "Frees" are much better indicators, and FT3 actually correlates best with hypo symptoms.  

You would be amazed at how many members we hear from with hypo symptoms that have FT3 and FT4 in the lower half of their very broad ranges.  My own explanation for that is contained in this copy of an email that I have sent to the Amer. Thyroid Assn. twice, with no response of course.  





After having gone through years of not being treated for hypothyroidism, because my TSH was 4.97 and thus "normal", I was very pleased to note that the AACE had finally recognized that the range was incorrectly determined.  After removing some suspect hypo patients' data, and recalculating the range, they recommended  it be lowered and narrowed to .3-3.0.  Six years after this recommendation, why is it that most labs and doctors still do not recognize the change and still use the old range?  Since doctors also over-rely on TSH as the gold standard for thyroid testing, multitudes of hypo patients are still being told they are "normal" and do not get treated.  Is the ATA doing anything to encourage the medical community to change this practice?   If so, why is it taking so long?

My second concern is that doctors predominantly rely on TSH in determining a patient's thyroid status.  Why is this, since TSH is a pituitary hormone that is affected by so many variables, including even the time of day when tested?  Why not promote more widespread use of the actual thyroid hormones that are biologically active (FT3 and FT4) and that largely regulate metabolism and many other body functions?  From studies I have seen and much personal experience, TSH does not even correlate very well at all  with  hypo symptoms.  The test that has been shown to correlate best with hypo symptoms is free T3.  Yet there are very few doctors that order a FT3 test as a matter of course, and some that refuse to order one at all.

When FT3 and FT4 are tested,  the ranges are so broad that patients with overt hypo symptoms will usually still fall in the lower end of the current range.   As a result they are also told they are "normal" and receive no treatment.  Why haven"t the reference ranges for FT3 and FT4 been corrected like TSH, to exclude suspect hypo patients?  If this were done, these ranges would likewise be raised and narrowed,  comparable to the new range for TSH.  I'm sure that some would say that the range is just a reference range, that as you approach the lower end of the range, that the probability of being hypo goes up and that in those cases, doctors look further to determine if medication is advisable.  I agree that this should be the case but I assure you it isn't. Labs and doctors interpret results within the reference range as "normal" and don't want to go any further.   As a result of all this the above  misunderstanding and misapplication, millions of patients go untreated and remain miserable with their hypo symptoms.

Is the ATA doing anything to raise the awareness  of these problems among the medical community so that we hypo patients can look forward to some positive changes?  If you are not, then I cannot imagine any other organization that could do the work necessary to coordinate changing the awful mess that exists in the area of diagnosis and treatment of thyroid patients. Your response will be greatly appreciated.






I have some background in statistical analysis, which I have applied to the question about the ranges for the "Frees".  Based on the change to the TSH range, if suspect hypo and hyper patients were purged from the data bases, I'd estimate that the range for FT3 would go from 2.3 - 4.2 pg/ml up to 3.2 - 4.3.  Likewise the range for FT4 would go from .60 - 1.5ng/dl up to approx. 1.0 - 1.55.  I'm convinced that this is why we hear from so many patients whose Ft3 and Ft4 levels fall in the low end of their ranges but they continue to have hypo symptoms.  I think it is also why you can read articles by many doctors advocating that when necessary a patient's FT3 and FT4 levels should be adjusted upward to alleviate symptoms.  In fact, if you read the link I gave you previously, Dr. Lindner did just that.  He advocates a therapeutic trial of thyroid meds in those cases.  

Hope I didn't put you to sleep with all this.

[TamraW]

I can only answer the thyroid portion. Your frees are on the low end and your TSH has been too high in the past. D and B12 issues are also common in hypothyroid disease. Your fatigue is classic thyroid. If I had a dime for every doc who just blew off my fatigue issue. They always blamed it on something else.

If I were you, I'd also request a thyroid ultrasound and the thyroid antibody blood tests (TGab and TPOab) to determine if you have Hashimoto's causing this.

Too many endos just don't know enough about thyroid disease, IMHO. If you are looking for a second opinion, then try this website.
http://www.thyroid-info.com/topdrs/

First call the doctor and ask if the doctor tests and treats the free levels (FT3, FT4). Those are a more direct indication of thyroid activity. My doc treats 75 percent thyroid, not diabetes, like so many endos.

I think the doc should try you on thyroid hormone with your low free levels. You could feel a lot better.

:) Tamra

[Super_sally888]

Your testosterone is also low, and a supplement may help there.

If the thyroid and the testosterone is addressed, plus you go ack on the vit D supplements, I suspect you may be feeling a whole lot better.