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Please explain thyroid numbers.
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Please explain thyroid numbers.

My Dr. said that being hypo may be part of my problem.  I started on Levothyroxine .25mcg, 5 days ago.  I am now feeling VERY tired ~6 hours after taking it.  Is it possible that I don't really need it and this could be the cause of being so tired?  My labs reports concerning thyroid are:

T4 -----------     5.7        (6.1-12.2)
TSH---------    1.43       (0.34-5.6)
FT4----------      .66       (0.58-1.6)
Transferrin:  409          (200-360)
FSH---------   8.0          follicular phase 3.9-8.8
HAIC--------   6.4            
Ferritin-----    20         (11-307)

I was told that symptoms can get worse before they get better.  I have a ultrasound of the thyroid to do tomorrow.   If anyone could answer my question or help me to understand, I would greatly appreciate it.

Thank you;  Amy
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213044 tn?1236531060
The first T4 test is a Total T4, and is not very acurate, so the fact it is below lab limit is not important.

Your TSH is perfect, so I don't know if you need meds or not.

Your Free T4 is low, and that is why you are on Levo now.

There was no Free T3 run, and that is the test that ties the whole picture together and says whether or not you need to be on the Levo. But it wasn't run.

Normally the doctor will run A TSH and a Free T4. If your TSH is high, and your Free T4 is low, then more tests are run, and sometimes a person is put on meds while the other tests are pending.

Your TSH is absolutely beautiful, and the fact that your Free T4 is low should be taken into account, but I think the doctor jumped the gun a little on the Levo. If you were low on Free T3, then you would need hormone replacement. If you were low on Free T3, your TSH would be higher.

Request a Free T3 be run as soon as possible to verify whether you need the Levo or not. Most doctors would not even consider putting you on Levo when your TSH is 1.43.

TSH is an indicator of whether your hormones are low or not. It is only an indicator, but it is a reliable one. A TSH result between 1.0 and 1.5 is perfect. It would take compelling evidence that your Free T3 is low to justify putting you on levothyroxine. Like a Free T3 test that shows a low level.

A high transferrin result indicates iron deficiency, but can be elevated by pregnancy or oral contraceptives.

A ferritin result of twenty indicates iron deficiency. The level should be at least 80.

Regarding symptoms; symptoms lag behind hormone levels. They are slow to manifest and slow to dissipate. If you are hypo, you will feel bad even after you have been on meds for a few weeks, or a few months.
390388 tn?1279639813

Hi.  Thank you very much for your reply.  I go for a US of the thyroid tomorrow morning and after I get home I will call and ask for the Free T3 test to be run.  

I found way back in 2006 a result of 113 for a T3-TOT but that was 2 years ago.  At that time the FT4 was 1.11, T4 6.9, and TSH 1.25 but as I said that was two years ago.  All of my blood work and test was based around heart issues.  (hs CRP, Chol., EKGs, etc.)
I have also had alot of strep test and they all come back neg.

As far as the Transferrin results they have been in the 400-450 range threw out the years in all my test.  I don't take contraceptives because I can't get pregnant.  Not an option.

As for the Ferritin it has never been over 30 over the years.  I did read up on iron today though and found out that it can also cause leg/muscle cramps, tiredness, heart palps, angina and headaches.   That's me to a tee.  
I can not for the life of me figure out why though.  I eat venison, eggs, 15 grain bread, whole grain cereal with raisons, love salads, beets, fish (fresh & seafood) ect.  I even grow and can (cold pack) my own fruits and veggies.  Make spag. sauce ect.  

(Just trying to figure out why my hs CRP, Transferrin, cholesterol, WBC and BP are always high and my Ferritin is always low.  There has to be a reason for feeling as bad as I do at times.  Last year I couldn't even go hunting due to the pains.)  

Since I started on the Levothyroxine I noticed that I was not as flushed in the face.  Today was the first day that I didn't feel totally wiped out and could get some yard work done.  Though I still felt foggy.  I am very pleased to get an answer back from you concerning the T3 and explaining all of the other thyroid test.  The last thing I need is to try to fix something that is not broken.  LOL.  I will take them until I get the T3 results just to not upset my Dr.   I just can't understand why every 2-3 months I feel the way I do, so I'm now trying to reach out to good people like you that can give me input.  I feel like ET.  Must have input.  LOL.  Sorry it's getting late.  LOL.  Sorry about writting a book here.  Thank you so very much;


213044 tn?1236531060
With a Free T4 that low, you are sort of teatering on the edge.
I can see what the doctor is thinking.

But you must be converting sufficient T3 from that T4, or perhaps your T3 is over-abundant and your thyroid is compensating by producing less T4.

Without the Free T3 test, you just don't know. And the thing is, Free T3 is the hormone that actually gets used by your body. It feeds the cells, not the Free T4.

There may be some reason your TSH is not higher. But the most likely reason is that your levels are good. Although with a Free T4 that low, your TSH may go up soon. It's hard to say.

If you're starting to feel better, that's good. Get re-tested in 4-6 weeks. You don't want to go hyper.

You need to talk to the doc about how to get your ferritin level up. It takes a long time to do it right. It needs to be above 80, and higher is good.

You might want to get a few more things checked.
vitamin D

Good luck figuring it all out.
390388 tn?1279639813
Hi.  Wow.  Thanks for the reply back.  As I said I'm ignorant as far as thyroid test numbers go, so you sort of lost me on the T3/T4 conversion thing.    A  Daaa.   LOL.  Sorry.  If you don't mind though I would love to keep this post going with you once I get the ultra sound done and more results back.

I should still ask about the T3 test though before the 4-6 wk re check right?

With the ferritin # she said I should take a multi vit. and an iron pill daily.  There is not much I can change with my diet to make it healthier.

Though I do cheat sometimes with my cravings for salt (mainly) and potatoes.  As mommytwo2 says sometimes the cravings are just so great.  I also like expresso and latta's but have been drinking 1/2 reg. and 1/2 decaf instead due to BP issues.  I do smoke but have been trying to cut down, again due to BP and heart issues.  I openly admit my faults to her though so she knows.  She just tells me I'm a ticking time bomb ready to go off, and I have to bloom first?  She means well.   I am no longer showing an AV block which is great.  I'm just a bit stubborn so I'm told on slowing down on my bad habits and tend to push myself to hard sometimes.

As far as the calcium she said it was low but I don't know the #s.  I was told to add 2% milk into my diet instead of soy.  As for the others, mag, pot, and D, I don't know but will find out.  Thanks again so very very much for all of your help.

390388 tn?1279639813
Well the US results just came back and it showed a small non-specific nodule in the L lobe of the thyroid.  The recording was not to worry about it and have it re-checked in one year.  So I guess that is good new.?  Amy
213044 tn?1236531060
That is very good news.

The report usually has all kinds of gory details that you have to go to medical school to understand. Short and sweet is a blessing.

The T4/T3 conversion thing is like this;

Your thyroid puts out a lot of T4 and a little T3. As it circulates in your body, the T3 is used, and T4 is converted to T3 as the body demands it.

It's more complex than that, but it gives you an idea of how T4 is used.

It sounds like you are in good hands. I would just request a Free T3 test be run when you have your TSH and Free T4 checked again.

Doctors don't order it routinely for several reasons. It is more expensive, very few labs run it "in house", so it is always sent out and takes a week or so to get the results, and it often shows the same thing your Free T4 shows.

But sometimes it detects a high Free T3, contradicting the low Free T4 test. This can happen for various reasons, and would have an affect on how your treatment is handled. You should have it checked, but I may have been a little overly dramatic saying you should have it checked as soon as possible.

The thought of putting you on meds when your TSH looked so nice freaked me out a little, but the doctor may be correct. Time will tell.

Congratulations on the Ultrasound report!
390388 tn?1279639813
Hi. Thank you for the reply.  
I'm guessing then that since this sm. nodule was found in the thyroid that this is probably what threw my thyroid off in the first place.  So if I got this right the thyroid pills are right to be taking then?  

What causes these nodule's anyway.  Would it be caused by low numbers or would the #'s be caused by the nodule or just plain idiopathic?  Just curous?  

My biggest worry was taking something I did not need.  I just can't wait to feel normal again.  I'm just so tired of being tired, SOB and having these stupid chest pains.   Hopefully everything will level out soon.

Thank you for the congrats on the test and helping me out with all my questions.  It really means alot to me.

213044 tn?1236531060
Small nodules are found on most people's thyroid. Most of the time they do not affect thyroid function. What exactly causes them I cannot say.

I don't know what to say about the meds, except that time will tell. When you get retested, you will find out.

I just had my blood checked today.
My free T4 is 0.99, with a range of 0.58-1.64.
My TSH is 4.47.
My current dose is too low. I need more Synthroid.
(big surprise, stupid doctor!)

But my Free T4 is higher than your's.
Your Free T4 indicates you need medication.
Your TSH says you don't.
A Free T3 test might explain the conflict there.

I have a wad of these things laying around, so let me find a few with a normal TSH.

When my TSH was 0.92, my Free T4 was 1.38
When my TSH was 1.70, my Free T4 was 1.24

See what I mean? Your Free T4 is low. Your TSH should be higher. Hard to say why. Full moon? Maybe one of the machines is out of calibration?

Your Free T4 says "feed me!".
Your TSH says "I have plenty of hormones, thanks".
390388 tn?1279639813
Thank you so very much for the explanation.  LOL.  And in terms that I can understand.  I know I've been asking alot because I'm new and ignorant to it.  Thank you very much for walking me threw it.  

I ordered some books today called "Hypothyroidism: The Unsuspected Illness"  I was told it was good in understanding along with "The First Year- Hypothyroidism" to understand it better.  

My luck I'll get the books and 2 months later will find out I don't need them.  LOL.  Actually that wouldn't be so bad.  I'm finally understanding the chest pains, muscle cramps, SOB, bp, tiredness, thirsty, flushed, iron, etc. and all of the other symptoms  "of what I/ my Dr. thought was heart issues" is thyroid.  WOW.  Wish I would have known that 1000's of dollers ago.  LOL.  

Don't mean to ramble on;  just wanted to say thanks a million for all of your help.

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