Thyroid Disorders Community
Low T4, normal TSH
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Low T4, normal TSH

My TSH levels are normal but my T4's are low.  Not sure what this means since if my pituitary glands are producing enough TSH what is happening to make my T4's low?
Doctor wants we to take a THS 3rd generation and a CBC and basic Metab panel.

I have all the symptoms of hypothyroid, depression, fatigue weight gain, joint pain, have cold hands and feet and got grey hair at a very early age as well as suffered infertility but she has not mentioned that and just told me to take these additional tests, so I am confused.
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Tags: lowT4
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Avatar_m_tn
I think the most important information (your symptoms)  has already established that you are hypo.  The FT3 and FT4 tests will further confirm that, by their being in the lower part of their reference ranges.  These tests then further useful as markers to show your progress as you start taking thyroid meds and progress to symptom relief.
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Avatar_m_tn
What doctors consider as normal TSH depends on the reference range they use.  The old range was .5 - 5.0.   Over 8 years ago the AACE recommended that the range should be changed to .3 - 3.0.  Unfortunately most labs and doctors have yet to adopt the new range.  

More importantly TSH is a pituitary hormone that is affected by so many variables that it is inadequate as a diagnostic.  At best it is an indicator, to be considered along with more important indicators  such as symptoms, and also the levels of the biologically active thyroid hormones, which are free T3 and free T4 (note these are not the same as total T3 and total T4).

FT3 is the most important because it largely regulates metabolism and many other body functions.  Studies have also shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate very well at all.  So it is important that you be tested for both FT3 and FT4.  If the doctor resists, you should insist on it and not take no for an answer.  Remember that you are the customer.  

As far as why your T4's are low, I'd like to have you post the actual test result and reference range, please.   Also TSH please.  

I have  known of patients with pituitary issues that were somewhat similar, where the TSH was actually on the lower end of the range, so of course their FT4 and FT3 were low, resulting in hypo symptoms.  

So let's start with that.  There are a lot of  dedicated members here who will also be glad to provide you the benefit of their knowledge and experience.
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231441_tn?1333896366
Next step, as mentioned by Gimel, aside from the tests your doctor wants is to test FT3 and FT4.  Once you have results, please post them and the reference ranges.

Please also post your actual test results (and the reference ranges) from the tests already done.
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1567786_tn?1295906846
Thank you both!
As of December 16, 2010
T4                 5.09        Reference  6.09-12.23  UG/DL This was "flagged" L
TSH              1.12                         0.34-5.6  uIU/ml
TRIIODO       84.4                           54-149  NG/DL

Today I go for TSH 3RD Generation
                     CBC (Includes DIFF/PLT)
                    BASIC METAB PANEL W/EGFR

I should have the results of the above three early next week.

Thank you!
L

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Avatar_m_tn
I suggest that you request that they test for free T3 and free T4, not the total T3 and total T4.  the latter are somewhat out of date and don't provide nearly as much useful information as the test for the Frees.  If they resist and give excuses as to why it is not advisable, just insist on and don't take no for an answer.  Remember that you are the customer.  If you get agreement, then also make sure the lab people know it is to be free T3 and free T4, not the Totals.  You wold not believe how often mistakes are made and you end up with the Totals.  

If they have not ipreviously dentified the need to check your pituitary function, then I would strongly suggest that you try to get that done as well.  A low functioning pituitary would fit the pattern of test results that you have had, namely low TSH, with low T4.  
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1567786_tn?1295906846
Not sure if I am misreading your post, but my TSH levels are not low....they appear to be right in the mid range1.12 in a ref, level of 0.34-5.6 it is the T4's that came in low 5.09 in a ref, range of 6.09-12.23.The test I had today is not another TSH total,,,,it is TSH 3rd generation which I think has only recently been used,  It is far more specific that the first THS test I had done,  
I will ask about having freeT3 and freeT4 since from what i have read it allows testing without the protein attachments confusing the results.
I will post once I get the result from todays test...I think I can pick them up tomorrow.  I will be seeing doctor early this week to discus the results of todays tests.
Thank you again,
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Avatar_m_tn
I should have been clearer and said that your TSH was relatively low in the range, taking into consideration your low T4 result.  They usually show in opposite positions within their ranges.  A low T4 will usually be accompanied by a higher T4.  When the results are more like yours, that can be an indicator that the pituitary signal (TSH) is weak, resulting in low T4 levels.  You should discuss this with doctor at next appointment.  Also make sure to get the FT3 and FT4 tests done, to help in diagnosis and treatment.
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Avatar_f_tn
if it is the pituitary signal, what can they do to fix the problem?
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Avatar_m_tn
It isn't a very satisfying answer, but it depends on the cause.  Relative to having low thyroid hormone levels, and hypo symptoms, the answer for that is medication to relieve symptoms.  Unfortunately in similar situations,  many patients never get thyroid meds, because their doctor only looks at TSH and tells them their thyroid is good, symptoms must be from something else.
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1567786_tn?1295906846
Haven't spoken to doctor yet but yesterdays blood work came out more confusing to me,
TSH 3rd generation is 1.02 with a reference of 0.34-5.6 ...on the low side but certainly within the range.
The blood work and chemistry was a bit more (I think) concerning,
HGB 14.3  H (ref. 12.0-14.2)
Neut 35 L,
Lymphs 53.0 H
LY# 3.71 H.
Chemistry BUN 23 H, BUN/CR RA 33 H, and CO@ 37.0 H....wbc 7.0 and rbc 4,45 both ok.
So, now I don't know if this new information suggests that I don't need to take  a Free T3 and Free T4 since it is something else or if I still should insist on both tests.
L


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Avatar_m_tn
With the symptoms you listed above, be sure to  get the FT3 and FT4 tests done.
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Avatar_m_tn
Here is a link to a bit more information on the pituitary.

http://www.webmd.com/a-to-z-guides/hypopituitary
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1567786_tn?1295906846
Thank you. If doctor does not suggest Free T3 and Free T4 I will tell her I want it done.
WIll these tests be able to determine if I am in fact Hypo?
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Avatar_m_tn
I think the most important information (your symptoms)  has already established that you are hypo.  The FT3 and FT4 tests will further confirm that, by their being in the lower part of their reference ranges.  These tests then further useful as markers to show your progress as you start taking thyroid meds and progress to symptom relief.
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1567786_tn?1295906846
THANKS AGAIN...i will let you know what the Dr. has to say. Either way, I will insist on getting the FT# and FT4 if she doesn't.
L
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1567786_tn?1295906846
before I drive myself crazy(er) I thought I would ask if you know what two of my more trobling (to me) test results signify. Needless to say, I have not gotten a cll back from my doctor let so I my be doing a bit too much reteach with out enough knowledge on what it all means.  My co2 is high (37.0 as are my HGM 14.3.
The most troubling to me is a GFR of 86. Not sure if this has anyting to do wit being Typo or if this is just in addition to it.
thX
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Avatar_m_tn
I have no experience or knowledge to offer on those tests, other than what I see on the 'net, which I'm sure you have already gone through.  So I think you should give your doctor a chance to get back to you and answer those questions.
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1567786_tn?1295906846
Results were discussed with Doctor last night, Other than my CO2 levels being high (could be breathing shallowly) all else is o.k.  Still does not explain my Hypothyroid systems and the Low T4.  She is still insisting that the TSH (3rd generation) which "tells you what the brain is doing" means that I am NOT hypo. I was so relieved to find out that I didn't have Leukemia, Kidney or liver problems I hung up without insisting on the Free T tests. Do I have the right to call her back and insist on getting these other tests? I would think that there must be something going on if my T4 results were low and my symptoms are on in line with the Hypo..  I have a good relationship with my primary doctor who I have got to for 20 years,. If the endocrinologist (no history until 2 weeks ago) wont authorize, can I have tests ordered by him?
L
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Avatar_m_tn
Again, remember that you are the customer.  You can call back and ask for whatever you think is necessary.  If the doctor resists, then just insist on it and don't take no for an answer.  One of our members claims that in a similar situation, she told the doctor she was going to get a big chain and lock and lock herself to his desk until he relented and did the testing she wanted.  Others have found that tears worked.  LOL   If need be, then get your primary to do the resting.  Whatever it takes.

The bigger issue for you I think is that even after getting the testing done, where are you going to find the good thyroid doctor that will treat you clinically by testing and adjusting FT3 and FT4 adequately to relieve symptoms?  Unfortunately, an Endo is not usually so inclined.  They tend to be more rigid and only look at TSH, or if they test beyond TSH they consider any result within the reference ranges as "normal" and don't want to do anything to relieve symptoms.  Do you have any prospects for finding a good thyroid doctor?
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1567786_tn?1295906846
NO I do not have a thyroid Dr. I did however get a script for Free T3 and FT4.
Taking those on Friday. Endo is female so she is a bit more willing to go with what I ask...even if she thinks THS is the way to go.
What are numbers for The F t3 and F t4?
L
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1567786_tn?1295906846
Free T3 and Free T4 are in the "range". FT4 is 0.75 (range is 0.548-1.64)
and FT3 IS 2.9 (range is 2-3.5)
This doesn't seem to explain my symptoms, my low T4 of 5.09 or my enlarged Thyroid.
I did an Iodine Patch, at the suggestion of a nutritionist friend, and within 8 hours after applying is it totally disappeared.
All of the other tests seem to be normal so I am at a loss to know what to do now.
L
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Avatar_m_tn
The thing you need to do is to get your doctor to prescribe meds for you to increase your FT3 and FT4 adequately to relieve your symptoms.  I would suggest that you give the doctor a list of your symptoms that you have mentioned, along with a copy of this letter, and ask her to prescribe enough meds for a therapeutic trial.  

http://hormonerestoration.com/files/ThyroidPMD.pdf

If the doc resists, then ask her for an explanation of your symptoms, if she says it is not thyroid related.  

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1567786_tn?1295906846
Thank you. I truly appreciate your taking the time to respond and to send met the link to information that will help me to persuade my doctor to start a "clinical trial".

FYI I ordered some Iodoral...figured in the interim it couldn't hurt and possible could do some good,
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1584478_tn?1296748368
I think you might want to do some checking into the free T4. Generally, the school of thought is that the low end of the range is .8 (.548 seems like a very low reference range). My free T4 is .75 and is considered hypo by my doctor. I'm new to the board, so others might want to chime in :)


Adult Reference Ranges:

FT4 = 0.8-1.5 ng/dl

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1567786_tn?1295906846
Thank you. My endo still says that I am in the normal range....very frustrating.
May I ask what sate you are in? And who is your doctor, perhaps he could recommend one to me in New Jersey.
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Avatar_m_tn
It really doesn't matter if you are in the so-called "normal" range or not.  The important thing is how you feel.  If you still have symptoms, then you need for your FT3 and FT4 levels to be adjusted until your symptoms are relieved.  The ranges for FT3 and FT4 are too broad.  They have never been adjusted, like was done for TSH over 8 years ago.  At that time the AACE decided that there were lots more patients with hypothyroidism than would be predicted by their old range for TSH.  When they purged the data base of suspect hypo patients and recalculated the range limits, there was a huge drop from .5 - 5.0 down to .3 - 3.0.

With my background in statistical analysis, I estimate that if the same thing were done for FT3 and FT4, the ranges would change to about the upper half of the current ranges.  I firmly believe that is why we hear from so many patients with FT3 and FT4 levels in the lower half of the ranges that are suffering with hypo symptoms.

The problem is that most doctors and Endos have the "immaculate TSH Belief" and only want to use that as a diagnostic.  If they do go beyond TSH they usually only test for total T4 and only occasionally for total T3.  Even if they give in and test for the Frees, they still want to use the current (too broad) reference ranges as a pass/fail decision, rather than as guidelines within which to adjust levels as necessary to relieve symptoms.

You could try going over this with your doctor and I could give you lots of links to supporting data, but I don't have much confidence that anything would change.  But I suspect that your doc is dug in to his current position and unlikely to change.  

As an alternative, have  a look at the doctors listed in this link, for the state of NJ.  Pay special attention to the patient comments and look for a doctor near you that is willing to treat a patient's symptoms, and also use meds other than just T4 types.  

http://www.thyroid-info.com/topdrs/newjersey.htm

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1584478_tn?1296748368
Hi Rojas123,

Here is most of the background of my experience and what I've learned recently:

I have felt horrible for a few years, since around the beginning of 2008. My hair fell out (I actually purchased wigs). I was so tired, etc...all of those good symptoms. But my doctor said I was perfectly healthy. So I plugged away, as we do because I  truly thought I was just burned out after he told me I was healthy. I actually ended up quitting my job because I felt so horrible. I've been working p/t from home since and it's been hard to even do that.

My mom was concerned, came out to visit in May 2009..scheduled an appt with the top endocrinologist in Seattle. Went to see him. Thyroid came back 'in the normal range', but now I know that they actually were not. My free T4 was .75, but my TSH was 2.0. So TSH in the normal range, but this shows that our bodies are the ones that dictate our normal levels..I was out of range though. Although barely.

I started to feel a bit better. for a while.  About 8 months ago my hair started falling out again. I was in bed by 6pm. It was really bad. Then I got flu at Christmas. I plugged away and finally went to a clinic close to my house. I have to say that this is the first time I was interviewed about my body and my symptoms beyond what I was saying presenting. This was an by an ARNP (advanced registered nurse practitioner with a cert in family practice...can write scripts, etc). Advanced training...MA or PhD, etc. She is also on the faculty as a professor at the UW Medical School. Anyway, I was there for a sinus infection and she said I had thyroid problem. I had been waking in the middle of the night for some time, so cold to the bone that I had to take hot baths every night which I just happened to mention.  

She did test, ALL OF THE BLOOD WORK (the the 'free's, autoimmune, etc...I didn't even have to ask...which was amazing...and besides I didn't know to ask for them). I was so convinced it was not my thyroid because I had been told that my blood work was fine for so long by these top doctors.

Came back out of range in their lab (their range for TSH is .4-2.5 and free T4 is .8). My TSH was 3.0 and FT4 was .75. Although not a huge thing, my body has had a horrible reaction to it.

Upon getting these tests, I went back to the endocrinologist not sure what to believe. He sent me home and said that their lab was wrong. It should go to 5.6 for the TSH and down to .56 for the free T4. And he could not explain my symptoms. His exact words were 'sometimes we just don't know what is wrong'. He did do my Vit D which came back at 10, but that was it. He even said that 'any reputable lab would not have that low of a range'. Which I'm learning is really more of a reputable reputable range.

One more thing is that my BP and heart rate fluctuate tremendously. My heart rate goes down to under 50 sometimes. My brother is a nurse and says it all fits. I told him that my BP went down to 80/50 and heart rate to 45 and he didn't even know what to say. That happened almost a year ago.

I was confused as to who to believe and called back the ARNP. She had a very strong opinion that it was my thyroid. And personally, I look at someone like her, not being an actual doctor and going against a top endocrinologist, as having a lot of confidence in her diagnosis.

I had to check one more avenue, so I spoke with my pharmacist. She knows me pretty well and actually just  to the point and said take the medicine - I need it. She said she could tell that I had not been feeling well for quite sometime. She asked me about my symptoms and was just very adamant, like the ARNP, that I have a problem with my thyrroid that needed to be addressed.

This all has happened within the past 2 weeks.

I guess what I'm saying is that I really got an education on this thyroid issue and different labs, etc. I did a lot of research. And, the TOP Endo in my area did not want to treat me, but an ARNP was the one who diagnosed me when I went in for a sinus infection. It's amazing.

What I've read is that you can have a normal TSH and a low free T4 using that .8 as a reference and be hypo. This has been my scenario for a few years and I lived in hell not knowing. It's taken a toll on my professional reputation. Financially, because I haven't been able to work much. What a mess.

There are ARNP's out there with family practice - they may not be in beautiful offices, etc...but she has been awesome for me as you can see. And I had nothing to do with even knowing I had a problem.

I even went to the top psychiatrist in my area and she said for 2 years that she did not know what was wrong with me. I explained all of my medical symptoms, etc...she did not even do blood work or suggest it. Just gave me wellbutrin (which was awful) and had me come back every few months for 15 minutes). And would just say 'I don't know, we'll treat the symptoms'.  

It's been crazy. I gained 50 pounds in two months at one point, and I wasn't even eating out of the norm.

I hope this information is helpful to you and shows you that everything is not as clear cut as it should be or as we are told it is.

Personally, I'm making this ARNP my primary care from now on. Maybe it helps that she is a woman and nurses are much more about diagnosis without labs/rather symptoms.

Let me know if there is anything I can do for you...help you do research or provide any information to you.

I hope you feel better soon.




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1567786_tn?1295906846
Thank you for the link to NJ doctors.  One in particular has offices not too far from me and from what her patient's write is willing to treat the symptoms not the narrow test ranges.
Although I could probably convince my doctor to do a clinical trial, it seems to be a waste of time if she is convinced that her way of treating (do nothing) is best.
Fortunately my symptoms are no where as  severe as Nina's but the depression is probably the worst, for me. The weight gain doesn't help and I am tired of living on broccoli and carrots!
Anyway, I will make an appointment with the doctor from the link Gimel sent and  let you know how it goes.

Again, thank you!

Nina, hope you are feeling better very , very soon!
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Avatar_f_tn
Hi,

I got a Thyroid Test Done. The values are as follows :

TT3 - 106.82 (range is between 70 - 204) - Test Method - Chemiluminescence & Sample Type Serum
TT4 - 6.6 (range is between 7.3 - 15) - Test Method - Chemiluminescence & Sample Type Serum
TSH - 2.20 (range is between 0.35 - 5) - Test Method - Chemiluminescence & Sample Type Serum

Please let me know if I have any thyroid problem

I am not decreasing weight though I am on diet, have joints pain, hair loss, constipation, tiredness etc.

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Avatar_m_tn
I replied to the post on your own thread.
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Avatar_f_tn
You seem to be very knowledegable about hypthyroidism.  I am having a problem getting my RE to diagnose me as been hypothyroid.  I have all the classic symptons . ( I believe) I have rheumatoid arthritis, polycytic ovaries, irregular menses, increase prolactin, cool hands and feet, frequently constipated, and have been battling infertility for years without success.  My TSH level is 1.88 and my FT4 is 0.67. She is saying everything is normal but my instincts say something is not right.  Please help if you can.  I live in Montg, Alabama and there are only 2 endo in the area.  i havent heard anything about the other Endo.  
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Avatar_m_tn
Many doctors have the "Immaculate TSH Belief" and only diagnose by using TSH testing.  When some doctors go beyond TSH, the next test they tend to use is FT4.  Unfortunately, they then tesnd to use "Reference Range Endocrinology", by which they interpret any test result that falls within the so-called "normal" range as being adequate.  This is also unfortunate because the ranges are far too broad, since they have never been correctedlike done for TSH over 8 years ago.  

Another thing that your doctor should have done is to test for Free T4 rather than just assume that if FT4 is okay, then FT3 will be as well.  In fact your FT4 is probably right on the lower limit of its range.  I expect that if tested our FT3 will also be in the low end of its range, both of which are frequently associated with being hypo.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not test results.  If you want to read about the type of treatment you should be getting, have  a look at this link.  It is a letter written by a good thyroid doctor for patients that he is consulting with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.  Well, I was going to provide a link, but having trouble with that, so here is a copy of the letter.  






For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.







I'll search around for a doctor that might be a prospect for you later.

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Avatar_f_tn
Hi everyone--

I need some advice! I've never been on here before, but just stumbled upon this site as I was trying to do some thyroid research. For a few years now I have been dealing with depression and extreme fatigue, among other things. My doc has checked my thyroid a couple times and here is my latest result:
TSH is 1.57 (range is .34- 4.82)
and FT4 is .5 (range is .7- 1.7) flagged as Low

Last year this was essentially the same and my dr. wanted to put me on Synthroid. I didn't want to jump into this because I didn't know much about it.... So I went for a couple other opinions. Went to an endo in March 2010... my results:
TSH was 2.310 (range: .350- 5.5)
FT3 was 3.13 (range 2.30- 4.20)
FT4 was .81 (range .89-1.76) this was flagged as Low.

They weren't convinced anything was wrong w/thyroid. Went to Boston for another opinion. Said nothing was wrong.

But...symptoms haven't gone away. Depressed and seeing counselor for that plus have taken zoloft for a year. Still extrrememly tired all the time. I have the HARDEST time losing any weight, even when eating healthy. Plus, this summer I gained about 15 pounds and didn't eat a ton.

Was just diagnosed with celiac disease and haven't eaten gluten in 3 weeks. Eating mostly healthy meats (chicken, fish) and veggies, fruits, etc. Not eating a lot of fatty/processed/starchy foods and haven't lost a single pound.

So now I want to go back to my PCP or something and figure out this thyroid thing and get another blood test. Have one scheduled for November, but don't really want to wait that long.

Does anyone have any thoughts/advice/suggestions???? Thanks!!
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Avatar_m_tn
many people seem to find symptom relief when their Free 4 is MID RANGE AND meaning in addition, their FT3 is in the UPPER 1/3 of the range.

You are far from being close to mid range in Free T4 which is 1.3 from the latest test range,  In fat you are BELOW normal range.  Furthermore your FT3 which is the only thing your body uses is well below the upper 1/3.  You would have to test at about 3.6 to get to the upper 1/3.

It is no surprise that you are feeling Hypo with those results.  Since your FT4 is so low it would make sense to start on a T4 med such as synthroid or Levothyroxine (ie levvo).  Starting dosages are usually 15 to 25 mcg.  And shouldn't be above 50 mcg. Many people can't start right out at 50 without side effects.

T4 meds take 6 to even 8 weeks to stabilize in the blood.  So if you do start medication, don't expet instant results.  Another blood test will have to be done again after 6 to 8 weeks. In which case a modification of dosage may be required until you start to feel good.

It is important to make sure that you continue to get BOTH the Free T4 AND the Free T3.  many Dr's don't want to medicate because they only use TSH which is almost useless unless you are REALLY Hypo or Hyper.  Beyond that TSH is just about worthless.  Even so the Dr's who believe in TSH only, commonly will want the TSH to be between 1.0 and 2.0.   With yours being a bit over 2.0,  you may have some luck asking your Dr. to prescribe a starter dosage of synthyroid.
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Avatar_f_tn
I am also searching for answers. It is hard for me to say when my symptolims began because I have been through so much, I always choked my feelings up to stress and life. I became pregnant with my 3rd child in 11/2010 and by January was on bedrest for placenta previa issues. I became deprssed and gained lots of weight! My baby was born 7/2011 via my first c-section due to failure to progress. I became hypertensive after she was born and was put on Lasix for swelling. Since then everything has been difficult. I am depressed (the worst ever in my life) and have anxiety/panic attacks, I have gained more weight even after watching my diet (which I have never had to do), I am irritable/moody, I have dry skin, coarse hair, and my cholesterol levels are climbing. I have being see my primary who started me on celexa, then paxil, now lamictal with no relief. I have decreased libido, I am tired 24/7, no interest in anything. Most recently I hit "rock bottom" felt like a mental breakdown, have taken a medical leave from work and insisted my doc help me. Thyroid levels tested : Tsh 0.61, free T4 0.8, and T3 total 112. So my free T4 is low by 0.1, my tsh is at the low end of normal and my total T3 is smack in the middle of normal. She sent me for a thyroid scan which showed a goiter and small nodules. I went for my referral appt to an endo today and she says she thinks the T4 level was a lab mistake and is going to have it rechecked as well as having me do a steroid test for cortisol to rule out Cushings. So over the next 3 weeks I will be having these labs drawn and then I go back to her. Even if cortisol shows signs of Cushings she says that will just indicate need for more tests. Should she have not diagnosed me as hypo today and started some type of treatment in the meantime? I am miserable and losing a paycheck. I need answers!!! Please help
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I have one  ya. .....

TSH  9.04
Free T4~ 0.64
Free T3~ 3.8
I am having a hard time getiing these levels in the close together. Doc's are stumped.  
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Avatar_m_tn
Usually better to start a new thread. But whatever.

Mandy.  In your case your thyroid hormones are kinda low and TSH is 'normal' and you have a bunch of symptoms.  Normally when thyroid hormones are low, TSH is 'high', often spectacularly high, like 100.

TSH stands for thyroid stimulating hormone and is produced by your pituitary.  I think your endocrinologist wants to test your pituitary function to rule or detect any other insufficiency.  You really want that.

Also I totally understand the I'm losing a paycheck problem. I've been there. In my book inability to work is a symptomo el grande  that doesn't get paid enough attention by doctors.

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Avatar_m_tn
I like to ask u a question my tsh is normal range but my free t4 is 7.0. Do u know what this means
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My tsh blood test came back at 2.17 but my free t4 came back at.70 which is low. Does anyone know what this means?  At what point do you need medication?
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Thyroid related test results vary from one lab to another.  So it is important to always compare test results to the reference ranges listed on the same lab report.  If you will please post the reference ranges for those tests, members will be better able to comment on your test results.  

That said, I expect that your Free T4 is low in the range, which often is associated with being hypothyroid.  What symptoms do you have?  Symptoms are even more important than test results, in trying to diagnose a patient.
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Hi,

Could you tell me more about that the pituitary doesn´t always work perfect. Because the piece about TSH and that you need to measure free t4 and free t3 is important.
I have relatively low TSH and low free t4 and in the lower end free t3 and no anti TPO so why do I have low free t4. They have measured my pituitary hormones and all 3 hormones are low except my growth hormone it is a little higher than max if 238 means anything to you. If I don´t take medicine my t4 will fall, but I do not feel well. Hope I have expressed my self correctly since I am danish, so please excuse my grammar and spelling. Hope you will answer best regards Ms Larsen
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Avatar_m_tn
Welcome to the Forum.  Your English and grammar are great.  No problem there.

Having low TSH and also low Free T3 and T4 are indications of what is called central hypothyroidism.  Central hypothyroidism is due to dysfunction in the pituitary/hypothalamus areas, that results in relatively low TSH.  When the TSH is too low to stimulate the thyroid gland to produce adequate thyroid hormone, Free T3 and Free T4 will be too low in their ranges, resulting in hypothyroid symptoms.   Even though they may be within the low end of the so-called "normal' ranges, that does not mean it is adequate for all patients.  The ranges  are far too broad, due to the erroneous way they are determined.  Many of our members, myself included, say that symptom relief required Free T3 in the upper third of its range, and Free T4 around the middle of its range.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  

So, please post your actual thyroid related test results and their reference ranges shown on the lab report, so that we can better assess your status.  Also, have you been tested for Vitamin D, B12 and ferritin?  The reason I ask is that many hypo patients find they are too low in the range for those as well.

I am also providing a link written by a good thyroid doctor.  A good thyroid doctor is willing to test and adjust Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not just TSH results.  I think you will find the info useful.

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