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Need Help w/Lab Results - normal TSH, low FT3 FT4
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Need Help w/Lab Results - normal TSH, low FT3 FT4

Hi guys - love this website and thanks in advance (GIMEL I remember your help last summer when my thyroid was freaking out on me!).  I have been so exhausted and depressed lately.  The results aren't all that bad compared to some I've seen on this forum.

Here are my newest lab results:  What's throwing me is the normal TSH.  I've been prescribed Synthroid 50  mgs.

TSH 3rd Gen 1.81 mIU/mL             (range)  0.34 - 5.60 mIU/mL
T4 Free          0.54 ng/d             (range)   0.66 - 1.20    ng/d
T3 FREE          2.02 pg/mL             (range)   2.50 - 3.90 pg/mL

18 Comments Post a Comment
TSH is a screening tool at best.  And completely unreliable and useless at worst.  TSH is completly inadequate to use as a tool to adjust medicine dosages.

The FT4 and FT3 levels are MUCH more valuable.

With your low levels in both of these it is no wonder you feel terrible.

Was the 50 mcg prescribed AFTER those tests or were you on the medication prior to the blood test. And if so for how long were you on it prior to the test?

You have been prescribed a T4 medication. This takes up to 6 weeks to build up and stabilize in your blood stream.

T4 is NOT used directly by your body's cells. Instead it is a storage hormone and remains in you blood until you body calls for thyroid. At which time the Free T4 homrones in your body is converted into T3 mostly in the liver but in other places in your body as well.  Only the Free T3 in your blood is used by your body.  

This is why it is so important to get BOTH the Free T4 and Free T3 tested at every visit!

Many people have found that in order to feel well they need to have BOTH of their Free T4 and Free T3 levels well up in the range. Infact BOVE the 50% mark.  The rule of thumb for people who are symptomatic but still at the bottom of the "normal" range, is;

1) Free T4 (FT4) to be in the MIDDLE of the range (50%) if not slightly higher.

AND- that means in addition to

2) Free T3 (FT3) to be in the UPPER 1/3 of the range (66.7%).

Notice that the rule of thumb is WELL higher than your current levels.   In fact BOTH of your leves are BELOW the normal range.  Which is why I stated that I'm not surprised that you feel Hypo.

Don't be surprised if you just started taking the medication.

1) that you may even feel worse intitially.  As your body ajusts to haveing some thyroid hormone again.

2) That you don't feel any dramatic improvement.  As stated above it takes 6 weeks to build T4 up into your bloodstream.

3) that this will NOT be your final dosage.  this is a common "starter" dose and you will likely need to be tested every 6 weeks and subsiquent increases in your dosage will be required.  This is the proper slow and steady technique.  you want to work up to your optimized dosage slowly.  Making too many changes too fast only usually causes problems.  I know you want to feel well ASAP. But with Thyroid it is a mind game of persistence and patience that is needed.  Trust me I know you just want to feel better FAST.
Good to hear from you again.  Sorry you aren't yet feeling your best.  Good info above from flyingfool.  

You said, "The results aren't all that bad compared to some I've seen on this forum. "  I have to disagree a bit.  Both your Free T3 and Free T4 are well below their ranges, which is about as bad as it gets, hypo-wise.   In fact, unless someone has another nominee,  I think your levels may just qualify you for an award as no. 1 in the Worst Levels category.   So don't be trying to avoid all that fame and fortune.  LOL

Most hypo members seem to have had FT3 and FT4 levels that are at least in the low end of the ranges and they still have hypo symptoms, because the ranges are far too broad to be functional for most people.   Yet, because the ranges are so broad, due to the way they were established, doctors frequently ignore hypo symptoms and pronounce patients within range as "normal", no meds required.  A result at the top end of the range is over 80 % higher than one at the low end, yet both are pronounced as "normal".  Are we really supposed to think patients feel "normal' as long as they are just anywhere within the very broad range?  Would they really be "abnormal" if outside the range by .01?  Not very logical, is it?  How can such a range be used as a yes/no decision regarding medication or not?  

While on the subject of reference ranges I should point out that hypo patients are also frequently too low in the ranges for Vitamin D, B12 and ferritin.  If you haven't been tested for those, I urge you to do so.

Thankfully, your doctor has started you on thyroid meds.  That is a big step in the right direction.  The biggest question is whether your doctor is going to be willing to treat you clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.   Also, if your body is not converting T4 med to T3 adequately, then is the doctor willing to prescribe T3 type meds?  If either answer is no, then you are going to need a good thyroid doctor that will do so.

I am providing you this link because it was written by a good thyroid doctor and it covers this subject very well and could be useful if you have to have a discussion with your doctor about getting adequate testing and treatment.

I'm having hypo symptoms and my levels are not as low us yours
Tsh .451 (.44 - 4.50)
Ft4 1.09 (.89-1.78)
Ft3 2.9 (2.0-4.7)
I'm having ache buzzing legs, hair loss, waved of tiredness, heart palps, weight gain.

I can't get any Dr to prescribe low dose of replacement to see if it helps because they go by my Tsh and not my free levels.  
Thank you so much for your time and thorough reply!  I swear, people here know more than my Doctor, or at least COMMUNICATE and teach more.  I feel relieved - yes, the 50 mcg was prescribed after these lastest values.  I started taking the Synthroid 4 days ago, and was going to comment I didn't feel any better yet, but I see it will take a long time.  :)  Any thoughts about also adding in a T3 medication or trying Armour?  It seems if some T3 were dumped into my system I might feel better faster, right?
Gimel, again thank you - I am wondering, from the values I tested for, it seems my T4 is converting nicely to T3, is that correct?  Do you think ADDING T3 to T4 is warranted, or do you believe Armour is the answer - I'm a bit confused after reading Dr. Lindner's papers.  He seems to feel Synthroid is not a good method of treating patients.  But he does not come out and recommend Armour - and it concerns me greatly that just giving me Synthroid could possibly make me feel WORSE.  If you ran the zoo, what would you do if I came to see you with these values?  :)  (obviously I am not asking for direct medical advise that I will take and hold anyone responsible for - just a scenario to help me understand things better!)
Karli, have you ever emailed your doctor a copy of a scientific study - like one of the ones presented at the website Gimel recommended, and put in writing (somehow Doctors seem to get their rears in gear with written documentation - do a CC: HealthNet Insurance or whatever your insurance company is so they feel it in their pocketbook as well.  LOL!),

"Dear Doctor Arrogant,

At our last visit we discussed that based on my normal range TSH, you did not feel it would be necessary to begin treatment with thyroid medication.  After much thought, although my TSH levels appear to be within normal range, it is increasingly common and backed by scientific studies (refer to study) to treat patients according to symptoms, along with greater focus on free T4/free T3 availability in the body.  AFTER CONTACTING MY INSURANCE COMPANY (mild threat!) I would like to request treatment based on the symptoms of sub-clinical hypothyroidism I am currently experiencing, such as ________________ but more importantly, my lower range free T4/free T3 lab values as of (date _______).  Low dose Synthroid could be called into my Pharmacy at 503.464.xxxx - thanks for your response."
From those test results, I wouldn't conclude anything except that they are very , very low.  Now wonder you feel so bad.  

Dr. LIndner has no problem with T4 meds.  It is just that his experience is that many of his patients don't adequately convert T4 med to T3, so he uses NDT, combo T4/T3 types, frequently.

There are advantages to using T4 meds, as long as the patient converts adequately. T4 builds up slower and maintains a more consistent effect over the day.  You only have to take it once daily.   I  have no problem with you starting on T4 med, to see how you accept the med and convert.  

To get you feeling better as fast as possible, in 4 weeks you should go back and get tested again to see how it has affected your Free T4 and Free T3 levels and proceed from there.   I would also suggest that if not done already, you should also test for Vitamin D, B12 and ferritin, since hypo patients are frequently too low in the ranges for those as well.
So sorry you are feeling bad :)  

I didn't start to feel much improvement until I switched to Armour. That was in February.  I started at 30 mg and worked up to 90 mg.  Since Armour also has T3 I take 60 mg in the morning and 30 mg in the afternoon.  Both on an empty stomach and four hours apart from any  supplements.

I feel the full effects of the Armour now.  I just have to say yesterday I bustled around for over 12 hours without needing a nap - or any muscle pain!  It has been a long time since I have done that.

I do supplement with Magnesium, Iron, Vitamin D, B12, Selenium, Vitamin C and an adrenal glandular. My B12 was extremely low and iron kind of low.

I was on levothyroxine and my free t's never came up. But fell within the normal low. I felt terrible exhaustion, muscle pains, headaches, etc..

On Facebook I belong to a group where we all love NDT's (natural desiccated thyroid) and it is amazing how many people experience the same symptoms that seemed unrelated to thyroid! Love those ladies!
My blood report was
TT3.    0.88  0.58 - 1.59
FT3.    2.57. 1.71- 3.71
FT4.    1.01. 0.70- 1.48
TSH. 1.20.  0.35-4.94
Is this a good reading?
Those levels are good for you only if you are not having any hypothyroid symptoms.  People are different enough that some can be symptom free at levels that are inadequate for others.  So what, if any symptoms are you having?  Are you taking any thyroid mediation?
Thank for replying gimel. I went to the Doc he said for me these are normal readings. Its just that I was a bit worried of my dizziness and lack of energy after I eat in the mornings. Sorry I didn't get to peply earlier. Thanks for your comment.
Hi all,

I'd be very grateful if someone could give me some advice. I'm a 26 year old female. For the past 2+ years my symptoms have been:
-body temp is consistently 96 degrees
-extreme fatigue, I often feel like I’m in a fog or daze, almost disconnected from the real world
-trouble going to sleep at night, wake several times throughout the night, wake feeling tired
-Raynaud’s: cold hands and feet, especially feet. They go numb and turn white if even slightly cold, then turn red/purple
-edema, swelling in right foot, calves
-Chronic constipation, bloating, digestive distress
-Chronic sprain/tendonitis in foot/ankle that won't heal going on 2 years
-high cholesterol of 230 despite great diet
-extreme difficultly losing weight
-irregular, heavy periods. I’ll go 2-6 months without a period. Flow is heavy, clots.
-anxiety and panic attacks
-chronic low-grade depression. Then every 3-4 days, I’ll wake up severely depressed. I’ll not want to talk to anyone or even look people in the eye. Feel like I don’t want to be alive and very hopeless.
-severe mood swings, content one day, angry, hostile the next
-thinning of eyebrows,
-brittle, ridged nails
-heavy feeling in legs like I'm dragging through mud
-loss of interest in activities and life in general; I don’t want to talk to anyone or see my friends

I recently got a thyroid and other blood work done and my results were:

TSH: 2.0 (range 0.55-4.78)
FT4: 1.0 (range: 0.89-1.76)
FT3: 2.1 (range 2.3-4.2)
Reverse T3: 11.4 (range 7.5.19)
No antibodies

High sensitivity CRP: 0.2 (puts me in the low risk range for future MI or Stroke)
ANA: Negative

Other info: I had a bad car accident 2 years ago, but my MRI was clear. I had a brain and cervical spine MRI last year, which came back clear (would a pituitary tumor show up on those?). I binge drank 1-2 times per week from 2007-2013 and did recreational drugs from 2011-2013 include ecstasy (about 20 times) and cocaine (about 6 times). I do not drink or do drugs anymore. I have Raynaud's Syndrome. I have a high lipoprotein A (136 with the range being <30), which indicates a higher risk for eventually developing cardiovascular disease. My triglycerides, however, are in normal range.

Since I have hypo symptoms, low FT3, low-normal FT4, and a normal TSH, I believe I have central hypothyroidism, caused by a dysfunctional hypothalamic-pituitary system.

As I understand it, the hypothalamus-pituitary system can be dysfunctional due to genetic alterations, toxins, drugs, stress, aging. I also researched that it can be caused by tumors on the pituitary, vascular disease, traumatic brain injury, infections.

My big question is: How do you determine what the underlying cause of the hypothalamic-pituitary dysfunction is? Should I treat the underlying cause, or is supplementing with natural desiccated thyroid hormone sufficient? I don't doubt that NDT would remedy my symptoms, but I would also like to determine what is causing the dysfunction. Is it dangerous to jump straight to treating with NDT, without figuring out what caused this state in the first place? Or is it best to treat with NDT, while trying to figure out the underlying cause? If the dysfunction is due to stress or something non-threatening, is it possible to get the hypothalamus-pituitary system back to normal without NDT?


I have Graves Disease. I am experiencing Hypo symptoms at this time and weight gain beating me up inside and out!
TSH 3.38
fT3 2.2
fT4 1.2
Taking Synthroid 100mcgs daily for 2 years
My question is, how can I stop this weight gain, joint pain and swelling, fatigue, bitchy symptoms?
Get your Free T3 and Free T4 to optimal levels.  For most hypo patients that means not just within the bottom limit of the ranges, but in the upper part of its range for Free T3 and at the middle of the range for Free T4 at minimum.  It appears that your body is not adequately converting the T4 to T3, so your free T3 is much lower in the range than your Free T4.  That is a common occurrence when taking T4 meds.  So you will need to add a source of T3 to your meds.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just lab results.  You can get some good insight about clinical treatment from this link written by a good thyroid doctor.

Also, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  So, if not tested for those, I highly recommend it.
Just diagnosed with hypothyroid, adrenal fatigue and estrogen  dominance three months ago. I have been taking 60mg of compounded desiccated thyroid, made from porcine. I just received my blood work and it looks like my TSH level is low. Does anyone know what this test results is about? Thanks!

TSH 0.05     0.50-5.20 MCLU/ML
FT3 3.4        2.3-4.2 PG/ML
FT4 1.0        0.8-1.8NG/DL
Just addressing the thyroid issue, your Free T3 and Free T4 are low enough in the range to cause hypo symptoms.  Please tell us about any symptoms you have.  

Scientific studies have shown that TSH is frequently suppressed below range when taking adequate thyroid hormone.  So that is nothing to be concerned about.  For example my TSH has been less that .05 for probably 30 years without ever having hyper symptoms.  

For about 3 months I have been taking 50mcg synthroid for hypothyroidism. in the past week, I have developed extreme dizziness and nausea, that seems to go away everyday at about 2pm. I take my meds at 6am.
latest test results are:
T3, 96
TSH 1.34, was 5.25
Free T4 1.1, was .9
This morning, I felt fine for the first 1.5, then while eating breakfast, all of a sudden, I felt like I just got off a merry-go-round, and felt like I was going to vomit. Until 2:30, I felt weak, dizzy, extremely tired.

When I first started taking synthroid, my energy level increased and I have grown back hair that fell out.

I am tempted to not take this med tonight and see how I feel tomorrow.
Any suggestions.
What were your thyroid test results before starting on the 50 mcg of Synthroid?  Also, please post the reference ranges shown on the lab report.  
Were you having any symptoms before the past week?  Have you been tested for Vitamin D, B12 and ferritin?  If so, please post those as well.
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