Interpretation of T4 and TSH levels

[DLP1013]

My daughter, 15 1/2, has been having tyroid tests for the past 6 months.  The TSH levels started at .46 and were run because her doctor noticed tenderness on her tyrod glands.  1 1/2 months ago she had the test run as she has been having unexplained stomach issues, that doctor had said the thyroid could cause her system to slow down and she was always cold so he ran a TSH it was then .34.  Now it has been rerun and she is now at 0.30.  Her T4 is 1?  Is this cause for concern.  I know that the new standard for TSH is .3 - 3, I am just having a hard time understanding T4.  If there is an issue I am assuming I should have her see and endrocronoligist instead of her pediatrician for initial diagnosis?  The doctor that ordered the second round of tests is a gastroentronologist and he said this wasn't his specialty so I should discuss the results with another doctor.

[gimel]

First, I agree with Tamra that you need to find a good thyroid doctor.

Second, the best place to get the reference range is from the lab report itself.  The reason for this is that results differ from one lab to another and many have accordingly established their own reference ranges.  Doctors are required to provide a copy upon your request.  

TSH is a pituitary hormone that is affected by many variables, and is therefore not reliable enough to be used as a diagnostic for thyroid problems and dosage of medication.  At best it should be used as an indicator, along with the most important indicator, which is symptoms, as well as blood levels of the actual, biologically active thyroid hormones, which are FT3 and FT4 (not to be confused with total T3 and total T4).  It is my firm opinion that the best way to treat a thyroid patient is to test and adjust FT3 and FT4 levels with meds, as required to alleviate symptoms.  Frequently we find that this requires not just getting FT3 and FT4 into the lower limit of their reference ranges, but adjusting the levels into the upper part of the ranges until symptoms are relieved.  Treatment of symptoms should be all important, not just getting TSH, FT3 or FT4 somewhere within their ranges.  

One other thing is that if FT3 and FT4 results are found to be in the lower part of their ranges, consistent with hypothyroidism for many people, then the low TSH is not consistent with that and the pituitary function may also need to be evaluated.


I think you will get some good info from this article.

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

[DLP1013]

Thanks Tamra,

In February during my daughter’s yearly exam the doctor noticed pain in her thyroids.  Her TSH was .46 at that point.  

Then in April she had an ovarian cyst, starting around this time she has had stomach pain that every test imaginable has now been run to diagnose.  She definitely doesn't have Pancreatitis, Gallbladder, Kidney problems, IBS, Reflux, Celiac the only thing they did find was gastritis in the lower esophagus and upper colon.  She has had bloating, weight gain (even though she is a very active varsity cheerleader) and a full colon.  

During the visit with the Gastroenterologist my daughter mentioned that she was always cold so he ordered the thyroid test along with the other blood work.  It came back at .34.  They told us to rerun it in a month.  It is now .3 and I was told her T4 was 1.  Since I don't know what normal ranges are for T4 I don't know what that means.  

I, myself, have Hypothyroidism and I have always just gone with my TSH levels to determine were I am.  Since I was in 6th grade when I was diagnosed I never asked some of the other questions that I would now that I am an adult.  I know her TSH is right at the low end of normal but I am confused when we add the T4 into the mix.  

Do you know what the T4 range is?  I have been looking everywhere on the internet and I can’t seem to find it.  Just the TSH range which I already know.  I just don’t want to run off to yet another doctor if I don’t have to.  

[TamraW]

You should take her to an endo, one who specializes in thyroid. Many are diabetes specialists, and I personally think I know more about thyroid disease than my endo.

The TSH is low, indicating hyper, but the FT4 is also low, indicating hypo. So many issues can be directly related to thyroid, such as fatigue, depression, bi-polar, weight gain or loss, constipation, diarrhea, GERD, heartburn, racing heart, ear pain, neck pain, chest pain, swollen joints, swollen abdomen, weakened muscles, especially in lower legs, rashes...

Please post her symptoms here.
:) Tamra