Several months of low TSH...

For several months now I have had a general thyroid panel done and each time the result is the same: very low TSH and normal T3, T4.  Due to errors with communication, sometimes the lab would run a free T3 or T4 or both.  Her are the results:

Sept 2009: TSH-.06, Free T3-2.8, T4-10.1 (typo?)
Aug 2010:  TSH-.02, Free T4-1.4 and no T3 run
? There was one run in the fall of 2010 - TSH was .08, but I don't recall the T3 or the T4.
Jan 2011:  TSH-.16, Free T3-2.6, Free T4-2.6

I was on 125mcg of Synthroid prior to Sept 2009 and am now taking 112mcg for two days, then 125mcg for one, then 112mcg for two, etc.  I have gained at least 10lbs since 2009.  I do not have prolonged periods of fatigue, just somedays (due to other factors).  My menstrual cycle has been changing slightly, but not anything drastic.  Just a few more days and some months two in one month.

Does anyone have a suggestion?  Thanks.

[gimel]

It would help members respond if you would also post the reference ranges shown on the lab report.  Also, please check the free T3 and free T4 results for Jan 2011.  Looks like a repeat.  

[shuga1109]

The normal range for TSH is 0.35-5.60...give or take.  Some websites have 0.5-5.0.  your results don't look very good.  I would have been a complete mess!  Even when my levels are somewhat on the normal range, but on the low end or high end of normal, I get really bad side effects.  I am always told to take the medication on an empty stomach every morning with a glass of water at the same time each day!  You are not suppose to eat until an hour after.  I swear by this and it does make a difference.  My body is sensitive and if I am off by about a few hours, or if I eat too soon, the medication will not be as affective.  I am currently on .88mcg one day, and .75mcg the next day and so on.  I alternate them every other day.  I take it faithfully at the same time each morning with a full glass of water.  I also get bloodwork done every three months to keep my levels normal.  My periods are crazy, but thats just one of those things I have to deal with having this disease.  I get it every 21 days and about 7 -8 days long.  i was also told that no matter how normal my ranges are, just having the disease will cause me to have side effects.  I know this wasn't much help, but hopefully you can get your levels checked more often, since they are not normal.

[Barb135]

I agree with gimel, it would be very helpful to see the reference ranges for the FT3 and FT4. These ranges vary from lab to lab, so must come from your own report.  You have the exact same results for FT3 and FT4? Please check the numbers.

Low TSH does not automatically mean you are hyper; my TSH consistently runs at < 0.01 or 0.01, and I'm not hyper.  TSH should NEVER be used alone to determine whether one is hypo or hyper.  

[CalypsoO]

The reference ranges vary from lab to lab.  The general ranges are as follows (what I found on the internet-don't write back I am wrong..I told you these are varied base on the source)

TSH is .03 to 6.0 mIU/L
Free T3 is 1.4 to 4.2 pg/mL
Free T4 measurement was recently changed from ug/dL to ng/dL so I don't know the conversion from a year ago.  As I said labs vary and the general NOW is .07-1.5 ng/dL.

I understand that you cannot go by TSH alone and say one is hyperthyroid.  My concern is the total picture and what does this mean.  I have read other posts and they do not answer they question, they only provide antidotal comments on how they feel with these symptoms as well.  I am not looking for emotional support, I am looking for an objective answer.  I have searched the internet and spoke with my healthcare provider and everyone is at a loss as to what is happening.  I would like to know so I can take appropriate action.  Thank you.

[CalypsoO]

One more thing..gimmel..look again, the 2011 test is not a repeat, the number are not the same.  The free T3 is 2.6 and in 2009 it was 2.8.  The free T4 is 2.6 and in 2009 was 10.1.  The 10.1 is not a typo.  It is due to the old measurement of ug/dL in 2009 and now (2011) the labs are using ng/dL.  So, again, if I gave all of you the reference ranges for each test they would mean nothing.  All I can say is that on the labs, the T3 and T4 were within normal lab reference ranges and the TSH was not and hasn't been for over a year.

[gimel]

Sorry that we seem to be struggling to get those test results clear for us.  My question was with the FT4 result for Jan.  2011, since it was the same number as the FT3 result.  You also say that all FT3 and FT4 results were within the ranges.  If 2.6 is correct for the Jan FT4, then that is above any range I have seen.  Again, not trying to be a problem, but don't want to mistakenly use the wrong number.  

Would like t comment more, but can you please clear this up for us?

[CalypsoO]

Forget I asked the question as everyone seems to getting hung up on the minutia.  For gimel READ AGAIN these are general reference ranges and ONE T4 reading out of a YEAR of tests does not constitute and abnormality.  Secondly, the reference ranges are general since they vary from lab to lab and again you missed the point that the lab changed the way they measure T4.  Lastly, the main issue is the TSH to T3,T4 ratio.  I am concerned that the TSH has been so drastically low as compared to the overall T3 and T4 levels.  FORGET IT.  I wish I could delete this question as this was an exercise in futility.

[Barb135]

I'm not sure why you are getting so frustrated.  Gimel was only trying to clarify, in order to make sure he, or others give you proper information.

No one is saying you are wrong about the ranges you posted, and I've no doubt that you found a website that gave those ranges.  We know that reference ranges vary from lab to lab; that's why they must come from your own report, not something generic that doesn't pertain to your results.  Whether the lab changed the units they report in, or not, is irrelevant; the important thing is where your levels fall within the ranges on YOUR lab report, no matter what units they are reported in.

I don't understand your thought about TSH to T3/T4 ratio.   TSH is a pituitary hormone that's simply a "signal" for the thyroid to produce more hormones; when the thyroid doesn't respond, the pituitary puts out more TSH; if there is adequate or too much thyroid hormone, the pituitary stops producing TSH - at least, that's the way it's supposed to work, but it doesn't always.  

As I stated in my post of Jan 21, my TSH stays at 0.01, or less, and I'm not hyper.  To my knowledge, there is no specific ratio of TSH to FT3/FT4.  There should, however, be a proper ratio of FT3 to FT4.  Many of us feel best with FT4 at mid range or higher and FT3 in the upper 1/3 of its range - another reason why the ranges on your own report are so important.

[gimel]

First, the reference ranges do vary from lab to lab.  That's why you were asked for the ranges shown on your lab reports.  We always try to evaluate the relative position of a test result within the correct reference range, so that we can give the best response to a member.  

Second, the reason I asked about the Jan FT4 result of 2.6 was that it looked suspiciously like it could be an accidental duplication of the Jan result for FT3.  With your medication data, and symptoms, there did not appear to be any reason why the FT4 should go up so much from the 1.4 result in Aug. There is no FT4 range that I have ever seen that would seem to be consistent with the 2.6 number you listed, as compared to prior levels, and in view of your meds history.  Therefore, I asked the question, which you totally misread, as follows.

"One more thing..gimmel..look again, the 2011 test is not a repeat, the number are not the same.  The free T3 is 2.6 and in 2009 it was 2.8.  The free T4 is 2.6 and in 2009 was 10.1.  The 10.1 is not a typo.  It is due to the old measurement of ug/dL in 2009 and now (2011) the labs are using ng/dL."

I clearly understood the different units of measurement and range info, but you didn't look at the 1.4 (within range) result in Aug compared to the 2.6 in Jan (well above range).   There was no logical reason that I could think of other than a typo, or lab error.  That's why I asked.  

So in spite of your pointed accusation, I haven't missed a single point of your posts.  If you will kindly dismount from your high horse and slow down a minute, there  is a lot you can learn here.  For example I have found research data that explained that it was not uncommon for TSH to be suppressed when taking significant quantities of thyroid meds.  In spite of what many doctors will tell you, this does not mean that you have become hyper and need to reduce meds.  You are hyper only if you have hyper symptoms due to excessive levels of the biologically active thyroid hormones FT3 and FT4, which you probably do not.

Another thing that should interest you is that FT3 is the most important of the tests because FT3 largely regulates metabolism and many other body functions.  Scientific studies have shown that FT3 correlated best with hypo symptoms, while TSH and FT4 did not correlate.  

From the information that you have provided, I expect that your hypo symptoms are due to your FT3 being too low, and likely in need of a T3 med source.  Just because Your FT3 is within the range does not mean that it is okay for you.  The ranges are far too broad for that to be the case.  Besides the anecdotal info that Barb mentioned, I can give you a scientific reason as to why that is the case.

The ranges for FT3 and FT4 have never been corrected as was done for TSH over 8 years ago.  At that time the AACE decided that there were far more hypo patients than would be predicted by their old ref. range.  So when they carefully purged from their data base suspect hypo patient data and recalculated the limits, the range changed significantly from .5 - 5.0 down to .3 - 3.0.  If the data bases for FT3 and FT4 were similarly corrected, with my training and experience in statistical analysis, I have estimated that the range for FT3 would be more like 3.2 - 4.3 and the FT4 range would be more like 1.0 - 1.55.  That is why I think we hear from so many patients with FT3 and FT4 levels in the lower part of the current ranges, yet they still have lingering hypo symptoms.

I have found further support for this in studies on patients with no hypo symptoms, where their FT3 and FT4 data would produce ranges more like what I have suggested.  Of course all this would be academic if the doctors appropriately used the ranges clinically, as guidelines within which to adjust levels as necessary to relieve symptoms.  Instead they use them as pass/fail, and many patients in the lower end of the ranges suffer with that decision.

Another thing you should be aware of is that very frequently patients taking sig. doses of thyroid meds do not adequately convert T4 to T3, resulting in low FT3 such as yours, and resultant hypo symptoms.  Concurrent with this, low selenium and low iron levels seem to inhibit this conversion.  So it would be a good idea to be tested for those.  Also, hypo patients often have low Vitamin D and B12, as well.  So, also worth checking.

Probably the best suggestion I can make is for you to discuss all this with your doctor and see if you can reach some understanding of your intent to be treated clinically by testing and adjusting FT3 and FT4 levels as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief has to be all important for you, not test results.  Test results and reference ranges should only be markers to track your progress toward becoming euthyroid.  If your doctor has a problem with this approach, or with prescribing meds other than T4 types, then you will need to find a good thyroid doctor that will do so.

I think you might find very interesting this link to a letter written by a good thyroid doctor.  He often consults with patients located at some distance from his office.  The form letter is sent to the PCP of the patient, for use a guideline for treatment.  

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