Low TSH Normal Free T3 and Free T4 SHGB way elevated
I am 45 years old and have been diagnosed with hyperthyroidism about 3 years ago
I have had to revise my dosage of medications several times over the last 2 years as I can not get my levels regulated and I am constantly exhausted, I work out hard core with weights and running 4 times per week high intensity, eat beyond healthy and can not lose a pound! 4 months ago I adjusted my meds to 25mcg Cytomel (from 50mcg) and 75mcg Synthroid (from 150mcg) and I was just re-tested again last week and my TSH only went from .01 up to .03 My FT3 is 306 and my FT4 is 0.8 - normal but very low in the range (0.8 - 1.8) I am so confused as I know a low TSH indicates Hyper thyroid and yet since I am consistently exhausted and can't lose weight I am wondering if it is something else such as a Pituitary problem since the Pituitary Gland is supposed to secrete TSH correct? and if it is a Pituitary problem would it just be a tumor that would have to be detected by an MRI? or is there other testing Does a non function pituitary gland also cause metabolism to slow? The other thoughts I had were possible autoimmune problem?? I did test for the Antibodies and they were in range Lastly I tested my Testosterone and the SHGB was way elevated It was 282 (11 - 100) which I researched and found Hyperthyroidism can cause an elevated level but so can be from Primary Biliary Cirrhosis Any light to shed on this whole thing I just want to feel good again have energy and be able to lose weight indicative of my healthy lifestyle Thank you
Your FT3 and FT4 look low to me, indicating hypo, but your TSH indicates hyper. Still, TSH is not always a reliable indicator of thyroid, since it is a pituitary hormone.
Exhaust and weight gain are hypo issues. Used to be a gym rat, until two years ago. Now, I stick to light walking and pilates because of the pain associated with hypo/Hashi. I am now taking the advice of other members on this forum and quitting gluten and soy because that interferes with T4 absorption.
What were your antibody results? Post numbers!
I would look ask the doc to run pituitary tests, but I'm not all that familiar with the pituitary. Strange, though, how the TSH conflicts with the FT4/3. Maybe get a thyroid ultrasound to see what's going on there.
Your post is a little bit confusing...I think you meant to say that you were diagnosed with HYPOthyroidism three years ago. Cytomel and Synthroid are meds given for hypo, not hyper. TSH is the least important of the three.
25 mcg of Cytomel is quite a high dose relative to your 75 mcg Synthroid. You didn't post the range on your FT3, but if my memory serves me (and don't trust me for a minute!) that's about midrange. However, your FT4 is extremely low in the range..
My guess is that your Cytomel/Synthroid is out of balance and that the high dose of T3 is suppressing your TSH. I think you need more T4 and less T3. Also, do you split the T3 into more than one dose during the day? Were you put on T3 due to conversion issues? If not, why?
Were you originally diagnosed as hypERthyroid or hypO? You would not be taking synthroid and cytomel for hypER........ Fatigue, exhaustion AND weight gain can actually be symptoms of EITHER hypER or hypO........ most people who are hyper will lose, but there are some that gain.......Listing other symptoms might be helpful.
That said - IF you were originally dx'd as hypO and started on synthroid - you would be in about the same boat I'm in...........I was dx'd hypo in Jun '08 with a TSH of 55.51; Free T4 of 0.4 (range 0.8-1.8); no Free T3 was run; and started on synthoid - my TSH bottomed out within a very short period of time and my pcp started cutting back on the med, even though I was still having hypo symptoms and things went from bad to worse........One mistake that a lot of doctors make is to treat thyroid issues based solely on TSH.
I finally was sent to an ENT for what was supposedly and unrelated issue that turned out to be thyroid related. The ENT sent me for antibody testing + an ultra sound, dx'd Hashimoto's and ultimately referred me to an endo. Fortunately, the endo goes a lot by symptoms, along with the lab #'s - mostly Free T4 and Free T3........
What is the range of your FT3? Your result would be in the "low normal" according to MY lab, but different labs use different ranges and/or units. It sounds as though you are having some of the same problems I'm having. The thing is - even though your TSH is very low - my last one was, like yours, 0.03, you are still slightly hypo.
TSH is a pituitary hormone and not really indicative of what the thyroid is doing. You need to go more by the Free T4 and Free T3, which are the actual thyroid hormones. In my opinion, you are still hypo and need to increase your dosage of meds. Do be careful of too much cytomel though. Cytomel is a T3 only med and T3 is about 4 times more potent that the T4 med (in your case, synthroid). I'm on cytomel also, but had to cut my dosage all the way back to 5 mcg and up my T4 med because the cytomel caused rapid heart rate and palpitations.........
It could also make a difference if you have autoimmune (Hashimoto's and/or Graves disease) - the treatment for Hashi is the same as hypo, but Hashi is harder to control because you are dealing with the antibodies.
You say your antibodies were in range but SHGB was elevated - I'm sorry to say I am not familiar with SHGB - can you tell me what it is?
I know for myself, I don't worry about my low TSH too much simply because my FT4 and FT3 are still only about mid range and I still have hypo symptoms, so I know I'm not hyper.
The pituitary does secrete the TSH (thyroid stimulating hormone) which tells the thyroid to put out and if it doesn't obey, the pituitary keeps putting out TSH as a demand to the thyroid ---- however, since you are supplying the thyroid hormones, the pituitary no longer has to demand....
SHGB is Sex hormone binding globulin.
And I totally agree with your posting.
I think too much T3 and not enough T4.
The ratio of T3 is usually 5 to 1
So in actual fact.......too much T3 is being taken.
T3 is also something that wont make you lose weight.
If your levels are unstable..then the weight will not come off until they are stable.
I gained with hyperthyroidism too (all 16kgs ..approx 34lbs).
Since getting my levels stable on T4 alone, I have lost 11 kgs.....no exersise either.
Just healthy eating and not eating any packaged foods..everything fresh.
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