Low T4, normal TSH

[ROJAS123]

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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[lemay]

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.

[gemrjewels]

TSH                         2.330  uIU/mL         0.450 - 4.500 01
Thyroxine (T4)          4.2   Low     ug/dL      4.5 - 12.0 01
T3 Uptake       27 %                                     24 - 39 01
Triiodothyronine (T3)   81 ng/dL                71 - 180 01
Triiodothyronine,Free,Serum 2.7  pg/mL      2.0 - 4.4 01
T4,Free(Direct)       0.78 Low ng/dL           0.82 - 1.77 01
Reverse T3, Serum        11.0        ng/dL     9.2 - 24.1 01



Thanks!

STan

[gimel]

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.

[bs25612]

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
Help!!

[gimel]

I just sent you a PM with info.  To access, just click on your name and then from your personal page click on messages.  

[susanfrae]

Thanks again!

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 live in Chicago - any suggestions?

Thank you again!