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TSH & free T4 came back normal but have symptoms of thyroid problem...
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TSH & free T4 came back normal but have symptoms of thyroid problems

TSH - 3.76
Free T4 - 1.20

Symptoms:
-mood swings
-always nervous
-can't put on weight (fat or muscle - I'm 6' and 135)
-always thirsty with dry mouth (I drink about 128oz water per day)
-shaky hands

My vitals are normal. What do you think could be causing this?
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35 Comments Post a Comment
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Avatar_f_tn
Are you on thyroid meds?

Have you been diagnosed with a thyroid disease or disorder?
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Avatar_m_tn
I am not on any thyroid medications.

I have not been diagnosed with a thyroid disease.

My sister has hypothyroidism. My aunt & grandmother also have a thyroid disease (not sure if hypo or hyper).
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Avatar_f_tn
Recommended reference range for TSH according to AACE is currently 0.3-3.0.  Your TSH is a bit high, which indicates hypOthyroidism.  I should have asked you for a reference range on your FT4.  Ranges vary lab to lab so have to come from your own lab report.  However, given a "usual;" range of something like 0.8-1.8, yours looks pretty good...a tad low, perhaps since target for FT4 is midrange.

The really puzzling part is that your symptoms all sound hypERthyroid.

Do you know the causes of your relatives' thyroid problems?  Do they have Hashimoto's thyroiditis or Graves' disease, both autoimmune thyroid diseases that tend to run in families?
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Avatar_m_tn
The reference range for the FT4 is 0.76-1.46 ng/dl.

I'll get back to you with the cause of the family's thyroid issues.
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Avatar_n_tn
What has your doctor said so far as an explanation of this?
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649848_tn?1357751184
Have you been checked for diabetes.  Inability to gain weight, excessive thirst, mood swings, along with irrational behavior are major symptoms.  
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Avatar_m_tn
I'm not sure the cause of my grandmother's thyroid problems.

My aunt's hypothyroidism is caused by a growth on her thyroid.

My sister's hypothyroidism is caused by Hashimoto's (says her endocrinologist). She also has trouble putting on weight and is incredibly skinny. So the weight-factor may just be genetic. All of her other symptoms, however, fit those of hypothyroidism.
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Avatar_m_tn
My doctor (general practitioner) has said that everything looks normal. The nearest endocrinologist is quite a ways away from where I'm currently living. So that's why I'm trying to get this worked out through my GP.
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Avatar_m_tn
I was tested for diabetes. The results came back normal.
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Avatar_f_tn
Some people do lose weight or can't gain weight hypo or hyper...just lucky in the gene department, I guess!

So, with the range you provided, you are a little higher in the range than I'd tought at first...quite a bit over midrange.  With an FT4 that high, I'd expect your TSH to be lower than it is.  Your TSH is in hypo territory, but your FT4 by no means is.  However, TSH is volatile and swings a lot even intraday.

It might be worthwhile to request another set of labs.  I'd request a repeat of FT4 and TSH and ask the doctor to add FT3 this time.  Since your sister has Hashi's, it might also be a good idea to test thyroid antibodies...TPOab and TGab.  If either of those is elevated, autoimmune thyroid disease (Hashi's or Graves') is indicated.  Since autoimmune disease tends to run in families (but often not the SAME autoimmune disease), you might also ask for TSI, which is the definitive test for Graves'.  Those would give you a much better idea of what's going on with your thyroid.

Does your PCP have a theory as to what's causing your symptoms?
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Avatar_m_tn
I had seen a neurologist for my tremors a little over a month ago and he ordered a blood test. I never saw the exact results, but he had said that my blood-work was abnormal and that it was pretty clear that something was up with my thyroid. He suggested I see an endocrinologist.

I spoke with my GP today and he told me the same thing - that my test results from the neurologist were clearly pointing to hypothyroidism, but that the latest test results looked normal. He said that he's not sure as to what's going on. I'll discuss the information you provided me with with him on Thursday and see if it's something he's willing to do, or if her just wants to kick me to the endocrinologist.

I really appreciate the help, goolarra.
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Avatar_f_tn
"I never saw the exact results, but he had said that my blood-work was abnormal and that it was pretty clear that something was up with my thyroid."  

Please, get those results from your neuro's tests.  One test is interesting, but more than one demonstrating a trend is even more useful.

Best of luck with your appointment.
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Avatar_m_tn
I spoke with my GP today and he said that he thinks I had an inflamed viral infection of my thyroid when I got my blood-work done in December. We scheduled some blood-work to be done in about a month to see if anything changes.

Here's a summary of what I've got so far...

||||||||||||||| 12/28/2011 |||||||||||||||
TSH (0.5 - 4.3)
   7.04

T3 Antibody
   negative

T4 Antibody
   negative


||||||||||||||| 2/13/2012 |||||||||||||||
TSH (0.4 - 4.0)
   3.76

Free T4
   1.20
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Avatar_f_tn
Your GP's theory is a possibility.  Had you recently had an upper respiratory infection prior to the labs?  Did you have pain in your thyroid?  He might have been thinking of DeQuervain's thyroiditis if you want to do some reading.

There's not a lot to go on there.  TSH is volatile, and that's all we have for comparison since FT4 wasn't tested in December.  I'm sure both your doctors were reacting to the elevated TSH in December when they said you "clearly" had a thyroid problem.  

Did you, perhaps, misread your lab report?  Was that TPO antibody and TG antibody that were negative?

As long as your symptoms aren't making you too terribly uncomfortable, I agree with your doctor that there's no danger in retesting in a month and seeing where this is going.  I'd ask him to test FT3 also at that time...in fact, I'd ask more than gently.  It's a missing piece of the puzzle, and it could explain your symptoms.
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Avatar_m_tn
The lab report does say "T3 ANTIBODY (TRIIODOTHYROXINE)" and "T4 ANTIBODY (THYROXINE)."

I had not had any sickness or pain prior to the initial lab test. I did come down with appendicitis about two weeks later. But I don't think there's any connection.

Life with the symptoms has been my "normal" for as long as I can remember. So I don't really feel any rush to solve this mystery.

I'll request that free T3 be added to my next blood-test.

Thanks for walking me through this!
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Avatar_f_tn
Wow, that's a new one on me...TPOab (thyroid peroxidase antibody) and TGab (thyroglobulin antibody) are the usual tests run for autoimmune thyroid disease.  TSI (thyroid stimulating immunoglobulin) is the definitive test for Graves'.  I have no idea what your doctor might have been trying to get at with these tests.  Perhaps he just ordered the wrong tests???
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Avatar_m_tn
It's definitely possible since he's a neurologist and rarely deals with that. It's also possible that the staff in the lab had trouble reading his handwriting. I have no idea.
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Avatar_f_tn
Ah, yes, the old handwriting excuse!  LOL

I think you should still ask for TPOab, TGab and TSI, then.  My guess is that whatever antibodies they tested were pretty useles in determining autoimmune thyroid disease.  
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Avatar_m_tn
Another reason to test for the Free T3 is to discover a possible poor conversion issue.

That is if your body does not convert the T4 into T3 efficiently, You could have plenty of gas in your fuel tank and simply no gas getting to your engine. T4 is a storage hormone and needs to be converted into T3.  the Body's cells ONLY use the FREE T3 hormone.  So if the conversion process is having trouble, there may not be enough of the active T3 in your body and THAT is the cause for your being Hypo even with plenty of FT4 storage hormone in your bloodstream.

Just another theory and it is another reason why it is important to get your Free T3 levels checked.

It always amazes me that the medical industry will not test for the ACTUAL Thyroid hormone that does ALL of the work.  The end result. It just baffles my mind.
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Avatar_m_tn
Haha. The lab technician was having difficulty reading what he'd written.

I told my doctor to add the antibodies and free T3 to my next test (March 26). Sorry it's so far away. GP wanted to see if there's a trend going on over time as opposed to rapid-firing the tests.
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Avatar_m_tn
I saw the endocrinologist the other day. He said that he thinks the increased TSH level was caused by thyroiditis, and that the excessive thirst may be caused by diabetes insipidus. I doubt I have diabetes insipidus, as it doesn't account for the variety of symptoms.

I will be getting another blood test some time this week. It will have all of the antibodies you suggested, TSH levels,diabetes insipidus things, along with other stuff.

Thanks for your help!
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Avatar_f_tn
Don't forget the most important...FREE T3 and FREE T4.  (Sorry, can't help myself!)

It will be interesting to see your results.I
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Avatar_m_tn
They're on the mile-long list!
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Avatar_m_tn
Thyroid Peroxidase is the anti-body test, right?
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Avatar_f_tn
One is thyroid peroxidase antibody (TPOab).

The other is thyroglobulin antibody (TGab).  Be sure they order thyroglobulin ANTIBODY because there's also a thyroglobulin test, and you don't want that.

Technically, a positive TPOab is sufficient to diagnose Hashi's, but a negative doesn't rule it out unless you're also negative on TGab.  So, as long as you're doing it, might as well cover all the bases.  
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Avatar_m_tn
When the technician was inputting the tests into the computer, I didn't notice a Thyroid Peroxidase Antibody option. I only saw a Thyroid Peroxidase option. Are they the same thing?
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Avatar_f_tn
I hope this statement doesn't come back to kick me in the butt...

I have never heard of anyone getting a thyroid peroxidase test, so I'm fairly certain that what the tech input was the antibody test.  

However, with TG, there is both the TG test and TGab.  

I think you've got the right one.
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168348_tn?1379360675
You have  brought back memories .. my Hashi's antibody test was a big fat ZERO (yoo hoo) and my Thyroglobulins have remained almost the same as 5 yrs ago when I had my surgery!

C~
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Avatar_m_tn
Everything came back normal. Every single thing.

So I guess it's not the thyroid causing the symptoms. And I don't have diabetes insipidus. I'm at a dead end.

Thanks for the help, goolarra!
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Avatar_f_tn
Would you mind posting your actual results (with reference ranges)?

Too often doctors tell us that everything is "normal" when either testing was inadequate (probably not in your case since you seem to have called the shots) or reference ranges used were obsolete or improperly used.
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Avatar_f_tn
Have you had any testing for adenal fatigue or Addison's disease?
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Avatar_m_tn
They mailed them to my home address. It will be a week or two until I make it home to see them. I'll post them here when I do.

I have not been tested for those. I don't have too many of the symptoms, I don't think.
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Avatar_f_tn
Great!

Adrenal fatigue, in particular, has a list of symptoms that can be as long as your arm.  Mainstream medicine tends to not treat adrenal problems well unless you have full-blown Addison's disease.  As a result, symptoms also seem somewhat ill-defined.

The symptoms you posted in your original question:
-mood swings
-always nervous
-can't put on weight (fat or muscle - I'm 6' and 135)
-always thirsty with dry mouth (I drink about 128oz water per day)
-shaky hands
seem to be consistent with AF.  You can goole the long list to see if anything else applies.

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Avatar_m_tn
Sorry it took me so long to get home.

Anyway, here are the results:

TPOab (0-20)
   6

TSH (0.3-4.2)
   3.2

T4 Free (0.930-1.700)
   1.190

TGab (0-20)
   <20

I have no idea why the Free T3 wasn't tested. It's on my bloodwork request sheet...
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Avatar_f_tn
About 8 (so long ago we're losing track!) years ago, AACE recommended that TSH range be adjusted to 0.3-3.0.  That change reflected the fact that the old range was severely flawed since a lot of hypos were included in the "normal" population.  It's an understatement to say that labs and doctors have been slow to adopt the new range.  

So, you can see that your TSH by that standard is slightly elevated.

Your FT4 is at 34% of range.  FT4 ranges suffer from the same flaws as TSH range, but no one has ever even attempted to adjust them.  As a result, many people find that FT4 has to be at least midrange before hypo symptoms are relieved.  

TPOab and TGab are both negative for Hashi's.

Most doctors were taught in med school that "if FT4 is good, FT3 is too", so you don't have to test for it.   Wrong, wrong, very wrong.   FT3 is the biologically active form of the thyroid hormones, and without it, you really don't have a complete profile.  It's also higher levels of FT3 that can cause some of the symptoms you mention...nervousness, inability to gain weight, hand tremors.  The upshot is that I wouldn't close the book on thyroid yet...why can't they just do what they're told???

Your labs look slightly hypo, which still conflicts with your symptoms.  Too bad you haven't seen FT3, so you could be confident in looking elsewhere.

Thanks for poting those.

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