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Low FT3 and FT4 - normal TSH
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Low FT3 and FT4 - normal TSH

Hello,

Can anyone please help me with my problem?  I have had an underactive thyroid for 3 years and have felt terrible nearly every day.  

My last blood test my results in Sept 09 were:

TSH - 1.5 (1-5.5)
FT4 - 10.1 (9.9-25)
FT3 - 4.4 (3.9-6.5)

As you can see, my FT3 and FT4 levels are at the low end whereby my TSH is within normal limits.  I guess this means I have have conversion problems.  I take 75mg of T4 and 5mg of T3.   My Endo suggested I increase the T4 to 100/75 on alternating days.  This gave me huge anxiety attacks and insomnia so I reduced it back down to 75mg.  

I am due a blood test in January.  The test is for TSH, FT4, FT3, Vit D (I was vit D deficient), Calcium and RT3.   Does anyone know what other tests I can ask for?  My DHEA was normal in my last test.

I've read a bit about conversion problems and know it could be due to adrenal, liver and digestive enzyme deficiencies.   Are there any blood tests I can do to find out whether these are the problem?

Thanks so much for any advice here.

Jo
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29 Comments Post a Comment
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Avatar_m_tn
if your FT3 and FT4 are in lower part of the range that does not say necessarily that you have a conversion issue ,that can say that this is how your body is !!!
I don't agree with those who say neglect the TSH and rise the frees to the upper part ,maybe there are some  who indeed feel well with high frees,but that is not the case always !!

regarding tests to discover whether there is a conversion problems,I never heared about such thing !

you are supposed to try and balance your gland by T4 meds if you tried all doses and that didn't work ,then reduse the T4 and add some T3 and try to find the combination ratio that works for you,or use armour thyroid !!

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Avatar_m_tn
one more thing , keep all dose changes coordinated with an endo !
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Avatar_m_tn
In my opinion the very best way to treat a thyroid patient is to treat symptoms by testing and adjusting the levels of the actual, biologically active thyroid hormones (FT3 and FT4) with whatever type medication is required to alleviate symptoms, without being constrained by resultant TSH levels.   Relief of symptoms should be all important.  Frequently, in order to alleviate symptoms, it is necessary that FT3 is adjusted into the upper part of its range and FT4 adjusted to at least the midpoint of its range.

From your test results, I see no evidence of a conversion problem contributing to your current concerns.  The problem looks to be inadequate medication.  I know you tried to increase your meds, but had a reaction to that.  Many members have reported a similar result when increasing their meds too fast.  In order to prevent this, the best way is to very slowly increase the amount, and give your body a chance to acclimate to the change.  Instead of increasing by 25 mcg, you can split the pill into quarters and take as little as 6 1/4 mcg daily for a few weeks and then increase again.  Slow and steady is the most successful approach for many people.  

As you proceed with this approach you will want to carefully monitor your symptoms, and also continue to periodically get tested for FT3 and FT4 and TSH, in order to assess with your doctor the possible need for more medication.  Remember, it should be all about relief of symptoms.
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798555_tn?1292791151
I will second gimel's comments on increasing meds slowly. Many find they eventually feel better after meds were slowly increased, where as before they thought the increase was not possible. Been there. Some need 'baby' steps. This is worth speaking to your doctor about, as we need to try all approaches for best thyroid health.
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Avatar_f_tn
You might also ask your doctor to give you some 88s.  You could split an 88 and split a 75 and take half of each every day, giving you a 6.5 mcg increase daily.  You could also use a three or four day rotation of 75/75/100 (83/day) or 75/75/75/100 (81/day).

I have to say that I agree with the above...don't see any evidence of a conversion issue in your bloodwork.  You just need an overall increase in meds to bring both FT3 and FT4 up.
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Avatar_m_tn
I expect that your comment was really directed to me, so let me just say that when you want to disagree with something you need to get your facts straight.  First , I always say what I stated in paragraph one, above.  Namely, that relief of symptoms is all important.  And that frequently, this necessitates that FT3 is adjusted into the upper part of its range and that FT4 is adjusted to at least the midpoint of its range.  Note, that I said frequently.  I have never said that the higher levels apply for everyone.  Medication adequate to relieve symptoms should apply to everyone, however.

In addition, apparently you have a long standing belief in the TSH test.  I really don't understand why this is so, since TSH is only a hypothalamus/pituitary reaction to the levels of thyroid hormone in the blood.  Doctors, and you, tend to believe that it has an infallible correlation with thyroid hormone levels, yet scientific studies that you love so well have shown this is not the case.  Scientific studies have also shown that TSH does not correlate very well at all with hypo symptoms.  In fact, by far the best correlation with hypo symptoms is with FT3.  So rather than rely on TSH and assume that it is providing accurate information about the necessary levels of thyroid hormone, and symptoms, why not just test and adjust  FT3 and FT4,  since they correlate best with hypo symptoms.  

Further, if you think of the logic of it, since TSH is a dependent variable (dependent on the hypothalamus/pituitary response to actual thyroid hormone levels), then you can;t adjust each independently.  If you adjust FT3 and FT4 levels, you get a resultant level of TSH.  If you try to control TSH level, then that dictates some level of FT3 and FT4., that may not be adequate to alleviate symptoms.  So why is that the preferred approach?  
Such a treatment protocol  probably leaves you where you have been for some time as I recall -- reluctant to turn loose of TSH and adequately adjust your FT3 level enough to alleviate your symptoms.

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Avatar_m_tn
You are one of the most important members in this forum ,further more ,your name appeared on the homor board !

If TSH is inadequat ,then why to suppress the gland one need to have a TSH <0.01 ,I would suggest instead to add T4 and T3 till they both in the upper part of the range !

I know about cases in which the FT3 and FT4 when there gland is balanced are the same as when being diagnosed as primarily hypo ,however ,the reduced the TSH and have the tens of symptos gone !

You can't direct the FT3 and FT4 alone ,since each body have certain valuse for these ,toward which it pushs ,even if you add more and more or if you are  hypo !!

that said ,I do agree to that  that getting TSH in normal range is not enough.
Some times there is a need for adding T3 also !

all the best to you gimel ,
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Avatar_m_tn
I'm very glad you responded to my post in a positive manner.  We are all learning here, every day, so I'm very happy to consider and discuss different opinions.  I wold like to try and reach agreement with you about the value of TSH, when medicating a thyroid patient.  This is important because if we give members different advice, then sometimes that can confuse them, at a time when they are trying to understand what to do to help them feel better.   So let me try to clarify some of my core beliefs.

First, symptoms are all important.  They are the reason we go to the doctor in the first place.  Any treatment that does not relieve symptoms is unsuccessful.  

Second would be that symptoms have been shown to correlate best with levels of the biologically active thyroid hormones, which are FT3 and FT4.  In fact, the very best correlation was established to be with FT3, which makes sense, because FT3 is at least four times as biologically active as FT4.  Symptoms correlate very poorly with levels of TSH.

So, doesn't it make sense that to alleviate symptoms, we should be the most concerned about the level of FT3, and then the level of FT4?  If you would agree with that, then the way we have to go about doing that is by prescribing medication to change the levels of FT3 and FT4.  If the patient's body converts T4 to T3 adequately, then a T4 med may by perfectly adequate.  If there is an imbalance of FT4 to FT3, then it may be necessary to also include a medication that includes T3.

The  amount and type of medication that is required to alleviate symptoms will, of course result in a corresponding level of FT3 and FT4.  So with medication you can manipulate the levels of FT3 and FT4 to whatever is required.  And yes, the reaction to meds differs among patients, but the levels can be still be adjusted to the desired levels by adjusting dosage.  

Since the TSH output from the pituitary is dependent upon the levels of FT3 and FT4 in the blood, this means that TSH is the dependent variable.  You cannot adjust TSH directly.  TSH changes in response to  the levels of FT3 and FT4 that are created by the amount and type of medication given.  

So if  given levels of FT3 and FT4 are required to alleviate symptoms, then that automatically gives you a TSH result.  If that TSH falls below the ref. range, so what?  If symptoms are alleviated and FT3 and FT4 are within the "normal" limits, why should we be concerned about TSH at all at that point.  Under those conditions I certainly would not recommend that medication should be lowered just to bring TSH within its "normal" range.  

So that's basically why I firmly believe that when a patient is on medication, TSH becomes relatively unimportant.  To me it is certainly not important enough to affect decisions about medication dosage.   And , by the way, I know this is only a sample of one, but my TSH has been less than .05 for well over 25 years and I still  had lingering hypo symptoms until I learned about the vital importance of FT3 and was able to get my medication changed to include a source of T3.  I'm still making minor changes, but my FT3 level has already gone up from 2.6 to 3.5 (range was 2.3 - 4.2), and I'm feeling the best ever.

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Avatar_m_tn
FT3 and FT4 in patient with balanced gland can be the same as those when he was hypo and the same as when he was overmedicated and hyper !!

any way ,having different point of views enriches the forum,so I am happy that there are others who think differently !
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Avatar_m_tn
Sorry, but since FT3 and FT4 are the biologically active thyroid hormones that affect metabolism and many other body functions (symptoms), I cannot agree that the same levels of FT3 and FT4 can be the cause of  a patient being hypo one time and overmedicated and hyper another time.   I think that such a result can only be caused by other variables that you haven't identified, such as adrenal problems, or sensitivity to medication, or starting on too high of a dose of medication, etc.   And it certainly is not due to TSH, since TSH does not affect metabolism and other body functions affected by FT3 and FT4.
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Avatar_f_tn
I'd just like to jump in here and correct one of your misconceptions from a couple of posts up:

"I know about cases in which the FT3 and FT4 when there gland is balanced are the same as when being diagnosed as primarily hypo ,however ,the reduced the TSH and have the tens of symptos gone !"

You have to understand that the level of TSH in your blood causes NO hypo or hyper symptoms, no matter what level it is.  Changing your TSH level, per se, does nothing to alleviate symptoms.  TSH is nothing more than a messenger from your pituitary to your thyroid to tell it to produce more hormone, but too much or too little TSH does not change how you feel.  There is only one way to alleviate symptoms, and that is by manipulating the actual thyroid hormones, FT3 and FT4.

This is not a matter of opinion, but a matter of fact.  

Let me use myself as an example.  My TSH is about 20 due to a pituitary issue.  However, I am euthyroid (neither hypo nor hyper) since my FT3 and FT4 are in reference range and I am asymptomatic.  When my FT3 and FT4 were below range, I was very hypo.  Getting my FT3 and FT4 to optimal levels for me relieved all my symptoms.  My TSH does not in any way affect how I feel.

You're right, differing opinions are what this forum is all about.  However, so is correcting misinformation and maintaining quality in what we write.  I don't think you really understand the role of TSH in the big picture.


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Avatar_m_tn
]]]You have to understand that the level of TSH in your blood causes NO hypo or hyper symptoms, no matter what level it is.  Changing your TSH level, per se, does nothing to alleviate symptoms[[[

]]] I don't think you really understand the role of TSH in the big picture.[[[

I do indeed !

My TSH when I was diagnosed was 12 ,FT4   14.5 (10-20) and I was dying .
after two years ,while on 700 mcg/week my TSH is 0.04 ,FT3 4.2 (3.5-6.5),FT4  14.4 ,and I was HYPER .
so TSH indeed have nothing to do with symptoms but if it is high that means that your gland works over time,and thus being symptomatic ,even though your body pushes the frees toward a certain valuse it's programmed to .

This is not the case always ,some times frees go below range,or low in the range .

Finally ,I am very happy to have the oportunity to have this conversation with you both .

all the best !



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649848_tn?1357751184
*My* TSH runs about 0.01, but my FT's are < mid range and I'm still hypo........

If your TSH is going high -- that means your thyroid gland is not working -- because the pituitary is demanding that it put out more hormones and it can't.......meds can suppress the TSH, but it often takes a lot of time for the FT's to come up to where we feel comfortble.  There comes a time when we all have to stop looking at TSH and look at the FT's -- that's what I have been trying to get my docs to do, but because my TSH is low, they keep wanting to reduce my med --- sends to hypo he// every time.......

BTW -- I wasn't listed on the "honor board" either --- so don't sweat it........
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Avatar_m_tn
First  I want to wish you happy new year .

The reason for that I give from my time to help others through this forum has  nothing to do with honour boards at all .

The piece of information I wanted to add is that ,some times one can be hypo with the frees exactly where they should be, with high TSH, or hyper with the frees where they should be and low TSH ,that because the body is programmed in certain way .

happy new year !
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Avatar_m_tn
Don't know where you get those ideas, but you're wrong.  A body may be normally "programmed" to have TSH and the Frees at a certain level, but when that level results in being hypo or hyper and medication is subsequently prescribed, then the "programming" no longer applies.  If medication is given, the level of the Frees will change.  If the Frees are adjusted to where they need to be for you, then you will become Euthyroid, not hypo or hyper.
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Avatar_f_tn
You are quickly becoming my new problem child!  Happy New Year to you, too.  Perhaps it's time for a new year's resolution?

Here are my latest numbers:

FT3 2.5 (1.8-4.2)
FT4 1.17 (0.6-2.0)
TSH 17.9 (0.3-3.0)
no thyroid symptoms, either hypo or hyper

Please explain to me, using your logic and your beliefs about TSH, why I am not hopelessly hypo.
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Avatar_m_tn
goolarra ,I am very very happy to have this dialogue with you,and I don't mind at all to call me your problem child .

What I described does not hold always ,there are such cases .
Regarding your numbers , there are people who don't feel that they are hypo at all !

How would you explain my numbers ?

By the way ,if I am allowed to ask ,do you have a computer science degree ??  
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Avatar_f_tn
I would argue that if they don't feel hypo (or hyper), then they are not.  This is a condition based on symptoms.  The "numbers" can be a guide, but feeling well is what we're all after.

I have tried to explain your numbers to you on other posts.  In a nutshell, your FT4 is too high, your FT3 is too low.  The frees are out of balance.  You need to add in some T3 and lower your T4 meds.  It is not your TSH that is making you either hypo or hyper.

No, my degree is not in computer science, but I was a systems analyst all my life.  I'm self-taught in the computer field...old enough that all of us were back then...no one had a computer science degree (and that's old!).  
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Avatar_m_tn
]]]I have tried to explain your numbers to you on other posts.  In a nutshell, your FT4 is too high, your FT3 is too low.  The frees are out of balance.  You need to add in some T3 and lower your T4 meds.  It is not your TSH that is making you either hypo or hyper. [[[

I have no doubt regarding your knowledge ,and I respect you very much ,but ,no,I have no conversion problem ,I was hyper on 700 mcg and now I am on 650 mcg/week and start to feel better and symptoms are disappearing !

I asked regarding computer science degree because you mentioned the top down and the bottom up approach !
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Avatar_n_tn
I am learning and enjoying this forum. Please continue and Happy New Year to everyone.

tilusrc
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393685_tn?1325870933
tilusrc - I am glad you are here and find great comfort contributing and reading. I really think this is a healthy discussion on the lab roles for thyroid but I must intervene at least on one topic.

I did speak to Barb and she helped me understand some things. Never did I try or intend to outcast anyone on the post I made a few weeks ago. I did not pull that post up to quote things, but I am pretty sure my wording on it was not to "honor" anybody and that all the members here are very valuable.

The reason why I reached out to those particular people is I was in close contact with them on my own issues with things. I was near the end with my thyroid meds and was scared... I also tried other forms of thyroid meds that were said identical - and I spiraled fast down into hypo within days. I also was working on the mass global shortage of desiccated meds for personal... and leadership reasons.

Plus personally I was in a job situation that was tearing me apart - I was searching for a new job. We had no Christmas due to money issues and it was a very tough time for me thyroid and personally. The death of my father was very hard this year too for me.

I spoke to those members in messages about my issues and they helped me alot. It was only showing appreciation as me-  as a person very scared and not able to be totally a Co Leader at that time. - not trying to push anyone into hurt feelings. Sometimes that little purple flower can look like something its not and if anyone is upset - they should of sent me a message.

If there are any - still bothered by that "honor" post which if I am reading right - some think (that "honor" word does bother me being used)- which certainly was not my intentions, I would greatly welcome the chance to explain and apologize in a message.

I really don't expect this wonderful post be consumed with my post here and hope it continues posting about how important labs are to get well.
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Avatar_m_tn
[quote] Never did I try or intend to outcast anyone on the post I made a few weeks ago. I did not pull that post up to quote things, but I am pretty sure my wording on it was not to "honor" anybody and that all the members here are very valuable.  [quote]

No body feels outcasted .

[quote] not trying to push anyone into hurt feelings. Sometimes that little purple flower can look like something its not and if anyone is upset - they should of sent me a message. [quote]

No body feels hurt .

[quote] re are any - still bothered by that "honor" post which if I am reading right - some think (that "honor" word does bother me being used)- which certainly was not my intentions, I would greatly welcome the chance to explain and apologize in a message.  [quote]

THere is no need for apology at all , I meant to till gimel how important is he ,and that I am not contradicting him .
I already said that the reason I give from my expensive time here has nothing to do with honour boards at all .
I think it's a good idea to have an honour board in this great forum to make more competition  between the members !

all the best !
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798555_tn?1292791151
OK, but,

"I think it's a good idea to have an honour board in this great forum to make more competition  between the members ! "

- Hu?  This forums intentions and reason for existence is not about competition between members. This is not a game to be competitively won or lost. This is about peoples health.

Its about helping others gain knowledge about there ills, by offering facts learned, new information and personal experience from within your knowledgeable area.  Many here know a lot, but only answer what is in their range of specialty, most likely from personal experience. And we must remember, that our personal thyroid issues can be different from others, there is no 'standard' treatment for all. This forum provides the proof and sometimes specializes, to some extent on some peoples more challenging thyroid issues that the medical system does not manage or treat very well.

Didn't mean to 'hijack' this thread, but this is not the place to be 'competitive'.  Of course people being people, dont always use there best words of choice at the time when posting either.


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Avatar_m_tn
I don't know what to say,actually .
What I meant is competition regarding better , more informative and helpful answers .
Maybe I miss used the phrase .
So excuse me and I withdraw from that last line !

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798555_tn?1292791151
Ok.

"more informative and helpful answers"  - yes.

With this site being world wide, peoples  definitions and the use of  English can greatly vary as well -no way around this. Many list there general location, this helps in several ways, in communication, meds, available treatment options, and even their view point ect.  
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649848_tn?1357751184
I agree with LazyMoose on this one. First off, I don't think you "hijacked" the thread.  This forum is not about who knows more or who can post the most responses, just to be posting.  I think it's much easier to work from a personal stand point, rather than a "general" one and post our own information and experience.  For instance, I have hypothyroidism/Hashimoto's -- I rarely post anything regarding hypERthyroidism/Graves -- that's not my area of experience.  

We are here to help people answer questions, not compete with each other.  

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Avatar_m_tn
English is not my mother language.
I have much respect to what the US contributed to the man kind in many fields .
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649848_tn?1357751184
All is *forgiven*.................LOL  
Have a good evening.
B
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393685_tn?1325870933
Let's continue this post only on the lab question. Thanks
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