Normal TSH/High Free T4

Hi,
I have always had an enlarged thyroid.  As of the last couple months, I have lost half of my hair volume, had a major increase in palps and also some insomnia, feeling hot all the time.  My TSH was withing normal range, but free T4 was high.  T3 was on higher end of range, but not out of range.  I have had pain in my neck with a squeezing sensation.  I have had a treadmill, holter monitor and thryoid antibody tests.  All negative (accept the confirmation of PVC's and PAC's) Ultrasound on thyroid showed enlarged thyroid with 2 small fluid filled cysts that were said to be too small to be suspicious or to cause increased T4.  Doc (nurse practioner) thinks I had a thryoid "burst" or temporary syndrome and wants to retest in a month.  My hair continues to come out in gobs everyday and it is disturbing.  Could I still be hyperthyroid?  Would there be anymore tests that would help pinpoint problem?  Thank you and nice to be here!


This discussion is related to Normal TSH, High Free T4.

[enitsirhc973]

I have the same problem. I have hashimotos and my lab results said normal tsh high t4 and normal t3 but in the higher end of normal. Im super hungry all the time and I feel hyperthyroid sometimes but I'm also gaining weight like crazy. I dont get it!!???

[TamraW]

A small number of patients will have thyroid disease and never test positive for antibodies. It would help if you would post the results, so that members of this forum can give you a more informed opinion:

TSH
FT4
FT3
TGab
TPOab

:) Tamra

[TamraW]

Same as above. Post your labs. Some of us don't lose the weight if our frees aren't treated and the doctors focus on TSH.

We Hashis tend to swing from hypo to hyper as our nodules leak hormone. The key is to get on enough thryoid medication to shrink the nodules, and suppress the TSH, so that the antibodies calm down.

Get a thyroid ultrasound if you haven't already.

Over the counter anti-inflammatory drugs help with swelling, as does one tablet of Selenium daily. Take vitamins at least four hours after taking thyroid meds.

See article about Selenium and antibodies:
http://thyroid.about.com/library/news/blselenium.htm

:) Tamra

[TheDanimator]

I am 20 years old and these are my thyroid  results...

t4 free (direct)  1.75      ng/dl      Reference interval    .82 - 1.77

I noticed im right below the interval range, can this still cause problems?

Tsh  1.410             uiU/ml        Reference  0.450 - 4.500

Vitimin D   21.1 LOW          ng/ml         Reference    32.0 -100.0

I was retested

t4 free- 1.6

t3 120 "not sure if this is free or total"

[MikiL]

I am a 38-year old woman and was recently referred to have my thyroid function tests, due to a complaint of low body weight for a long time.  The results were as follows:  TSH 1.34 UIU/ml, Free T3 5.1 pmol/L, and Free T4 21.5 pmol/L (with the normal cutoff 19.00).  Does this mean anything of significance?

[farmwife67]

My test results:
t-3 free 4.86
Thyroxine, free (t4) - 2.27 (2.3 is the highest normal)
TSH, erd generation - 1.5

I feel tired all of the time, brain fog, dry skin, sores in my scalp, low temperature, depression occasionally.
Do you think my free t4 should be a little lower and if so, how do I get that to happen?

[goolarra]

What is the range on your FT3?

Your symptoms sound confusing since your FT4 is high (which indicates hyper), but your symptoms sound hypo.

[farmwife67]

range of FT3 is (2.8-7.10)

[goolarra]

Sorry to keep asking questions...Are you on thyroid meds?  If so, which and what is your dose?

[farmwife67]

Don't be sorry about asking questions, I'm so glad to have your help!  I do take synthroid, (generic) 225 mcg daily.  In order to get that combination I have to take two pills 200 and 25.

[goolarra]

Apologizing again...I've been away for a few days...sorry to be so long in getting back to you.

I do think your FT4 should be a bit lower.  It's over the top of the range, and midrange is the target for FT4.  On the other hand, your FT3 is at 48% of range, and the rule of thumb for FT3 is upper half to upper third of the range.  Also, your FT3 is too low relative to your FT4.  Ideally, FT3 should be higher in its range than FT4 is in its.  So, for example, if your FT4 is at 50%, your FT3 should be up around 70-75%.

You can lower your FT4 by decreasing your levothyroxine a little.  However, I think you will still not feel well because you are a slow converter, and not enough T4 is being converted to T3.  I think it would be a good idea to drop the levo a bit and, at the same time, add in a little T3 (Cytomel).  You might start by dropping the levo to 200 mcg and adding in 5 mcg of Cytomel (Cytomel is more potent than levo, so you only add in a little bit).  Give that change four to five weeks to see how your symptoms improve and have more bloodwork.  If you still have symptoms, you could then reduce the levo a bit further and add in another 5 mcg Cytomel.

Is your doctor agreeable to using Cytomel?

[farmwife67]

I don't think my doctor even understands any other drug except levo.  I am seriously considering changing Doctors.  However, we live in a very rural area and I think they are all the same around here.  I don't mind driving for an hour for a Doctor, but I just don't know where to go or even how to go about finding a good Doctor..... This is sooooo frustrating.
Lori

[goolarra]

I live in a rural area, too, and it is difficult.  However, I think the upside in some of the less populated parts of the country is that endos are usually "generalists", i.e. they don't specialize in diabetes, but treat all endocrine problems.

Maybe your doctor would be willing to work with you and give the Cytomel a try???  But, I agree that finding a doctor who knows what he's doing is a lot better option.

When I was looking for an endo, I sent out a questionnaire to all the endos in the area in my insurance plan (multiple choice so it wouldn't take a lot of their time!)..  You might try that or just call their offices and interview them over the phone before making an appointment.  You'll probably have to do this through a nurse.

Some good questions to ask:

Which tests do they regularly order to manage hypo?  If they say just TSH, run.  In your case, if they don't test FT3, run also because testing is preliminary to treating with T3 meds.

Which medications are they open to using?  T4-only meds (like Synthroid), synthetic T3/T4 combos (like Cytomel/Synthroid), dessicated (Armour, NatureThroid, Erfa, etc.).

I also have a heart arrhythmia, so I asked if the doctor had experience treating the two together.  If you have any other health problems, you might ask about that.

I also asked if the doctor expected the patient to "do as he said" or if he was agreeable to working with the patient.  I think most staff in a doctors office are usually pretty honest (amazingly enough) when itcomes to questions of "style".

You can just ask a few minutes worth of questions and eliminate a number of doctors who won't be able to treat you properly because of their biases.  I got lucky...my endo was the only one who answered my questionnaire, but his answers were acceptable, and he turned out to be great (and I'm a tough sell...I was prepared to hate him!).  So, don't despair, just put a little time into research and save yourself some time and money.  Good luck!

[sadatka]

im male 38 years old the result of my lab is TSH is .037 the normal is (O.4-6.0 uiU/ml) and FT4 3.79 normal is (0.8-2.0 ng/dL)..What is the interpretation of this result?this can lead to a what problem?thanks so much for your answers to my query...

[gimel]

Rather than attach your post to this old thread, if you will click on the Post a Question button at top of page, and re-post your question, you will get lots more notice and response.