Low TSH

[jacquelynogle]

Thank you for responding Goolarra.. Hope to hear from you soon.

T4 Total is 10.5 Reference range is: 4.5-12.0

T3 Free is   2.6  Reference range is: 2.3-4.2

TSH is 0.04L      Reference range is: 0.40-4.50

Thyroglobulin Antibodies 20H Reference range is <20


I hope this helps,

Thanks again,

Jackie

[goolarra]

Thyroid peroxidase antibody (TPOab) is the test for Hashi's.  Yours is negative (31 with a range of less than 35).    Your TGab is right at the top (20) of the normal range.  Those probably bear watching.  As I mentioned, we often see results for these in the hundreds or even thousands on diagnosis of Hashi's.  Hashi's is the most prevalent cause (by far) of hypo in the developed world, so it's never a stretch to test for it.

It seems like your doctor has noted the problem.  Has he indicated how he plans to treat your conversion issue?

[jacquelynogle]

Thank you so much for helping me understand these results better. I haven't been diagnosed nor tested for Hashi's. Do you think that it is a possibility that I may have it?  Should I ask my doctor to test me for it? I did have lab done on Thyroid Peroxidase and mine is 31 Reference range being <35.

I am having the symptoms of hypo as far as major fatigue and hair falling out. Haven't had a problem with any weight gain. In fact, I have lost 8 lbs from last year. What I don't like is feeling great  one minute and the next dragging my feet.

Thank you again for helping me understand all of this better.

Thanks Jackie

[goolarra]

As I mentioned in the other thread, total T4 is not nearly as useful as free T4.  Total T4 tells you the total amount of T4 in your blood, however, much of that is chemically bound by protein and unavailable to your cells.  Free T4 tells you what's actually available.

Your TT4 is quite high in the range.  That is probably what's suppressing your TSH and making your TSH look "hyper".  TSH is a pituitary hormone and can be affected by anything in the thyroid/hypothalamus/pituitary axis...it often doesn't reflect true thyroid status.  

On the other hand, your FT3 is extremely low in the range.  Many of our members find that FT3 levels have to be in the upper half to upper third of the range before they feel well.  Your FT3 is way down near the bottom.

Furthermore, your profile is a little "upside down".  FT3 should be higher in its range that T4 is in its.  That's why your doctor indicated that you convert poorly, and I agree with him.  Our bodies can't use T4 until it is converted to T3.  Some of us don't convert well, or convert slowly.  

It looks like you need to add a direct source of T3 to your meds.  You can do that by adding Cytomel (synthetic T3) or by switching to desiccated, which contains both T3 and T4.  Since your doctor has identified the problem, let's hope that means he intends to and understands how to treat it.

TGab is a marker for autoimmune thyroid disease (Hashi's).  Your level is a bit high, but I'd consider it distinctly marginal...antibody counts often run in the hundreds or even thousands.  Did your doctor run TPOab (thyroid peroxidase antibodies) as well?  They are the other marker for Hashi's, and much more prevalent than TGab.

So, your doctor seems to have arrived at the right conclusion though he arrived at with a kind of mish-mash of tests.  It would be really nice to have blood drawn again and request FT3, FT4, TSH, TPOab and TGab.  If FT4 is high (doesn't necessarily correlate to TT4), you will probably want to drop your T4 meds when you add in the T3.  The rule of thumb is to decrease T4 by 20-25 mcg for every 5 mcg T3 you add.  T3 is about four times more potent than T4.  T3 is also very fast-acting, compared to the much slower T4.  Most people split their T3 dose and take half in the morning with T4, the other half later in the day.

Have you been diagnosed with Hashi's?  Do you still have a lot of hypo symptoms?