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.
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.
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 the latter are somewhat out of date and don't provide nearly as much useful information as the test for the Frees.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.
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,
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.
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.
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.
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.
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.
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.
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?
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?
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?
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.
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.
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 :)
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.
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.
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!
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.
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.
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.
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!!
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.
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
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.
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.
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
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.
My personal TSH has to be below 1 or I have hypo symptoms. Everyone is different as to how they feel in the "normal" range. If you are having hypo symptoms then ask to have your meds increased. I am on Armour which works great for me, Synthroid lowered my TSH but T4 and T3 were still out of whack.
TSH causes no symptoms. Doctors like to believe that TSH is all they need to know to diagnose and medicate a hypo patient. That is very wrong. TSH cannot be shown to correlate well with either Free T3 or Free T4, which are the biologically active thyroid hormones. Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all. So a hypo patient cannot be dosed effectively based on TSH testing. Studies have shown that the majority of hypo patients taking thyroid meds adequate to relieve symptoms find that their TSH becomes suppressed below range, which many doctors erroneously interpret as being hyperthyroid. When already taking thyroid meds, TSH is basically a useless test.
Please advise My 17 year old daughter has had weight gain,lethargy,depressed mood Exercises every day and eats a very strict diet with no weight loss in 9 months naturopaths have been supplementing OTC glandulars and Iodine for hypothyroid but Doctor says no thyroid but testing for Adrenal Fatigue
TSH 1.0 Range (0.4-4.0)
ft4 16 Range (10-20)
ft3 5.7 Range (2.8-6.8)
I wouldn't normally expect that a person with those lab results would be hypothyroid; however, symptoms are even more important than test results, and she has symptoms that are frequently related to being hypothyroid. Assuming those labs represent her supplementing with glandulars and iodine, what were her lab test results before starting on those?
Hi! Sorry to reply on this super old thread (just randomly found this page on google search for thyroid help) You seem to answer everyone. :)
I've gone to 2 doctors to look at my thyroid. They say even though my antibodies are high, my thyroid is still holding its own.
Free T4: 0.8 (range 0.8 - 1.8)
TSH: 1.49 (range: 0.4 to 4.5)
Thyroglobulin: 594 (range is 0-1.0)
I have been trying to conceive for 6 months, and with my 1 st child is was easy as can be to conceive.
Over a year ago I had levels for hyperthyroidism, but it leveled itself out, so I was never put on meds.
Now a year later- I feel tired. I keep thinking for sure I am pregnant because of how tired I am. I've gained a little bit of weight even though my diet had not changed and I started a vigrous workout routine 2x/week.
My skin is a little dryer, and I'm usually cold when others are not. My cholesterol is also rising, and vitamin D is low (not sure if that matters).
I have type 1 diabetes, but my a1c is good, and I know it is more common in type 1 to get hypo or hasimotos.
I really want to get pregnant and feel tired from being pregnant, and not feel tired for who knows why! :(
Have you ever seen any hypos with a ft4 of 0.8? I've already gone to 2 doctors, and I am not sure what else to do.
Your experience is a familiar one. The doctors have been trained and like to believe that TSH basically tells them all they need to know about your thyroid status. That is very wrong. TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T4 and Free T3. It is important ot know both Free T4 and Free T3 because Free T3 best correlates with hypo symptoms, whilce TSH and Free T4 do not correlate.
You were not tested for Free T3, and you should insist on both Free T4 and free T3 each time you go in for tests. Your Free T4 is at rock bottom of the range, which is inadequate. I expect that you will also find that your free T3 is too low in the range. In the words of a good thyroid doctor, "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just lab test results, and especially not TSH results. You can get some good insight from this link and also give a copy to your doctor for discussion.
In addition, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin. That can cause symptoms that are similar to being hypo. Low D and low ferritin also affects metabolism of thyroid hormone. So D should be about 55-60, B12 in the upper end of its range, and ferritin should be about 60 minimum for ladies. You need to get those tested as well, and supplement as necessary to raise those to optimal.
Since you are trying to conceive, all these things need to be discussed with your doctor and then you should request a starter dose of thyroid medication to start raising your Free T4 and Free T3 (I expect). You also need to find out if your doctor is going to be willing to treat clinically, as described above. If not, then you will need to find a good thyroid doctor that will do so. If you will tell us your location, perhaps we can suggest a doctor that has been recommended by thyroid patients.
There is no reason to wait around for help to get better. I am sure you would like to get on with this, so I am sending a PM with info on some LV doctors that you can read about and decide which ones to try to see. Then you can push for an early appointment.
From the info given on the doctors, you should not have any problem getting the testing and treatment you need, but go in prepared to insist, if necessary, on all those tests and a prescription for thyroid meds as a starter dose.
You are very knowledgeable and I thank you for your responsiveness to the community. I am also happy to hear you recommend that we demand proper tests and treatments for our doctors. I am in Chicago and have a great endocrinologist who totally follows your line of thought with testing and treatment, as well as having a phenomenal bedside manner and plenty of time for his patients. I have been on synthroid for 15 years, and the dose continues to climb.
I recently went in to my primary care physician for some digestive issues. She is in the same system as my endo, and she said, when was the last time you had your thyroid tested? It has been almost a year (shame on me!). She said, let's do a quick checkup while you are here. She did not do a full test - I will make an appt. with my endo for that. The results are: free T4 of .8; TSH of 2.13; and prolactin of 23.5 (it had been higher last time at 30+). She talked to me about pituitary function and said we might want to look at that down the road if prolactin continued to rise. I'm a 55 year old female that is in menopause.
I'm waiting to hear back from my PCP - but as we are going into a holiday weekend, probably won't until next week.
I clicked on the links you have shared, and I'm wondering what you think about Amour or Nature-throid? Should I ask my doctors to switch me to this? I have gained over 35 pounds in the last 5 years, and I exercise and maintain a good diet.
When you were first diagnosed as being hypothyroid, was the cause identified? I'm wondering if it was Hashimoto's Thyroiditis? That would be consistent with the need for increasing dosage of Synthroid.
Also, have you ever been tested for Free T3 along with the Free T4? Free T3 largely regulates metabolism and many othe body functions. Scientific studies have shown Free T3 to correlate best with hypo symptoms, while Free T4 and TSH did not correlate. With your current low Free T4 level, and you taking a T4 med I expect that you will find your Free T3 to be very low also.
I like whatever thyroid medication fulfills your needs. If the T4 is being adequately converted to T3, then that is certainly the most convenient medication to take, since it can be done once a day and is slow acting. If your body does not convert T4 to T3 adequately which is often the case, then a source of T3 is necessary. You could just add T3 to your T4 med for that. Or you could switch to an NDT type like Armour or Nature-throid. I am using Armour and Cytomel.
Also be aware that hypo patients are often too low in the ranges for Vitamin D, B12 and ferritin. If not tested for those, you should do so. D needs to be about 55-60, B12 in the upper part of its range, and ferritin should be 70 minimum. Deficiency in any of the 3 can cause symptoms, and low D and ferritin can also adversely affect metabolism of thyroid hormone.
Not diagnosed with Hashimotos - just got an annual checkup at age 40 and they found that 'thyroid was low' (I don't have the specifics as that was 15 years ago), as well as cholesterol was high - at the time I had absolutely no symptoms. Getting thyroid in range helped lower my cholesterol. At the time I was skinny as a whip, exercised frequently and ate cleanly. My mom also had thyroid issues. Since then my weight has increased by over 40 pounds, which is a lot for someone 5 ft 4. I am still relatively active and eat a healthy diet.
We are waiting on the T3 result according to my PCP (not sure why other results came back quicker?)
My endo doc tests everything fully and is really great. Excellent points about D and B12 - first time I've heard about Ferritin. I have had low D (34.8) in the past and am taking supplements (5000 IU), although during the summer I usually just take them included in my Nordic Natural Fish Oil (1000 IU) and my multivitamin (1600 IU) and get some sun. Same thing with B12: in range but needs to be higher (currently 385). Ferritin also normal at 78, so good. Last T3 result was 90, which is at the lower end of the range, but the endo didn't do anything.
I'm calling the endo to schedule an appointment tomorrow. He will do the full spectrum of tests and probably address the low T4 and possibly T3. The PCP felt that T4 was OK even though it was almost at the bottom end of the range. Is that because TSH was mid range and PCPs don't really bother with trying to treat symptoms?
You are a blessing to this thread! Hope you know that!
It isn't just PCP's that don't treat clinically. Endos seem to be even more rigid about using "Reference Range Endocrinology" by which they will tell you that a thyroid test that falls anywhere within the range is adequate. That is very wrong. The ranges are far too broad to be functional across their entire breadth for everyone.
The ranges for Free T4 and Free T3 are based on all test data at a given lab, with the only exclusions being patients that have a TSH that exceeds its range limit. Of course there are lots of hypothyroid patients that have TSH within the range, especially those with central hypothyroidism. This means that there are lots of hypothyroid patients' data included in the data bases for FT4 and FT3. So the calculated ranges are far too broad. If based only on healthy adults with no known thyroid pathology these ranges would be more like the upper half of the current ranges.
That is why we say that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. Many members, myself included, have found that relief from hypo symptoms required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, or as necessary to relieve symptoms. Your Free t4 is at rock bottom of the range, and I expect your Free T3 to be similar.
Is the test result you are expecting for Free T3, or Total T3? Will your Endo always test you for both Free T4 and Free T3? If not, you should insist on both. In fact I would even ask for Reverse T3 just to check that also. Also, will your Endo be willing to treat clinically as I described above? If not, then you are going to have to find a good thyroid doctor that will do so.
Well, T3 uptake and Free Thyroxine Index are outdated tests. I can't tell if your T4 and T3 tests were for Total T4 and Total T3 or Free T4 and Free T3. You should insist on the Frees each time they test you. Not sure what you mean by the TP+T3 test. If your PCP did those tests I suspect that he is also out of date when it comes to thyroid testing.
Be sure to get tested for Vitamin D, B12 and ferritin and supplement as needed.
Reverse T3 is the mirror image of T3, but RT3 is biologically inactive. T4 is converted to both T3 and Reverse T3 as a normal process. Under unusual conditions too much Reverse T3 is produced and that can offset the effect of Free T3. Reverse T3 dominance is not a frequent problem, but I just think it would be a good idea to check yours to verify it is okay.
As for finding good thyroid doctors, we are always on the lookout for those. We keep lists of those we find, and provide the names to members, if there is one in the area. If the Endo is not willing to treat clinically, then we will try to give you recommended doctors in your area.
It looks like they are only measuring free T4 and total T3 (as well as the other useless tests for TSH, etc. as you mentioned). The PCP is hesitant on making any changes, even when my free T4 is at an all time low (0.8). Still waiting on the total T3 but sounds like that won't provide any useful info.
I actually was impressed with the PCP because she said we need to watch prolactin, which could indicate a pituitary problem. The prolactin levels have decreased into the normal levels with this test.
B12 (385) and D (28) are low and I need to supplement more than I am doing. Ferritin is good at 92.
Can't get an appointment with my endo until end of August. In any case, I'll have the PCP forward over my recent test results in the hopes that he will at least prescribe something.
I am at a loss. I feel horrible but my drs keep telling me i'm fine. They have sent me to a psychiatrist for depression and ADD, Really?! I am 46! I have been going now for 3 years and they just keep prescribing different scripts. Nothing is changing the way I feel. I have been asking them to check my thyroid all this time and always the same, in range. So now I go to my pc dr. and he says my thyroid is enlarged so he sends me for an ultrasound. It comes back ok. So I asked why it is swollen then? I got the I don't know answer. Again really?!
My thyroid test results are
Free T4 .98 Range.80-1.80 ng/dl
Free T3 2.9 Range 2.3-4.2
TPO 47 Range <60 u/ml
TSH 1.02 Range .30-5.00 ulu/ml
Just because your lab results fall within the so-called "normal" ranges does not mean they are adequate for you. The ranges are faulty, due to the erroneous assumptions used in establishing them. I think you will get a better understanding of this when you read this, which was written by a good thyroid doctor. In the words of a good thyroid doctor,
"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."
Also, your doctor is no doubt confused by the fact that your TSH is low in its range, which with your FT4 and FT3 would be consistent with central hypothyroidism. Central hypothyroidism is associated with a dysfunction in the hypothalamus/pituitary system that results in inadequate TSH to properly stimulate the thyroid gland.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 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 TSH results.
Hypo patients are also frequently too low in the ranges for Vitamin D, B12 and ferritin. All three are important. Low levels can cause symptoms that mimic hypothyroidism and also adversely affect metabolism of thyroid hormone. D should be about 55-60, B12 in the upper end of its range, and ferritin should be about 70 minimum. So you should get those tested and supplement as needed to optimize.
Started on .25 Levo 2 months ago. After 2 years of being told my symptoms were menopause and offering antidepressant and counseling, I finally demanded more tests. TSH was 4.5 and FREE T4 was 1.0. Was told it was borderline hypothyroid and began treatment. Also Cortisol at 8:00 am was 23.7 ug/dl, which doctor said was elevated. Most recent labs are TSH is 1.8, Free T4 is 1.0 and Total T3 is 80. These are Kaiser labs. Wondering if my T4 and T3 are still low. I feel better on meds, but still off, horrible sleep, retaining water, fat face, weight gain. I'm 5'4 and 149 lbs. I've gained 25 lbs in one year before diagnosis.
Please post the reference ranges for the Free T4, Total T3 and cortisol tests, as shown on the lab report. The reason I ask is that results and associated ranges will vary from lab to lab so results should always be compared to ranges from same lab.
The jeopardy with your new lab results is that if the doctor has the "Immaculate TSH Belief' and only really pays attention to TSH, then you might be told that all is well and no further increase in meds is required. Not so. Your Free T4 is below level we consider minimum which would be 1.25 (middle of the range). You weren't even tested for Free T3 which is the most active thyroid hormone. FT4 and FT3 should be tested every time you go in for tests. If your Free T3 is as low in its range as your Total T3, that will be very indicative of being hypothyroid.
A good thyroid doctor will treat a hypo patient by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results, and especially not TSH. I say that because hypo patient taking adequate thyroid medication often find that their TSH becomes suppressed, and the doctor reacts by reducing meds. That is not correct unless the patient is having hyper symptoms due to excessive levels of Free T4 and Free T3. So your med dosage is only a starter dose and you need to be gradually increased as needed to relieve symptoms.
Also hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin. Low levels can cause symptoms. Low D or low ferritin can also adversely affect metabolism of thyroid hormone. D should be about 55-60. B12 in the upper end of its range, and ferritin about 70 minimum. After testing you can supplement as needed to optimize.
Thank you so much! I'm going to email my doctor tonight. I always feel like I'm going to "offend" him if I question things and request more tests. But, having said that, I would have never known I was hypo without demanding tests to begin with. The levothyroxine has helped tremendously with anxiety, depression and panic attacks but physically, I still feel "off". Thanks again and I'll post new results as you mentioned above.
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