Low TSH, low Ft4 and low Ft3

[dlstump]

1/29/2009

Felt like I was going through the change and foggy brained.  Went to Endo, Endo started me on Armour 30mg and up'd me to 60mg a week later, then to 90mg a few weeks after that.

Only listing things that were not normal

CBC

RBC 5.19H
hematocrit 41.8
MCH 26.4L
MCHC 32.8
RDW 17:9H


CMP

Glucose, Serum 108H

Lipid Panel w/LDL/HDL Ratio

Cholesterol, Total 279H
Triglycerides 171H
HDL Cholesteral 32L
LDL Cholesterol Calc 213H
LDL/HDL Ratio 6.7H

Some of these were normal but listing them due to Hashi Diagnosis
FSH 11.4
TSH 4.434
T4Free Direct .90
Hemoglobin Alc 6.2
DHEA-Sulfate 68
Estradiol 10L
Progesterone .07
Insulin 9.5
Prolactin 10.8
TPO ab 285H
Antithyroglobulin Ab <20
Triiodothyronine, free, serum 2.8

Blood Work 4/13/09

Was feeling really good at this time, lost about 20lbs

Hemoglobin Alc 6.1
T4 Free Direct .97
TSH 2.749
Thriiodothyronine Free Serum 2.7

Continued to feel great and lost 47lbs total,I had a Hystorectomy due to Fiborids in July, then in August, I started feeling no energy again.

Blood Work 8/17/09

RBC 5.26H
Hematocrit 45.3H
MCH 27.4
MCHC 31.9H
RDW 16.3H
Glucose, Serum 96
T4 Free Direct .72
Hemoglobin Alc 5.9
Estradiol 55
TSH .255L
LH 3.5
FSH, Serum 12.3
Progesterone .6
Triiodothyronine, Free, Serum 2.2L

Feeling Tired, Foggy Brained, no energy at all.  After seeing my blood work, Endo increased my meds to 120mg Armour.  Armour is getting hard to get now so he also gave me a script for Synthroid 175 (1 pill a day) and Cytoard (sp? doctor doesn't have good handwriting) 25 (1/2 pill a day) although I haven't had to switch yet because I have been able to find the Armour.  

The increase in my meds to 120 hasn't made me feel any better, it actually seems to be making me feel worse.

I looked up Low TSH, Low Ft4 and Low Ft3 on the internet and what I have read is scaring me.  Is there possibly any other reason my RSH,T4F & T3F are so low?  Could I possibly have something else wrong?

[Barb135]

Has anyone mentioned that you might be borderline diabetic?  With you hemoglobin A1c at 6.1/6.2 and a blood glucose at 108 (assuming this was fasting) - that's the first thing that comes to my mind....

Another thing that strikes me with the "tired, no energy" is pernicious anemia - vitamin B12 deficiency...........Your RDW (red cell distribution width) being high is an indication that this might be possible because your red blood cells are larger than normal, which is one sign of pernicious anemia, along with the "tired/no energy".  You might ask to get your levels tested for that.  If your levels come back low or "low normal" you could most like benefit from vitamin B12 shots and like thyroid med will have to be done for the rest of your life...... I do it every 2 weeks and it's not necessarily fun, but makes goes a long way toward determining if I get out of bed and navigate for the day or not..............

Without the lab's reference ranges for most of the parameters tested, it's hard to say anything because different labs use different reference ranges and or units of measurement.  If you could post the lab's reference ranges for, specifically, the FT4 and FT3, that would be good.........

[shallie]

Hi distump,

Some Dr's don't put alot of faith in the blood draws for the sex hormones.
Are you on HRT? Estrogen/progesterone balance is very important for
those of us that don't have ovaries. Were yours removed? Also, Estrogen can
cause problems with thyroids.
After I had my hysto, my life changed forever. I've not felt the same since.
I have low B12 and ferritin of 14. The thryoid meds don't absorb properly with these
deficiences. So, I have to get those up .

Good luck!

[dlstump]

T4 Free Direct Range is 0.61 - 1.76
T3 Free Serum Range is 2.3 - 4.2
Yes I was fasting in all 3 lab tests

Yes I  have been told I'm Borderline Diabetic, my levels on Hemoglobin A1c are at 5.9 now and my Glucose, Serum is now 96 from my blood drawn on 8/17.  I've lost 47lbs total, but have gained 8lbs back in one week.

I did a search on Low TSH, Low FT4 and Low Ft3.  Could I possiblly have Euthyroid Sick Syndrome or nonthyroidal illness?  I did just recently have a hysterectomy, could that have caused this.  I had Fibroid Tumors and they also make people anemic.  

[dlstump]

Hi Shallie,

My Ovaries are still in tact, I didn't have them removed.  But find it interesting that since my hysterectomy I now these problems.  I wonder if I can't absorb my thyroid meds?  

[Barb135]

I had a hysterectomy 13 yrs ago and was just dx'd with hypo/Hashi in 2008.  Dx'd with pernicious anemia in 2007, but I think I'd had it for many years......In fact, when I was in my mid 20's, I had an old country doctor tell me I had it and gave me B12 shots for a while, but I didn't think they did any good, so I quit going to get them.  My current pcp says I couldn't have had it all those years, but I don't believe him --- I had the symptoms AND the enlarged red blood cells for all that time - just no one ever checked my B12 levels.........

As far as absorbing your thyroid med - there are some foods that you should avoid because they do inhibit absorption (broccoli, cabbage and other cruciferous vegetables, along with some fruits - you can google that for an entire list).  You also should not take some vitamins and minerals within 4 hours of taking your thyroid med as they also inhibit absorption ---- this is true particularly with calcium - it should say that on the insert that comes with the med.  I just make a point not to take ANY of my vitamins and minerals within 4 hours of my thyroid med.  That way, I figure I'm pretty safe.  

[gimel]

Not saying that there isn't a possibility of other issues, but from your last blood test, and from your symptoms, your FT3 and FT4 were still too low in their ranges.  Many doctors think that just getting the "Frees" somewhere within their reference ranges makes you "normal".  This is not the case because in my opinion the reference ranges need to be adjusted, like TSH was, and for the same basic reasons.

Ranges were establishedfrom a large data base of patients.  The limits for TSH and the "Frees" were established originally so that 95 % of results fell within these limits.  Over 6 years ago, the AACE finally decided that there were far too many people who fell within the range for TSH, yet had hypo symptoms.  So they carefully purged suspect hypo and hyper patients from the data base and reestablished new limits.  The range changed from .5-5.0 down to .3-3.0, which was a huge change.  Unfortunately most labs and doctors have yet to adopt the new range.

Although logic says it should be done, the ranges for the "Frees" have never been revised like for TSH.  In one of my past lives (LOL) I had a lot of training in statistical analysis.  If I had to estimate where the ranges would be if the data bases for the "Frees" were purged similar to TSH, I think the range for FT3 would go from 2.3-4.2 pg/ml to approx. 3.2-4.3.  Similarly the range for FT4 would go from .60-1.50 ng/dl to approx. 1.0-1.55.  I think this gives us a logical reason why so many patients report having continuing hypo symptoms, even when their FT3 and FT4 levels are just within the low limit of their ranges.  For this reason my opinion is that the best way to treat a thyroid patient is to test and adjust FT3 and FT4 with meds as required to alleviate symptoms.  Following is a good link that recommends this type approach.

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