In 2004 I had 1/2 of my thyroid removed because of a nodule, which was benign. I have been taking Levoxyl, 25 mcg, once per day. I had been going to an endocrinologist yearly for check ups, until I moved in 2010. I decided just to rely on my primary provider to do the yearly blood work. (TSH, T4, and T3) In July of 2010 my TSH and T4 were in normal range. TSH 0.500-8.900 Mine was 3.413. T4 0.61-1.64 Mine was 0.93 For the T3 normal range is 100-215 and mine was 88. My doctor never mentioned it to me, and I just now realized it when I went back to check. What could cause the T3 to be low, and the others to be normal? I have gained 20 pounds in the time since then, could this be one of the reasons why? I am also very tired and run down, but I am also very anemic, and for that I will be seeing a hematologist. Thanks in advance for any answers.
First, let's make clear that TSH is a pituitary hormone that is affected by so many variables that it is inadequate as a diagnostic for thyroid issues. At best TSH is an indicator to be considered along with more important indicators, which are symptoms first, and then levels of the biologically active thyroid hormones, Free T3 and Free T4. Free T3 is the most important because it largely regulates metabolism and many other body functions. Scientific studies have shown that Free T correlated best with hypo symptoms, while Free T4 and TSH did not correlate.
Your doctor did not even test for Free T3, only Total T3. The largest portion of T3 is bound up with protein molecules and thereby inactive. Only the unbound (free) portion is biologically active.
I don't know where that range for TSH comes from, but your result is above the AACE's currently recommended range of .3 - 3.0. Also, your Free T4 is below the midpoint of the range, which is too low. Your Total T3 is even below the range, and I'm sure that your Free T3 will also show as low or below the range. The fact that your Total T3 is lower in its range than your Free T4 indicates a problem with conversion of T4 to T3. Low iron will contribute to a T4 to T3 conversion problem.
All in all your doctor doesn't understand how to best interpret test results and treat a hypo patient. 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. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance. The letter is then sent to the PCP of the patient to help guide treatment.
Take note of this statement. "the ultimate criterion for dose adjustment must always be the clinical response of the patient. I have prescribed
natural dessicated thyroid for your patient (Armour, Nature-Throid) because it contains both T4 and T3 (40mcg and 9mcg respectively per 60mg). This assures sufficient T3 levels and thyroid effects in the body. Since NDT has more T3 than the human thyroid gland produces, the well-
replaced patient’s FT4 will be below the middle of its range, and the FT3 will be high “normal” or slightly high before the next AM dose."
So I think you need to go back and request testing for Free T3 and free T4. If the doctor resists, then you should insist on it and don't take no for an answer. Also request testing for Vitamin D, B12, zinc and selenium. Be aware that just being in the low end of the range for theseis frequently inadequate also.
While with the doctor I also recommend that you give him a copy of the link above and ask to be treated clinically, as described. If the doctor resists clinical treatment or is reluctant to prescribe T3 type meds, then you will need to find a good thyroid doctor that will do both.
It is true different labs use different ranges. But I've never seen a lab that has the high point of TSH over about 6 let alone almost 9. MANY people feel symptomatic with a TSH over 3. And TSH is at best a screening tool.
As gimel points out the true tests really are the FREE T3 and FREE T4. Many people find they need to have their Free T4 in the MIDDLE of the range AND (that means in addition to) they need their FREE T3 to be in the UPPER 1/3 of the range. Just being "somewhere" within the range is not sufficient for many people. and both of your levels are below this higher target.
The free or unbound T3 hormone molecule is the ONLY thing your body actually uses at the cellular level. T4 is a storage hormone that remains in the blood an awaits the body to convert it when needed into T3. Again only the unbound or "free" hormone is able to be converted. This is why it is so important to test for the "free" and not total hormones. Testing for "total" is analogous to checking the fuel level in your automobile gas tank. Sure it provides some information but it does NOT tell you how much fuel is getting to your engine. To do that you need to test the fuel flow rate at the engine. This is what a "free" hormone test does. It determines the amount of hormones that is available to be converted and how much is available for the cells to use.
Conversion issue would mean for whatever reason your body does not convert the T4 into T3 efficiently. For this reason you may need to have a medication with a T3 component. Also selenium can sometimes help with that as well. Which is why gimel suggested getting your selenium levels checked.
I would tend to agree that your thyroid issue and your anemia may be unrelated to Thyroid. But that does not mean that you don't need thyroid medication increase to help you feel better. more than one person on the thyroid forum has pernicious anemia. Not saying they go hand in hand. But if you have this, you would not be the first person to have both thyroid issues and pernicious anemia.
Don't forget to insist on testing for Free T3 and free T4. Also request testing for Vitamin D, B12, zinc and selenium. Be aware that just being in the low end of the range for theseis frequently inadequate also. The specific reason I suggested zinc and selenium is that, along with iron they play a role in the conversion of T4 to T3. So it is very important to make sure those are adequate, and also for you to get your iron anemia taken care of, since that also has some very unpleasant symptoms.
I do want to make you aware that just because you will be seeing an Endo does not mean that he will be a good thyroid doctor. Many specialize in diabetes. Many also rely heavily on their "Immaculate TSH Belief', by which they want to use TSH as the primary diagnostic to medicate a hypo patient. That doesn't work. Also, many use "Reference Range Endocrinology", by which they will tell you that a thyroid test result that falls anywhere within the reference range is adequate for you. That also doesn't work.
I described for you previously what a good thyroid doctor will do. So after you request the above testing, and see how that goes, then you should also ask about being treated clinically. If your doctor does not want to do the testing suggested, and does not want to treat clinically, then you will have to provide enough info and persuade him to change his mind, or you will have to find a doctor that will do so.
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