Normal levels but still hypo symptoms??

[Md123456]

Hi, I have had hypo symptoms for years, steadily worsening (fatigue, foginess, cold hands/feet, brittle hair/nails). My TSH levels were tested in Dec 2012 & came back as normal at 1.49.  Had the full panel just recently, May 2012 & my doctor said these were also "normal.". I am feeling worse by the day! Am I missing something? Also on Vyvanse & Cymbalta. Recent test was taken at 2pm, not fasting. Thx.

TSH 0.85 (0.4-4.50)
T3 uptake 32 (22-35%)
Total T4 7.7 (4.5-12.0 mcg/dL)
T4 index 2.5 (1.4-3.8)
Antibodies <20 (<20 IU/mL)

[gimel]

First, which antibodies test would that be, TPO ab or TG ab?  Second, just because test results fall within the so-called "normal" ranges does not mean that is adequate for YOU.  The ranges are typically too broad, and patients' requirements are different.  

Third, the tests for T3 uptake, Total T4 and T4 Index are somewhat outdated and not very useful.  It would be far more revealing of your thyroid status if you get tested for the biologically active thyroid hormones, which are Free T3 and Free T4.  Of these Free T3 is the most important because Free T3 largely regulates metabolism and many other body functions.  Scientific studies have also shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  

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 test results.  Many of our members, myself included, report that symptom relief for them required that Free T3 was adjusted into the upper third of its range and Free T4 adjusted to around the middle of its range.

You can read about clinical treatment in this letter written by a good thyroid doctor.  Note the statement that "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

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

When you go back for the free T3 and Free T4 tests if the doctor resists, just insist on those and don't take no for an answer.  Also, I suggest that you should also test for Vitamin D, B12, ferritin, and a full iron test panel.  While there you may as well find out if the doctor is going to be willing to treat you clinically, as described in the letter.  If not, then you will need to find a good thyroid doctor that will do so.

When results are available, please post results and reference ranges shown on the lab report and members will be glad to help interpret and advise further.

[goolarra]

T3 uptake and total T4 are considered obsolete tests.  They have been replaced by FREE T3 (FT3) and FREE T4 (FT4) respectively.  Total T4 tells the total amount of T4 in your blood, but much of that is chemically bound by protein and unavaialable for use by your cells.  FT4 tells what's actually available.  T4 index (FTI) is a calculated approximation of your FT4 level; the direct test is much more informative.

You can ask your doctor to run FT3 and FT4.  He might cooperate.  However, don't be surprised if you find yourself looking for another doctor.  Don't let this one keep you sick.  You don't have to put up with those lingering symptoms.