Aa
Normal TSH but FT4 and FT3 in the lower 25% range?
Hi everyone!
I'm new here, so thanks for your help in advance :)
I'll try to keep it concise.
In a nutshell, I've been dealing with depression and anxiety for about 10 years now, taken a good cocktail of antidepressant medications and the such. Recently I got recommended to check my thyroid which is something I had never done. Doing a lil' reading I found out that feeling low on energy/sleepy, bad memory, lack of attention and low libido are also symptoms of thyroid problems which are things I deal with as well. So, I got tests done and got told my results were 100% good, but I noticed that a couple of things are on the lower end of the range.
Here are my results:
TSH 0.94 ref ( 0.35-5.50 )
FT4 1.01 ref ( 0.89-1.76 )
FT3 2.90 ref ( 2.30-4.20 )
T3 Uptake 28 ref ( 22.50-37.00 % )
RT3 10 ref( 8-25 )
TPO <4 ref( 0-25 )
Any thoughts?
I'm new here, so thanks for your help in advance :)
I'll try to keep it concise.
In a nutshell, I've been dealing with depression and anxiety for about 10 years now, taken a good cocktail of antidepressant medications and the such. Recently I got recommended to check my thyroid which is something I had never done. Doing a lil' reading I found out that feeling low on energy/sleepy, bad memory, lack of attention and low libido are also symptoms of thyroid problems which are things I deal with as well. So, I got tests done and got told my results were 100% good, but I noticed that a couple of things are on the lower end of the range.
Here are my results:
TSH 0.94 ref ( 0.35-5.50 )
FT4 1.01 ref ( 0.89-1.76 )
FT3 2.90 ref ( 2.30-4.20 )
T3 Uptake 28 ref ( 22.50-37.00 % )
RT3 10 ref( 8-25 )
TPO <4 ref( 0-25 )
Any thoughts?
The prevalent standard of care for potential hypothyroid patients starts with a test for TSH. If that is within range, typically nothing further is done. If it is above range, then Free T4 is tested and if within range, the patient is usually told that thyroid tests are "normal" and that symptoms are due to something else. You were tested beyond TSH and Free T4, but still told that your results were good. That was very wrong.
TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T4 and Free T3. Further just being in the low end of the ranges is inadequate for many people. First the ranges are far too broad, due to erroneous assumptions used to establish them. Plus everyone is different and may have different levels at which they feel best. And last is that there are a number of processes and variables that affect the all important (tissue thyroid effects) which do not show up in those tests.
You have mentioned a number of symptoms that are frequently related to hypothyroidism. In addition your Free T4 of 1.01 is only at 14% of its range, which is too low. Your Free T3 of 2.9 is at 32% of its range, which indicates that your body is trying to maintain thyroid function by converting more T4 to T3. Note the following quote from an excellent thyroid doctor. "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."
You apparently have central hypothyroidism. With central there is a dysfunction in the hypothalamus/pituitary system resulting in TSH levels that are inadequate to stimulate the thyroid gland, resulting in inadequate levels of Free T4 and Free T3. You can read about all of this in the following link. I recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
The most important thing for you is to find a good thyroid doctor that will treat you clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief must be all important for you, not just test results. Many of us have found that required Free T4 at least mid-range, and Free T3 in the upper part of its range, and adjusted from there as needed to relieve symptoms. In addition hypo patients are frequently deficient in Vitamin D, B12 and ferritin so you need to get those tested and supplement as needed to optimize. D should be at least 50 ng/mL. B12 at the higher end of its range, and ferritin should be at least 50. If you need help finding a good thyroid doctor we might be able to suggest names of doctors that have been recommended by other thyroid patients.
TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T4 and Free T3. Further just being in the low end of the ranges is inadequate for many people. First the ranges are far too broad, due to erroneous assumptions used to establish them. Plus everyone is different and may have different levels at which they feel best. And last is that there are a number of processes and variables that affect the all important (tissue thyroid effects) which do not show up in those tests.
You have mentioned a number of symptoms that are frequently related to hypothyroidism. In addition your Free T4 of 1.01 is only at 14% of its range, which is too low. Your Free T3 of 2.9 is at 32% of its range, which indicates that your body is trying to maintain thyroid function by converting more T4 to T3. Note the following quote from an excellent thyroid doctor. "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."
You apparently have central hypothyroidism. With central there is a dysfunction in the hypothalamus/pituitary system resulting in TSH levels that are inadequate to stimulate the thyroid gland, resulting in inadequate levels of Free T4 and Free T3. You can read about all of this in the following link. I recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
The most important thing for you is to find a good thyroid doctor that will treat you clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief must be all important for you, not just test results. Many of us have found that required Free T4 at least mid-range, and Free T3 in the upper part of its range, and adjusted from there as needed to relieve symptoms. In addition hypo patients are frequently deficient in Vitamin D, B12 and ferritin so you need to get those tested and supplement as needed to optimize. D should be at least 50 ng/mL. B12 at the higher end of its range, and ferritin should be at least 50. If you need help finding a good thyroid doctor we might be able to suggest names of doctors that have been recommended by other thyroid patients.
1 Comments
Hi gimel!
Thanks for the response, I think I'll goto an endo to show him the results because the doctor who interpreted them is an internist.
Also, to clarify, he only asked me for TSH and FT4 but since I read that to properly diagnose it was better to have a more comprehensive panel I ordered all the otherones myself.
Thanks for the response, I think I'll goto an endo to show him the results because the doctor who interpreted them is an internist.
Also, to clarify, he only asked me for TSH and FT4 but since I read that to properly diagnose it was better to have a more comprehensive panel I ordered all the otherones myself.
It is very unlikely that you will get the diagnosis and treatment needed from an Endo. They specialize in diabetes more than thyroid. They also typically have the "Immaculate TSH Belief" and only pay attention to that. That is wrong. If they look beyond TSH then they usually will use "Reference Range Endocrinology" and tell you that a test that falls anywhere within range is adequate. That is also wrong. That inadequate standard of care is why I offered to help find a good thyroid doctor, if you are interested.
4 Comments
I see, Well yeah! I'll take your word on it :)
SHould I give you my zip code? or how do we do this?
SHould I give you my zip code? or how do we do this?
A zip code will do, or just a description of the general area within which you would be willing to travel to see the doctor.
I live in New York
I just sent you a PM with doctor suggestion. To access, just click on your name and then from your personal page, click on messages.
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