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Hypothyroid symptoms with "normal" range test results
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Hypothyroid symptoms with "normal" range test results

I have been dealing with hypothyroid symptoms for a few years on and off but most recently it has been constant.... (20+ weight gain in 2 months, tired, high cholesterol, irregular frequent periods, low blood pressure, unregulated body temperature, allergy symptoms not relieved with meds, memory loss,etc) I went for a physical and had my dr. order thyroid test and the results came back "in normal range" ... they did not give me the ranges but my results were T4 1.03 and TSH 2.50 (they did not test T3) Could I still have hypothyroidism with normal test results? I am at a loss if it isn't my thyroid as to what else could cause all of these symptoms.. Any help would be appreciated, Thank you!
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Avatar_m_tn
Also, for background in case it matters, I'm a 32 y/o female with two kids 7 and 2
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Avatar_f_tn
Assuming a fairly typical range on FT4 of 0.8-1.8, your result of 1.03 is quite low.  Many people have hypo symptoms until FT4 is right around 50% of range (this is a rule of thumb and doesn't apply to everyone), and yours is at 23% of range.

Although few doctors and labs have adopted it, AACE many years ago recommended TSH range be adjusted to 0.3-3.0.  So, yours is high in range.

As you might suspect, few doctors will treat with labs in range (I'm not condoning this, just warning you).

It would be nice to see what your FT3 is doing.

Vitamins D and B-12 deficiencies and deficient iron and/or ferritin and selenium can have symptoms that mimic hypo.  Have you had any of those tested?
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Avatar_m_tn
Thank you so much for responding ! I had a CBC done along with the thyroid and cholesterol blood work  and they said everything was normal on the CBC but I don't know if they check the things you mentioned with that or if it is a separate test . Is it unusual for a thyroid test to be done and not have the t3 ? Maybe the nurse just didn't give me that # :/ ... What would be a normal range for the t3? How do the t3 #'s relate to thyroid function ( sorry this is all new to me an I am at a loss what it all means)
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Avatar_f_tn
You don't have to apologize...that's why we're here...to fill in the blanks.

No, the vitamins and minerals I mentioned are not part of a CBC or a lipid panel.  The doctor would have to order them individually.

No, it's not, unfortunately, unusual for FT3 not to be ordered.  Many doctors think it's too volatile to be useful, and the AACE didn't help us out a whole lot with their latest recommendation that it's "irrelevant" for hypo patients.  The fact of the matter is that FT3 correlates best with symptoms.  It's not important for some people, who convert well, but you don't know that until you test it.  I'd guess they didn't test it.  

Ranges on all tests vary lab to lab.  So, you really have to ask for reference range when you get results (or request a paper copy, which will have ranges on it).  For the most part, FT4 ranges don't vary drastically from one lab to another, but you should still get the range in case your lab is one of the ones with a lot of variation.  FT3, on the other hand, varies a lot, so I just cannot tell you what the "normal" range would be.  Even going to the same lab for years, my lab's FT3 range has changed several times over the years.

I'll give you a quick Thyroid 101, and you can ask more questions if it generates any.  

The pituitary is the master endocrine gland (it's in your head, just under you brain).  The pituitary regulates all the other endocrine glands.  It checks the levels of thyroid hormones and if there isn't enough, it sends out a messenger hormone (TSH) to your thyroid to tell it to produce more.  If it thinks your levels are too high or just right, it doesn't send out any TSH.

When the TSH gets to your thyroid, it causes your thyroid to produce T4(and a very little bit of T3).  T4 is the "storage" form of the thyroid hormones, and it floats around in your bloodstream until cells need hormone.

However, cells cannot use T4.  It first has to be converted to T3.  This happens mostly in the liver, but there are lesser sites throughout the body.  T3 is the "active" form of the thyroid hormones.  The vast majority of T3 comes from conversion, not from the thyroid.  So, you can see where T3 levels are important because T3 is all your body can use.

Some people, for unknown reasons, do not convert T4 to T3 well, or we should say they convert slowly.  So, even if FT4 levels are good, or even high, they can feel very hypo if FT3 is low.  Slow conversion seems to be more of a problem once people are on thyroid meds.

I think it would be worth your while to test the vitamins and minerals I've talked about.  You could be hypo with your FT4 and TSH levels, but it's by no means a clear cut diagnosis.  Vitamin D deficiency has become rampant in this country, and the symptoms can be so similar.  D, iron and ferritin are necessary for the metabolism of thyroid hormones, so if you have deficiencies of any of those, your body might not be using your thyroid hormones as efficiently as it could.  If you do have vitamin and mineral levels tested, be aware that just being in the bottom of the range on them is seldom sufficient to relieve symptoms, either.

If those levels show no deficiencies, you might be able to talk your doctor into a trial dose of thyroid meds to see if it helps your symptoms.

Has your doctor tested thyroid antibodies to see if you are in the early stages of Hashimoto's thyroiditis?  Hashi's is an autoimmune disease and, far and away, the most prevalent cause of hypo in the developed world.  The two markers for Hashi's are TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies).
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Avatar_m_tn
Thank you for all of that information! I don't think I have a vitamin d deficiency bc I take a multi vitamin along with a d3 supplement plus I own an organic grass fed dairy and meat farm so I certainly get vitamin d :) but I will still have them check it because I would rather rule it out instead of testing one thing at a time .... I don't know anything about hashimotos and I know they didn't  test for it since they only did CBC cholesterol and t4/tsh ... I have an appt scheduled for an endocrinologist but its still a month away (the downfall to a rural area) I'm thinking I will call them and ask if they can write a script to have the bloodwork done prior to my appt so I don't have to wait another two months to be seen and go over my results . Thanks again for all of your input , I'm hoping I can convince them to do a trial of the thyroid meds to see if that helps but hopefully a full work up will give more definitive answers :)
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Avatar_f_tn
Your D should be good if you spend plenty of time in the sun, but, you're right, best to be sure while you're at it.  How was your cholesterol?  I ask because high cholesterol is a symptom of hypo, but too low cholesterol can cause vitamin D deficiency.

It's an excellent idea to ask for a lab order before you see the doctor.  That will save you some time.  FT3, FT4 and TSH are a must.  I'd also ask for TPOab and TGab.  Hashi's is the most prevalent cause of hypo.  With Hashi's, the immune system starts to see the thyroid as foreign protein (much as it sees bacteria or viruses), and it produces antibodies that attack the thyroid.  If your antibodies are elevated, it can be easier to get treatment, even if your thyroid levels are not out of range yet.
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Avatar_m_tn
My cholesterol was high - tc 287 tri 76 hdl 56 and LDL 210 :( they want to put me on statins but I'm hesitant bc I believe the high cholesterol is a symptom and not the true problem :/ I have always had a good/ great diet but I'm incorporating even more things to hopefully help (supplements, fruit veggie smoothies, high fiber, low cholesterol, etc) glad you think it's a good idea to do the labs beforehand - now hopefully they will let me :) I read a little about hashimoto and the symptoms do seem to line up so I will ask for those tests as well , thank you for all the info and ill be sure to update once I get the next round of results :)
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Avatar_m_tn
I just thought of another question ... Do you think I should discontinue my supplements prior to my bloodwork so I make sure I have an accurate reading of all my levels?
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Avatar_f_tn
Most supplements don't effect thyroid blood work.  In fact, none do that I know of, unless you're taking something specifically for thyroid support.

Are you already supplementing the vitamins or minerals that you plan to test?  I know you said you were taking D and take a multi.  Anything else?  How much D do you take?

I just thought of something else, too...iodine.  Do you use iodized salt?  Do you eat a very "pure" diet, i.e. very little prepackaged/prepared food, little eating out, etc.?  Do you know if your geographic area has a problem with iodine depletion?  
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Avatar_m_tn
Thank you i will continue to take everything except the multivitamin and vitamin  d to see my true levels at the next blood work up if you dont think any of the following will interfere ....I have been taking d3 1000 iu / day, coq10 100mg, artichoke leaf 500mg ,plant sterols 1600 mg, fiber 5 g, and apple cider vinegar 1T .... As far as iodine we typically use sea salt and try to stay away from packaged foods mostly clean diet - prob 70-80% , 90% organic .... The multi I take has 100% DV of iodine in it and not sure about our area but we have well water if that matters  :)
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Avatar_f_tn
It might be worthwhile to test iodine.  Sea salt isn't typically iodized, and iodized salt is one of the major sources of iodine (along with just about everything that comes out of the ocean).  If you eat the typical American diet (which you don't) you get enough salt to kill a horse, so you get your iodine, too.  Multi vitamins are notorious for providing vitamins and minerals in their cheapest, least bio-available form.  

There is a home test you can do.  You paint a small spot of iodine on your stomach.  If the stain disappears very quickly, it's because your body is hungry for iodine and is absorbing it fast.  If it's there several days later, you're probably okay.  You can google for a more precise description of how to do the iodine home test.

Beyond that, I don't see anything in your list of supplements that would affect thyroid tests.  If you continue to take your D3, just bear in mind that your levels would probably be lower if you weren't supplementing.  7,000 IU per week isn't much...people with deficiencies often take 50,000 IU per week.  
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