Low TSH - High FT4 - Normal FT3

[gabby1944]

I am a 65 year old woman with no previously known thyroid problems.  A routine physical showed these results and I am hoping someone can help me understand what they mean in terms of a possible diagnoses.  I do have many symptoms or hypothyroidism but as I understand it these numbers reflect hyperthyroidism of which I have no symptoms.  What do you think?  Thanks for your help.

TSH .20   normal 3.4 - 5.6
FT4 .77    normal .6 - 1.6
FT3  3.2   normal .2.4 - 4.2

[goolarra]

You might want to ask for antibody tests to rule out Hashi's (TPOab and TGab).  Lots of times nodules are associated with Hashi's.  I don't think the nodules are "causing" your lab numbers, but are more likely another symptom along with the lab numbers that indicate that something is not right with your thyroid. Normal thyroids do not have nodules, but many of us with Hashi's, and other hypos do.

[gabby1944]

I will give you a update after my next appointment on Aug 6th.  I don't expect him to do anything at all about my hormones till I see the Endo on Oct.1 about these nodules that was found on my ultrasound.

Would these 5 nodules have anything to do with my lab numbers?

[goolarra]

After seeing your symptoms, I agree with gimel that you would feel better on a low dose of meds.  Your symptoms are pretty classically hypo, and both FT3 and FT4 are pretty low, though not alarmingly so.

It may be difficult to convince your doctor to treat you when TSH is "hyper" (not) and FT3 and FT4 are "normal".  Many people only feel comfortable when FT3 and FT4 are in the upper part of the range.

If you get your doctor to agree to try you on meds, keep in mind that if you are over 50 or have been hypo for a long time (more than a few months) or have a history of heart arrythmia, the recommended starting dose of levothyrxine is 12.5 to 25 mcg.  Starting out low and increasing (if necessary) slowly is very important if any or all of the above apply.  

Good luck, and let us know how your doctor reacts.

[gabby1944]

My symptoms are, always cold when everyone else is hot, constipation,
elevated cholesterol, muscle weakness, severe joint pain, leg and foot
cramps, night sweats,thinning hair, fall asleep easily but wake every
few hours during the night and some forgetfulness such as addresses,
phone numbers etc. Also some occasional dizziness.  I am a type 2 diabetic on Lantus and have had Hep C for many years due to 61 transfusions with platelets before there was a test available for Hep C. My liver enzymes are only very slightly elevated and I'm doing well in that dept.  I had a hysterectomy when I was 43 due to VERY heavy periods.  Immediately after that ( 2 Wks.) I had ITP hence the 61 units of blood.
I am 65 years old.

[goolarra]

I think you're right about the glasses!

Your labs are all within normal range.  FT3 and FT4 are a bit on the low side, but since I'm guessing your're about 64 or 65, that's not at all alarming.  We produce less thyroid hormone as we age.  TSH is just a tad low, and a low TSH does not necessarily indicate hyper.  It only indicates hyper if accompanied by hyper symptoms.  

What are your hypo symptoms?  

[gimel]

I agree with goolarra, that your labs look to be hypo.  Free T3 and free T4 are the biologically active thyroid hormones that regulate metabolism and many other functions.  TSH is a pituitary hormone that only signals thyroid glands to increase/decrease thyroid output.  TSH does not correlate very well at all with hypo symptoms.  Free T3 is the most important, because it is four times as potent as free T4 and it correlates best with hypo symptoms.  It is good that you have the FT3 and FT4 test results.  That puts you ahead of many thyroid patients.  Now, you need to get your doctor to treat your symptoms by continuing to test and adjust your FT3 and FT4 levels with medication as required to alleviate those symptoms.  If the TSH is suppressed below the range that does not mean you have become hyper .  Only hyper symptoms make you hyper.

Here is a good link that you can read about all this.  You might take a copy to your doctor to help persuade him to medicate you enough to get your "Frees" into the upper part of their range.

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

[gabby1944]

I finally seen my lab report and below is the right numbers.  I swear my doctors nurse needs glasses.  The results of my ultrasound came back but I'm afraid to quote what she said until I see the report myself.  She did say there is 2 nodules on the right lobe and 3 on the left.  Would these nodules have anything to do with my lab numbers?  Thanks for the infomation.

TSH .20   normal  .34 - 5.6
FT4 .77    normal  .6 - 1.6
FT3  3.2   normal  .2.4 - 4.2

[goolarra]

Thanks for checking on that.  As I said, I see a LOT of TSHs, and I have never seen a range with a lower end anywhere above 0.5.  I don't know how they can say your FT4 is above normal...maybe you can recommend a good opthalmologist to them!!!

Don't worry too much about a pituitary problem.  TSH can be off for any number of reasons, only some of which are pituitary.  Also, "pituitary problem" doesn't necessarily mean "tumor".  My pituitary problem is simply the lack of an enzyme that converts T4 to T3, so my TSH is always soaring.

Medication should always be prescribed and adjusted based on FT3, FT4 and TSH (sometimes TSH, and in that order).

Based on your FT3 and FT4 (and if you can get them to see that your FT4 is in no way high), I'd ask for a trial of a low dose of levothyroxine.  If it relieves your symptoms, that's wonderful, if not, you can always stop taking it.  You really have nothing to lose, but you may have to be prepared to beat your doctor up to convince him

[gabby1944]

The reference range printed on the lab report for TSH is 3.4 - 5.6 but they also said my FT4 was " above normal " when it is only .77 with a normal range of .6 - 1.6, so I am beginning to wonder about their interpretations.  I am so worried about a pituitary problem I can't sleep at night.  I already have so many medical problems with Hep C, diabetes type2 (on insulin) and severe osteoarthritis in both knees, I am really worried about any more problems.

[goolarra]

Actually, your labs look quite hypo to me.  Your FT4 is in the lower third of the range, and FT3 is midrange, both bordering on hypo.  Currently accepted reference range for TSH is 0.3-3.0, so your TSH is just a tad low.  However, TSH is the least important of the three tests since TSH is a pituitary hormone, and any number of things can affect it besides your thyroid.  TSH can be suppressed below the normal range, and that does not mean you are hyper, unless you also have hyper symptoms.

Are you absolutely certain of the TSH result and range?  I've seen a number of ranges from different labs, but have never seen one with the low end of the range as high as 3.4.  We are in the habit of using the current range established by the AACE of 0.3-3.0, no matter what the lab repoorts say.  For FT3 and FT4, we use the individual lab's ranges.  

[Barb135]

Were there any other thyroid tests done?  Such as antibody testing or anything?  Any ultrasound?  

I'm sure someone will chime in with some ideas soon.