Aa
Aa
A
A
A
Close
Avatar universal

Need advise from a pro

I joined this forum to get a bit of advice from healthcare professionals regarding the activity of my thyroid gland.
For 10 years now i'm experiencing various weird symptoms that always led me to think about underactive thyroid. It started with light head spinning back in 1999 and foggy sensation from time to time (just like if i was living in a dream). Then, a few years later i started to lose my hair and felt anxiety on a more frequent basis than usual leading to a moderate diastolic hypertension. Nowadays, 10 years after the first symptoms started, i've added awful amount of body weight (15kg through the past 10 years) on top of all previous symptoms + heavy constant fatigue through the day  + everytime i perform a blood checkup, my cholesterol is a bit higher than the lab "acceptable limits" (around 2.2 or 2.5 g/l when the limit is set to 2.0g/l)
Moreover, here are the historical results i got through the past 7 years regarding my thyroid gland :

2002 :

TSH : 5,865 mUI/l (0,400 - 4,400)

2004 :

TSH : 5,151 (0,400 - 4,400)

2005 :

TSH : 2,784 (0,400 - 4,400)

may 2007 :

TSH : 5,849 mUI/l (0,400 - 4,400)
T3L : 6,4 pmol/l (3,5 - 6,5)
T4L : 14,6 pmol/l (11,5 - 22,7)

november 2007 :

TSH : 3,603 mUI/l (0,400 - 4,400)

April 2008 :

TSH : 2,922 mUI/l (0,400 - 4,400)
T3L : 6,2 pmol/l (3,5 - 6,5)
T4L : 13,6 pmol/l (11,5 - 22,7)
Anti TPO : 31,0 U/ml (negative if < or = 34)
Anti TG : <30 U/ml (negative if < or =  60)

december 2008 :

TSH : 2,767 mUI/l (0,400 - 4,400)
T3L : 5,7 pmol/l (3,5 - 6,5)
T4L : 11,5 pmol/l (11,5 - 22,7)


march 2009 :

TSH : 2,569 mUI/l (0,400 - 4,400)
T4L : 12,69 pmol/l (11,5 - 22,7)

15th of October 2009 :

TSH : 4,980(0,270 - 4,200)
T3L : 5,3 pmol/l (3,1 - 6,8)
T4L : 14,5 pmol/l (12 - 22)


As of today, none of the dozens of GPs + 1 endocrinologist i've been seeing have been suspicious about those results. All i was told is that though my thyroid gland is a tad "lazy" from time to time the amount of T4/T3 produced is always within the acceptable range so it's impossible my symptoms come out from this.

Therefore i've been advised by my endocrinologist to perform a full checkup from adrenal glands as he suspected a kidney malfunction due to slight potassium loss in my blood (3,4 meq/l instead of a minimum of 3.5). All the checkups turned out ot be Ok in the end (catecholamins, cortisol, ACTH, Aldosterone + adrenal gland echography & scanner)

So i end up with absolutely no improvement in my health status after 10 years (symptoms never stopped worsening through years) and according to all the praticians i've been seing it's impossible the source of the problem is linked in any way with my thyroid. Hence, none of them would recognized a potential sublinical thyroid underactivity and accept to give me at least a try on Thyroxine to lower TSH for a few monthes and see if symptoms would improve.

Any opinion from an expert about all this ?

Thanks in advance for your reply :=)
4 Responses
Sort by: Helpful Oldest Newest
Avatar universal
For over 20 years I was taking a full daily replacement value of Synthroid, , with a TSH of less than .05, yet I never got rid of all my hypo symptoms.  When I learned just how important FT3 was, and got it tested, I found that mine was low.  I was switched to Armour thyroid and my FT3 went up to the upper part of its range and FT4 then went down to the lower part of its range, somewhat like where you are right now.  Since I still had light symptoms, I have now supplemented with Synthroid and reduced the Armour, to try and get a better balance, and get both FT3 and FT4 into the upper part of their ranges.   I'm not quite there yet, but feel the best ever.

Taking this approach of testing and adjusting FT3 and FT4 until symptoms disappear is the bottom line to all that info I posted previously.  As you know, doctors will look at your particular test results and decide to do nothing further, regardless of your symptoms.  I hope the info I posted will give you confidence and the rationale to try and  get your doctor to at least give you a therapeutic trial of thyroid meds, and monitor carefully the effect on your symptoms.   If you don't succeed with current doctor, then you will need to find one that will treat your symptoms, rather than
just accepting your test results as "normal", and concluding that nothing further is required.
Helpful - 0
Avatar universal
Thanks to both of you for your comments.
To laura : The T4L and T3L in the results i published earlier are indeed FT3 and FT4 (the L means Libre "free" in french)
Regarding pituitary gland, i performed a few investigations already. 2 brain scans focused on the hypotalamic region have revealed nothing and ACTH (a pituitary hormon that regulates cortisol) frenation has been tested as well as insuline tolerance which is quite a reference test for assessing the integrity of the hypothalamo-pituitary-adrenal axis.
In my case the over-production of TSH by the pituitary gland is probably caused by the low levels of T4 in the serum (i have always been close to the lowest lab reference values). The lack of T4 triggers the secretion of TSH in higher quantity by the pituitary in order to "overwork" the thyroid and leading it to produce more T4 in order to reach the proper T3 Levels. It worked quite well until the midst of 2008 as i managed to get FT3 values in the upper range even with low FT4 in the blood. But since then, with T4 levels remaining low, the production level of T3 has never stopped decreasing (and i guess that is the reason why my symptoms are more intense now)

I think i'll follow your advice and get Antibodies tested once more to see how it evolves as a year and a half ago it showed quite a substantial level of anti-TPO (31 U/ml) even though it was not exceeding the threshold value (34 U/ml)
Helpful - 0
Avatar universal
Just to supplement the good info Laura provided, here's a post I made previously, for similar concerns.



I can see from the results why many doctors would send you home as "normal; however,  there is more than ample reason to say that you are hypo and should be given at least a therapeutic trial dose of thyroid meds to evaluate the effect on your symptoms.  There are multiple reasons for saying this.  

First, the AACE recommended over 6 years ago that the ref. range for TSH should be lowered to .3-3.0.  Many thyroid authorities have stated that anything over 2.0 should be suspect.  In addition, TSH is a pituitary hormone that is only an indicator of thyroid hormone levels in the blood.  It is affected by many variables, including the time of day when the blood was drawn for the test.  Also, it does not correlate very well at all with hypo symptoms.  Why the medical community continues to use the old test range and rely predominantly on TSH as a diagnostic, when it is not, is a mystery to most of us on the Forum.

The most important tests are for FT3 and FT4, which are the actual, biologically active thyroid hormones.  Free T3 is actually four times as potent as free T4, and it correlates best with hypo symptoms.  Many patients with hypo symptoms have reported the best result by adjusting FT3 and FT4 into the upper part of their ranges.  Being in the reference ranges for FT3 and FT4  doesn't mean everything is okay.  The ranges should really be considered as guides within which to adjust levels as required to alleviate symptoms.



Sorry about the length, but here's another prior post that explains why I think the reference ranges for the "Frees" are too broad and result in patients not being properly medicated.



The reason the reference range for TSH is called "normal", is that it's based on a large population of patients' test results.  From that data base the decision was made that about 2.5 % of people would would fall out of this "normal" range because they were possibly hypo or hyper.  From this decision limits were placed at plus and minus two standard deviations (which correlates with plus or minus 2.5%) from the overall average and that was called the "normal" range, supposedly representing people who had no thyroid problems.  

After many years of bad experience with this "normal" range for TSH, they finally acknowledged 6 years ago that there were a lot more patients out there with hypo  and hyper problems, than previously accepted when they originally used their data base to established the range.  
After excluding from the data base those patients who were suspect for hypo and hyper, they again analyzed the remaining data base and established limits that included 95% of the total data base and called these new limits "normal".  This changed the reference range from .5-5.0  down to .3-3.0, which is a huge change.  Unfortunately this change hasn't yet been accepted or acknowledged by most labs and doctors, even though the change was recommended by the AACE over 6 years ago.

Also, realize that the reference ranges for the "Frees" were established the same basic way.  These ranges have never been reexamined and modified like the range for TSH.  I am absolutely convinced that this is the reason why so many hypo people fall into the lower end of the ranges for FT3 and FT4 and are still told they are "normal".

In one my past lives I had a lot of training and experience in statistical analysis.  Based on that experience, if I had to estimate what a revised range for FT3 would be if the data base were purged of suspect hypo and hyper people, like was done for TSH,then I would say the FT3 range should change from 2.3-4.2 pg/dl up to about 3.2-4.3.  And FT4 probably would change from .60-1.50ng/dl up to about 1.0-1.55. Quite a difference, huh?  Think maybe that is why we hear from so many people that have hypo symptoms, yet they are in the "normal" ranges for the "Frees"?  I'd bet my last dollar.

If you're not exhausted by now, you will benefit from reading this article by Dr. Lindner.

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

From all this I think you can see how all your test results can fall in the so-called "normal" ranges, yet suffer from hypo symptoms.  In my opinion the very best way to treat a thyroid patient is to test and adjust the actual, biologically active thyroid hormones (FT3 and FT4), with whatever meds are required to alleviate symptoms, without regard for the TSH level.  Relief of symptoms should be paramount.  The most difficult part of this is finding a doctor that will treat your symptoms in this manner.
Helpful - 0
499534 tn?1328704178
We are only patients here as you. We do our best to give support and our opinions, but we are not healthcare professionals.
The tests for the T3 and T4 are suppose to be Free T3 and Free T4. I am not sure what you had run. The levels should be mid normal range at least.
TSH is a pituitary function test.....not a thyroid hormone test. The Free T4 and Free T3 are the active thyroid hormone found in the body. Free T4 is actually converted over to Free T3.
I would ask for some further pituitary testing as well maybe.
Also wouldn;t hurt to do another TPO Ab to see if you have gone to the other side of normal and test positive for Hashimoto's.
Helpful - 0
Have an Answer?

You are reading content posted in the Thyroid Disorders Community

Top Thyroid Answerers
649848 tn?1534633700
FL
Avatar universal
MI
1756321 tn?1547095325
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.