thyroid normal

[tiredofbeingtired1]

I have been losing hair, tired, gaining weight, constipated, and very forgetful for the last several years.  I do have sleep apnea, which was diagnosed within the last 6 months.  My husband also has sleep apnea and feels wonderful after using the CPAP machine.  I can sleep 10 hours on the machine and am still so tired.  I have been sleeping through alarms the last several days.  I have noticed joint pain that comes and goes for about the last few weeks.

I am on spironolactone for the hair loss.  My gyn. says that I show classic symptoms of PCOS (weight gain, hair loss, strange hair growth).

I go to my primary tomorrow and I wanted to ask about my thyroid functions.  He did lab work in October but he didn't do the T3.

TSH                 1.3     (normal range .3-4)
Free T4              .9     (normal range .6-1.6)
Cortisol AM    23.1     (normal range 6.7-22.6)

Everything appears in the normal range, but I notice that my free T4 is on the low end.  With all of these symptoms, it keeps sending me back to hypothyroidism.  I am starting to feel like I am a hypochondriac.  I just want to feel better.  I would love any insight.  Even if it means seeing a different kind of doctor.  Thanks so much for your help!!

[tiredofbeingtired1]

Thanks for replying to my pm. Even though there isn't a thyroid doctor in my area, I was able to locate an endo that specializes in thyroid. I can't get in for a month but am keeping my fingers crossed that they'll figure something out. This forum really has been wonderful. Thanks all.

[Barb135]

Metformin is often used to treat PCOS, even when blood sugar levels are normal, but if they won't give it to you, there isn't much you can do.

Free T3 of 2.7 with that range is too low.  Did you discuss the possibility of Central Hypothyroidism with your doctor? If so and he wasn't receptive, that and the fact that he didn't order Free T3 with the Free T4, simply indicates how little he knows about the thyroid.

Find a thyroid doctor, though it doesn't have to be an endo, because not all endos are good thyroid doctors.  If you can be more specific about your location, we might have a patient recommended doctor in your area.  If you don't want to post it publicly, feel free to send me a private message.  To do that, simply hover your cursor over my name and you will get a drop down menu, click on "Send Message" to get the message box.

[tiredofbeingtired1]

So to update, my doctor didn't redo all thyroid labs. Said it wasn't thyroid but I did convince him to do free t3. I finally have results back and range is 2.3 - 4.2 and I'm 2.7. Does that seem ok? Should I try to find thyroid doctor or endo?

Thanks!!

[tiredofbeingtired1]

Thank you SO MUCH for the insight. I will definitely speak to my doctor about this. I will update the post once I have more information.

Also on the metformin, both gynecologist and primary said metformin won't help because my sugars are normal.  I'm happy to see this and I will push these issues.

Again thank you!!

[Barb135]

Just because everything "appears" to be in the normal range, doesn't mean it's normal for you.  You're correct that your FT4 is very low in the range.  It's only at 30% of the range, when most of find we feel best with it at least 50% of the range; but what stands out most is that your doctor failed to order the most important test, which is the Free T3 test. Free T3 is the most active thyroid hormone and has been shown to correlate best with symptoms.

Typically, we would expect TSH to be higher than yours, when FT4 is lower, which is suggestive of Central hypothyroidism, which would be a pituitary/hypothalamus issue rather than a thyroid issue.  This means your thyroid is probably working fine, it's just not getting the proper signal to produce adequate hormones.

Your morning cortisol is just a bit high and while a single cortisol level isn't telling enough to indicate much of anything, it's worth noting that the adrenals kick in to help take up the slack when the thyroid isn't producing enough.

Your symptoms do also correlate with PCOS.  Metformin is often used to treat PCOS and I'm somewhat surprised that you weren't started on that to see if it would help.

Many of us have been down that road of feeling like a hypochondriac and don't worry about that - make them keep looking/testing until they've found the answer and it could be a combination things.  It's not uncommon for PCOS and hypothyroidism to co-exist within the same person.

You should also ask to get vitamin B-12 tested.  B-12 deficiency makes one feel like there's not enough sleep in the world to make them feel better - been there done that.  Vitamin D deficiency causes hypo-like symptoms.  Iron is necessary for the metabolism of thyroid hormones and deficiency causes fatigue, tiredness, hair loss.  Ask to get ferritin, which is the iron storage hormone, tested.

Ask to thyroid hormones retested... Free T3, Free T4 (make sure you specify FREE for both), TSH; add on Vitamin B-12, Vitamin D, Ferritin.  

If your doctor refuses any of those tests, find another doctor asap...