Hi. I wasn't sure if I should post under thyroid or other hormones, so I guess I will start here. I have been fighting extreme fatigue, problems with sleep, being cold all the time, hair loss, and more for years. Several years ago, a PA-C had me on Armour and Cytomel, treating me based on symptoms, not solely on labs. Unfortunately, he also got "weird" and tried diagnosing with crystals and other things I didn't agree with so I stopped seeing him. While I was on those meds, I felt better than I have felt in my entire life. They were the only few years I truly felt "alive". I have tried numerous other docs (OB, general practice, endos, etc) over the years since and everyone says my labs are normal and are making me feel like an idiot, that everything is all in my head.
Recently I began working out 60 minutes a day (cardio) 5-6 days a week and eating a 1200 calorie diet. After 3 months, I'd lost a whopping 1 pound. I swallowed my fears and went back to the same PA-C. He said he no longer treats thyroid and feels everyones problems are cardiac related. Based on how I have been feeling, he did run a ton of labs (I have 6 pages of results sitting here). I pushed him to also test hormone levels, then after the results came back he said, "Oh. I don't routinely request those tests because I won't treat for them." He said there is nothing he can do about estrogen being low and suffering symptoms of menopause on top of already having felt tired and crappy for years. The problem is, now he wants me to do all this cardiac stuff (echocardiogram and other stuff that I feel is WAY off base) and yelled at me at my last appointment for not being part of his medical weight loss program yet. He said 1200 calories is way too high and I need to be at 900 or FEWER. After that, I fired him again. I have an appt with a new OB next Friday, but I'd like some advice so I know if what she says is true.
I'm 41 years old
No menstrual period since Aug. '08
Free T3 - 2.7 (range 2.3-4.2)
Free T4 - 1.0 (range 0.7-1.5)
TSH 2.46 (range 0.40-5.00)
Reverse T3 214 (range 90-350)
Cortisol, AM 13.9 (range 4.3-22.4)
Estradiol 34 (Post menopausal 0 to 35)
Estriol, unconjugated <0.3 (no range given)
Estrone 71 (Post menopausal 15 to 103)
LH and FSH Luteining Hormone 35.6 (Post menopausal 7.7 to 58.5)
Follicle Stimulating Hormone 51.1 (Post menopausal 23.2 to 121.3)
Progesterone 0.91 (Post menopausal 0.00 to 0.73)
Testosterone, Total 49 (range 7-46)
Testosterone, Free 1.2 (range 0.2-2.0)
I think your basic problem is that you need to be treated for your symptoms. Even though your TSH is within even the currently recommended range of .3-3.0, TSH is a pituitary hormone that is affected by many variables, including the time of day when blood is drawn for the test. TSH is inadequate as a diagnostic for thyroid problems. At best, it is an indicator to be considered along with more important indicators, which are symptoms and the levels of the actual, biologically active thyroid hormones, which are FT3 and FT4. FT3 is the most important since it is four times as potent as FT4 and FT3 correlates best with hypo symptoms.
If you look at your FT3 and FT4 results, FT4 is below the midpoint of the ref. range and FT3 is well below the midpoint. These reference ranges are too broad, because they have never been adjusted like was done for TSH. For this reason, many thyroid patients report feeling best when their FT3 and FT4 results are in the upper part of their ranges. In my firm opinion the very best way to treat a thyroid patient is to test and adjust FT3 and FT4 with meds, as required to alleviate symptoms. Symptoms should be all important, not just getting your test results somewhere within the so-called "normal" range.
At this point you need to find a good thyroid doctor that will treat your symptoms, by adjusting the levels of FT3 and FT4. If you don't have one in mind you might try posting a new message and asking if anyone has a recommendation for a good thyroid doctor in your area.
This is a good article on this whole subject area.
Thank you SO much for that information. I was wondering if thyroid meds might help again, even though the numbers fall within the listed ranges. I will definitely see if I can find a thyroid doctor who is willing to work with me on symptoms. So far, the numerous docs I've seen in my area all tell me my symptoms mean nothing since the labs are "normal". I appreciate your time!
You're very welcome. If you are interested, following is an email that I have sent to the Amer. Thyroid Assn. twice, with no response.
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 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.
Following the logic of this, from my experience in statistical analysis, I have calculated that if the ranges were adjusted for the same reason as TSH, then FT3 would probably change from 2.3-4.2 pg/ml to 3.2-4.3 and FT4 would change from .60-1.50 ng/dl to about 1.0-1.55.
Gimel is right. Just by looking at your numbers, I'd say you would benefit from some thyroid hormone. Your TSH is on the high end and your frees are nearing low. Most labs use outdated ranges. My endo told me that realistically 'normal' TSH is 1.1. Your frees should probably be mid to mid-high range.
If you are unhappy with your current doctor, here's a site with recommended endos:
It looked to me like in addition to finding someone who understands your thyroid - you do need someone who will look at the estradiol and other hormones.
Your cortisol is very low for a morning draw and that could be why you are feeling this way. The adrenals that are associated with the thyroid are very strong. When they are not stabilized and working right - it can throw the whole system out of whack and your labs certainly show numerous things that could be going on.
My first thought would be for you to look at the fatigue with your adrenals. That could be the whole issue - when thyroid meds are given to someone with adrenal fatigue - most often they fight against making someone feel good. AND you have a high(er) RT3 level right now too.
If you can - find a doctor that would look at adrenals and do a 24 hr panel saliva test to see how they function all day long.
You can google Adrenal Fatigue and read on that too.
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