Low TSH, low Free T4....?

[taosjulie]

I have a TSH level just inside the low-normal range for my testing lab and a Free T4 level just below the low-normal range.  I have ALL the symptoms of hypothyroidism....that is why I got tested.  I'm menapausal and using bio-identical HRT.  What could these test results indicate?  What further testing might I need?  Thank you so much for responding!

[taosjulie]

Thanks.  I'm seeing my doctor on Nov. 18....soonest I could get an appointment.

[Super_sally888]

This would likely indicate secondary hypothyroid (originating from pituitary not producing enough TSH to stimilate the thyroid).

You would need thyroid meds to bring your thyroid hormone levels up (probably mid to upper half of the reference range, depending on how you feel).

In some cases a raised TSH may lag well behind the symptoms.

In any case you should be monitoring and adjusting based on FT3 and FT4 results, ignoring TSH.

What did your doctor say?  If the doctor says all is normal and doesn't want to medicate, maybe you can ask for a trial of thyroid meds to bring your FT4 up and see if it helps your symptoms.  Else, get a second opinion.

Take it from there. Let us know how you go.

[laura1967]

Could you post the actual test results with ranges please?
TSH is a pituitary function test. Free T4 and Free T3 are the actual active thyroid hormone in the body. You NEED to have the Free T3 test done to see if maybe you are a fast converter, etc.
Are you on thyroid meds now?