Low TSH, Low T3

[MyZymurgy]

Hi!  I'm very confused by my bloodwork results but won't be able to see the doctor for a few weeks.  I am hoping someone here may have advise.

Just as a quick background, I was on 125 synthroid for many years. Last year my doc lowered it to 88 based on tsh results.  I continue to have hypo symptoms like fatigue, slow heart rate and low body temp.  Probably unrelated, but I'm also in the midst of getting diagnosed with Cushing's syndrome (high cortisol - symptoms for me were thinning skin and hump on my back)  I'm a 34 yo female.

OK...onto the question at hand!  I asked my doc to check tsh, t3, and t4.  The results are puzzling to me based on what I know about being hypothyroid.  My TSH indicates hyperthyroid, which should mean my t3 and t4 are high.  But instead they are low and normal.

Am I undermedicated or overmedicated or mismedicated?  Could it be related to my high cortisol levels? Any ideas?  Does this sound familiar to anyone?



Here are the numbers...
TSH  0.2 LOW  (0.3-3.0)
Total T3 0.85 LOW (0.87-1.78)
T4 Free 0.93 (0.56-1.34)


Thank you for reading!!!

[gimel]

Sorry, that got posted before I finished.  Here is the rest.  


In addition, low ferritin symptoms can mimic hypothyroidism.  Shortness of breath is also a symptom of low ferritin levels. 93% of patients with ferritin under 50 ng/ml were iron deficient.  Excessively low ferritin as well as low iron can resulting in hyper symptoms when raising desiccated thyroid (armour).  Severely low ferritin or iron can be improved quickly with iron injections or IV iron infusion - a few weeks as compared to a few months from iron supplementation.  

So in view of all this I think you should try to get some additional tests done before your Endo appointment, if possible.  Specifically I think you need to be tested for Ferritin and a full iron test panel (serum iron, TIBC, and % saturation), a 24 hour saliva (or urine) cortisol test, Vitamin D, and B12.

If you are able to get those tests done, then when the lab report is available, please post results and their reference ranges shown on the report and members will be glad to help interpret and advise further.

[gimel]

Your Free T4 level is fine, but if your Total T3 test is indicative of your Free T3 levels then that is too low.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  So a low Free T3 may be the cause for any hypo symptoms.  

Hypo patients taking T4 meds often find that their body is not adequately converting the T4 to T3, with resultant low Free T3.  This requires the addition of a source of T3 to your meds.  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.  

In addition, there may be other problems interfering with your thyroid meds.

One of those that occurs when a patient is hypo is that the adrenals try to make up for the lack of Free T3 and over a period of time adrenal fatigue occurs.  Another potential problem is from low ferritin.  Recommendations are that both of these problems should be addressed before actually starting on thyroid hormone replacement.

Low cortisol can cause symptoms such as the following:

Fatigue/Weakness
Poor Appetite
Weight Loss
Nausea, Diarrhea
Muscle, joint, abdominal pain
Light-headedness upon standing
Low blood sodium level
Skin darkening
Low blood potassium level
anxiety or nervousness
shakiness
dizziness
racing heart
feeling hot

[dgray143]

Sorry, I have no idea where those numbers came from!  I think from another member's post above?  

My numbers are:

TSH 0.62 (0.25-5.0)
FT3 3.85 (4.0-8.3)
FT4 15.22 (9.0-20.0)

[dgray143]

My test results are as follows:
Here are the numbers...
TSH  0.2 LOW  (0.3-3.0)
Total T3 0.85 LOW (0.87-1.78)
T4 Free 0.93 (0.56-1.34)

I just feel completely drained.  Besides feeling fatigued, the other symptoms include feeling lightheaded when going form sitting to standing too quickly, a stiff neck and loss of appetite.  I know this may not be related to my thyroid, but it's very frustrating to have no energy!  The most frustrating thing is... I am a runner and have not had a good run in almost two weeks.  I just feel depleted.  I did have a cold virus which cleared up after a week,but would symptoms linger for another week after?  Thank you for your help and for responding.  I just feel like there is something wrong.  

[gimel]

Sorry for the delay in responding.  I am not quite clear about the scenario your mentioned.  P{lease post your actual thyroid related test results and reference ranges shown on the lab report.  

In the interim, I would like to point out that TSH is almost a useless test when already taking thyroid meds.  Far better tests are Free T3 and Free T4 and sometimes Reverse T3 as well.  Accordingly, just because your TSH was suppressed below range does not mean that you are automatically hyper.  You are actually hyper only when having hyper symptoms due to excessive levels of Free T3 and Free T4.  

What symptoms are you having now?

[dgray143]

I have been reading on the internet and trying to find info on test results, specifically 'normal range' but not in the 'functional range TSH, low T3 and normal T4.  It's tough to find info on this scenario.  I have been hypo for 12 years.  In Feb.2012 my TSH levels were crazy high so my meds were adjusted and in May my TSH levels were slightly low [.23 (Normal range .25-5.0)] but she did not adjust my meds and I am still on the dosage from May of 125mcg.  Now after researching I feel like she should have adjusted them so that I was not being overmedicated.  I don't know if .02 difference would cause hyper symptoms.  I am definitely having symptoms now and very discouraged since I am an avid runner and have not been able to have a good run in over two weeks now.  Any advice would be appreciated.  

[MyZymurgy]

Wow --  great responses!!  (and fast too!)

Thank you so much.  I'll have to double check to make sure I wrote the results down correctly (total vs. free) and be sure to get the FREE t3 and t4 checked next time.

Thank you both for being so helpful to me!!

[gimel]

I agree with Laura about the need for more testing.   Based on the available test results, I'd say that you are hypo from being undermedicated.  It is not at all unusual for TSH to be suppressed when taking thyroid meds.  The fact that it is .2 does not mean you are hyper.  You are hyper only when having hyper symptoms due to excess FT3 and FT4 levels.  For example my TSH has been around .05 for over 25 years, with no hyper symptoms.  In fact I had lingering hypo symptoms until I learned about FT3 from members like Laura, and got my doctor to add a source of T3 to my meds.  Now I feel best ever.  There are a number of other members with similar experience with having TSH suppressed while taking thyroid meds.  

Just for info, many members report that relief of their symptoms required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range.  So it's clear that just being within the low end of the so-called "normal" range is frequently not adequate to relieve symptoms.

[laura1967]

Total T3 is a worthless test and outdated. The only ones you need are TSH, FRee T4 and Free T3. Unfortunately we can't get a true picture of what is going on because the free t3 wasn't done. In order to see what your Free T4 is doing and if you are converting properly, you need that free t3 done with the free t4.
I think I would also ask for a reverse T3 to be done too, to make sure you aren't dumping all your T4.