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Normal TSH Low FT4
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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Normal TSH Low FT4

I had a physical and testing done for thyroid. I have had fatigue, feeling cold, and noticed my hair is thinning for a while now. Didn't think a lot about it. Saw my doc for a surgical clearance (not related to thyroid) today. He told me my FT4 came back as 'borderline' low at 0.8 (0.9-1.7 normal) and my TSH is 1.4 (0.27-4.20 normal). He told me it's normal and nothing to be concerned about. I trust my doc, but hypothyroid is very prominent in my family. Should I have my endocrinologist take a look at this?
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Avatar_f_tn
Oh, and my Vit. D level is only 11 despite taking 15,000 IU of dry D3 a day.
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Avatar_m_tn
That is amazing to me that your doctor would pronounce as "borderline"  a FT4 test that is below the reference range (which is far too broad as well), and look at your TSH and say that it is normal and nothing to worry about.  

TSH is a pituitary hormone that is affected by so many variables that it is inadequate as the diagnostic for thyroid.  At best it is an indicator to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, FT3 and FT4.  TSH causes no symptoms.  It is utilized so extensively by doctors because it supposedly tells them all they need to know.  This is referred to as the "Immaculate TSH Belief".  In reality TSH does not correlate well with FT3 and FT4, much less with what is most important, which is symptoms.  Yet your doctor ignored the actual thyroid hormone result that was out of range and instead relied on the TSH test.

You don't necessarily need an Endo, but you do need a good thyroid doctor.  A good thyroid doctor will treat a patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  Test results are valuable mainly as indicators during diagnosis and then afterward to track FT3 and FT4 as meds are revised to relieve symptoms.  From your experience so far I think that you are going to have to find a good thyroid doctor that will treat you clinically.  If you want to understand more about this, here is a good link.

http://hormonerestoration.com/files/ThyroidPMD.pdf

I strongly urge you to get tested for Free T3, along with the Free T4 and TSH. Free T3 is most important because it correlates best with hypo symptoms and largely regulates metabolism and many other body functions.  

Also, having a low TSH along with those symptoms and a low FT4, you should also ask about the possibility of a pituitary issue as well.  Other tests that would be advisable are Vitamin A, B12, iron/ferritin, RBC magnesim, zinc, and selenium.  You also need to get your doctor to do whatever is necessary to get your Vitamin D level increased as well.  

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Avatar_f_tn
Thank you so very much for the valuable information. My vitamin D levels have been chronically low for years now, despite 50,000 IU a week for 8 weeks, and now with 15,000 IU daily. For some reason I am not absorbing it all. Of course everything is ALWAYS blamed on the gastric bypass (very successful in my case) from 6 years ago. I went through 2 iron chemotherapy treatments back in December when my iron levels fell to -5. My hematocrit and hemoglobin are now 12.5/38.6 respectively.  On the border again, but I will likely need iron treatments for the rest of my life as I do not absorb any iron I take in orally.My RBC remains below normal 4.8 (4.2-5.4) My B12 is good at 512 (211-946 normal). My iron levels are normal now, due to the iron iv therapy. I do not know my magnesium, zinc or selenium counts.

I guess my TSH is on the lower end of normal at 1.4 (0.27-4.2), but it's that FT4 being low that is being ignored that bothers me.

How do I find a good doc who deals with thyroid issues? I live near Syracuse NY. Is there a referral service that anyone knows of?

My mom had severe hypothyroidism and was on high does of synthroid before she passed away at the young age of 52 (asthma). I just think this is being ignored. I have adrenal issues including a adrenal hyperplasia in my remaining adrenal. My left one was removed in 1997 due to pheochromocytoma.

I thought after my iron treatments my fatigue would be better. It helped, but I'm still so tired out. I just want to feel better. Thank you again for the valuable information. You have no idea how much I appreciate it.
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Avatar_m_tn
Would either Albany or Rochester be too far away for you?
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Avatar_f_tn
Both are just a little over 2 hours from me, and if the doc is really good and highly recommended I'm more than willing to travel.
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