TSH Level

I went to the doctor's in August and had my TSH level checked because I am trying to get pregnant and I am not getting my period regularly or ovulating. Anyway...  I went back to the doctor last week and the retested my TSH and it was at 47.8! Is that possible? Do you think they made a mistake? Could it be 4.78? They also took a ultrasound of my thyroid and it came back that the tyroid is enlarged. My FT4 & FT3 are both .4 below what is average.

[goolarra]

Yes, it IS possible.  When I was diagnosed my TSH was 60-something, and I've seen members post levels in the hundreds on this forum.

Would you post your actual FT3 and FT4 levels along with reference ranges, which vary lab to lab and have to come from your own lab report?

[cat4720]

T4, FREE 0.4 Standard range 0.8 - 2.2 ng/dl
T3, FREE 2.4 Standard range 2.8 - 5.2 pg/ml
  

[goolarra]

Well, as you can see, your FT3 and FT4 levels are both below range.  Furthermore, what is "average" is right around midrange of these ranges.  So, your FT4 is really 1.1 below average, and your FT3 is 1.6 below average.  Many of us find that FT4 has to be midrange or above and FT3 in the upper half to third of the range before symptoms are relieved.  That formula doesn't work for everyone, but it's a place to start until we find our own personal comfort range.

With FT3 and FT4 that low, it's not at all surprising that your TSH is 47.8.

I'd suggest you have TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) tested to see if you have autoimmune thyroid disease (Hashimoto's thyroiditis), the most prevalent cause of hypo in the developed world.  Were nodules detected on your U/S?

Has your doctor started you on thyroid meds yet?  It's very important to get your thyroid condition stabilized before conceiving.  Pregnancy and childbirth can wreak havoc on even healthy thyroids, so any known problems are best addressed ahead of time.  Thyroid hormones and reproductive hormones are both part of the endocrine system, which is all interrelated.  There's a good possibility that once your thyroid hormones are adjusted, you will ovulate again.

Inadequate maternal thyroid hormones have been implicated in miscarriage and can impact your baby's development, especially in the first trimester.

How do you feel?  Do you have lots of hypo symptoms?  

[Barb135]

My TSH was 54.5 at diagnosis, and as goolarra said, we often see people whose TSH is in the hundreds.  

With FT3 and FT4 levels that low, I'm really curious as to how you are feeling, and what, if any symptoms you have, other than the ovulation issue.  

[cat4720]

THYROPEROXIDASE AB <1  Standard range 0 - 8 IU/ml

Above is the TPO test, but I don't believe I got the TGAB test. My doctor said that it wasn't conclusive for Hashi Thyroid. I started levothyroidxone .100 mg once a day. I just started them three days ago.

As far as symtoms (symptoms) go, I feel tired a lot, never well rested. I have a really hard time getting up in the mornings, I hit snooze for about an hour before I get out of bed. Throughout the day I have low energy. I am a teacher so that is never fun. I am also irritable and my husband usually see's this side of me unfortunately. Someday's I feel sad and depressed, but this isn't everyday, but more than it should be considering there isn't a real known reason why I should be feeling this way. I have muscles aches especially in my neck, shoulder area along with in my ankles and hips. Unfortunately I have also gained weight without really changing my eating habits or excercise regime. My doctor actually pointed out that I have gained about 22 lbs since last March. Needless to say I knew I had gained weight, but didn't really want to face the truth.

Will those symptoms subside with the med? I sure hope so.....

[goolarra]

A positive TPOab is considered adequate to diagnose Hashi's, but a negative does not eliminate the possibility since some of us are TPOab positive, some TGab positive and some both.

Those are all pretty classic symptoms, so they will go away once your levels come up.  I'm glad to hear your doctor started you on meds.  Most of us were amazed how many of our symptoms were thyroid related.

When are you scheduled for re-testing?

[cat4720]

I am scheduled to go back in 8 weeks from now. How long does it usually take before you start to feel better? Is it common to feel worse before better? The last couple of days seem to be worse for some reason. Thanks for all your feedback, it's so nice to hear from others that know information.

[goolarra]

It takes a given dose 4-5 weeks to reach it's full potential in your system after starting or increasing/decreasing. Usually, a re-test is recommended 4-6 weeks after each dose change.  Sometimes it takes several adjustments before levels become optimal.  After that, it can still take the body a while to heal completely from being hypo.

It's a process that will teach you the patience of Job!  BUT, you will feel better and better as your levels get back closer to normal.  It's not unusual to feel worse instead of better for a while.  Those meds just have to have time to build in your system.  

[cat4720]

Thank you for all your responses, I greatly appreciate it! Like I said before, it's always nice to talk with someone who knows about all this, especially when I am a newbee.

[cat4720]

I have another question....

I take my thyroid med every morning when I get up for work. I wait to eat like the instructions state. However on weekends, I take my med a bit later due to sleeping in. However I noticed this past weekend I didn't feel that well. I was sleepy and sort of run down. Should I be taking the med at the same time everyday? Can this make a difference?

[goolarra]

It's best to take your meds as consistently as possible.  However, my personal opinion is that "as soon as I get up" is consistent enough.  Levo builds in your system over time, so how you feel today has less to do with what dose or when you took your meds today than it does with the combined effect of everything you've taken for the past six weeks.  

When first starting meds, some alternation of improvement/backsliding is not unusual.  It all takes time to stabilize, and you might need a meds adjustment after you next blood work.  By all means, if you continue to have more symptoms on the weekend, it might be worth it to try getting up to take them at the same time you take them during the week  My bet, however, is that this will all even out once you've been on meds a while longer and are closer to your optimal dose..    

[cat4720]

It's been about seven weeks since I started my thyroid medication. Today I went in and here are my results:

TSH W/Reflex
6.870
Range 0.300-5.00 uIU/ml

T4 Free
1.2
Range 0.8-2.2 ng/dl

Last time results where

TSH Sensitive
47.869
Standard Range 0.300 - 5.00 uIU/ml

T4, FREE 0.4
Standard range 0.8 - 2.2 ng/dl

T3, FREE 2.4
Standard range 2.8 - 5.2 pg/ml

Can anyone help me out? How should I interpret these? I go to the doctor on Tuesday. What should I ask her?

[goolarra]

Your TSH is high, and your FT4 is on the low side, both indicating that you are still hypo.  Many members find that FT4 has to be about midrange before their symptoms are completely relieved.  Your FT4 has quite a ways to go to reach midpoint.

Unfortunately, no FT3 was run.

I think at this point I'd ask for an increase in meds.  I'll be very surprised if your doctor doesn't suggest this on her own.

I assume you still feel pretty hypo???

I'd ask for an increase, ask to be retested in 4-5 weeks and request FT3 be tested every time your doctor orders labs.

[cat4720]

Thanks for writing back to me. I am definately still have severe signs of fatigue throughout the day and a very hard time getting out of bed this week. I had a feeling my levels were still not where they should be. I did receive an e-mail from my doctor stating she was going to increase my med dosage. However I do have an appointment with her this coming Tuesday. Should I be asking anything else?

[goolarra]

Good, I'm glad your doctor is in agreement that you need an increase.

I'd ask your doctor to test FT3 and FT4 every time you have labs.  Get your results (preferably hard copy) and start keeping your own personal history.  If you jot down symptoms and meds doses on the report, you will start to see where YOU feel best...very valuable information.

I think I'd also ask to be re-tested sooner.  Yes, it can take 4-6 weeks for a dose to completely stabilize, but after 4-5 weeks about 90% is stabilized.  You can't rush this, but neither is there any reason to drag it out.  

It just takes some time...adjust meds, re-test, re-evaluate symptoms, repeat until you get there.  However, you will start to feel better and better along the way.  Best of luck with your increase.

[cat4720]

Thanks for the information I truly appreciate it!

[cat4720]

Below are my test results that I received today. I have not gotten my results from my Free T4 yet, however does anyone have any insight on the following results? They look like there in range, so does that mean my 125mg is the right dose? I went from 100mg to 125mg from the first time I was tested. Any insight would be appreciated.

6/29/11
TSH w/Reflect
2.070
Range 0.300-5.00 uIU/ml

T3 Free
3.8
Range 2.8-5.2


5/18/11
TSH W/Reflex
6.870
Range 0.300-5.00 uIU/ml

T4 Free
1.2
Range 0.8-2.2 ng/dl

3/29/11
TSH Sensitive
47.869
Standard Range 0.300 - 5.00 uIU/ml

T4, FREE 0.4
Standard range 0.8 - 2.2 ng/dl

T3, FREE 2.4
Standard range 2.8 - 5.2 pg/ml

[goolarra]

Wel, it definitely looks like you're moving nicely in the right direction.  

How are your symptoms?  Synmptoms are really the most important.

Your TSH is in range.  So is FT3, but it's still quite low in the range.  It's still in the lower half of the range, and many (not all) of us find that we feel better with FT3 in the upper half to upper third.  It will be interesting to see your FT4 and see how it looks realative to your FT3.

The most important thing now that you are in range is to evaluate symptoms.  Do you still have lingering hypo symptoms?  If so, a slight increase might be in order.  You're in the "fine tuning" stage, so you're close!

[cat4720]

I am feeling much better these days then I have in the past. Unfortunately I don't think my doctor ran the Free T4, which I am not sure why. Last time she only ran the TSH and T4 so I told her I wanted T3 as well the next time around and now I don't think she ordered T4. Ugh.... her comment to this round of tests where "your thyroid function is in goal range-continue current dosage and recheck labs in 3-6 months." Do you think I should see another doctor? Or since I am feeling much better wait it out?

[goolarra]

I suspect you're right about the FT4.  "TSH with Reflex" is an order to the lab.  It means that they test TSH, and only if TSH is out of range do they test FT4.  So, I'm guessing they probably didn't.

The important thing is if you're feeling well.  Your FT3 is pretty low in the range, but not all of us (myself included) need to be in the upper part.  I'm very comfortable low in the ranges.  Take a hard look at your symptoms and determine if you really are symptom-free or just "better".  

Would I find another doctor if I were you?  Probably.  There's no excuse for not running FT3, FT4 and TSH every time labs are drawn, especially after you request all three.  It's not like you're asking for anything controversial, expensive, dangerous, etc...it's a simple, inexpensive blood test.

If you do decide to stay with this doctor, I'd go back in three, rather than six months, and be sure all three labs are ordered.  Of course, if you have any symptoms in the meantime, request labs sooner.  

If you're feeling well, you have the luxury of some time to decide if you need a new doctor or not.  However, keep in mind that it can take a while to get in to see the good ones.

[cat4720]

I had my thyroid levels checked once again because unfortunately my period had not come for a while, so my doctor wanted to make sure it was still in range. I have been feeling better and not feeling so "hypo" in the last few weeks. Does it look like my T3 and T4 are where they should be? I am not sure how the numbers really work. I also want to add that I am trying to get pregnant and I have heard that your numbers should be different for that. Does anyone know if there is any truth to that? Any insight would be very helpful, thanks!

TSH, WITH REFLEX 1.387
Range 0.300 - 5.00 uIU/ml

T3, FREE 3.4
Range 2.8 - 5.2 pg/ml

T4, FREE 1.8
Range0.8 - 2.2 ng/dl

[flyingfool]

General rule of thumb is people start to feel symptom relief when their Free T4 is about mid range AND the Free T3 is in the UPPER 1/3 of the range.

Each person is different so you have to find out what works best for you.

But mid range on Free T4 is 1.5 using the range you provide and you are testing 1.8 so that would indicate doing pretty well here.  (depending upon how you feel)

Upper 1/3 of the Free T3 range is above 4.4 and you are testing 3.4.  So you are a bit low here and it is the Free T3 that does all the work.

You only say that you are feeling "not so hypo".  Exactly what does that mean?  if you are still hypo you MAY want to discuss with your Dr about adding a T3 med.  I suppose you could try adding more T4 med but you are already mid range or slightly above so this  MAY indicate you have some conversion problem converting T4 to T3.

If they do add a T3 med in, the dosage for the T4 med would most likely drop some with the addition of T3 since no conversion has to take place as T3 is immediately available for your body to use.

Please post how you are feeling and what your symptoms are.  Also my wife complained of being tired BEFORE the pregnancy test showed positive.  Since you are trying to get pregnant, this is also something to consider.  Also you may not want to be messing around with medication dosages.  A women's body is undergoing massive hormonal changes during pregnancy.  Just something to consider.  But menstrual irregularities is also common with hypothyroid women.

[goolarra]

I agree that your labs show that you are not conveting well.  While your FT4 is actually a bit high in the range, your FT3 is only at 25%.  You appear to be a slow converter.  If I were you, I'd take flyingfool's advice and ask my doctor about adding some T3 to your meds.  I don't think adding more T4 meds is going to help the situation.  

I'm not sure that your numbers should be all that different while pregnant, but your condition should be adequately treated and stabilized before conceiving.  During pregnancy, your thyroid hormones should be very carefully monitored and meds adjusted for the changing demands on your body.  You are being undertreated at the moment.  Pregnancy and childbirth can wreak havoc on healthy thyroids, so you want to have a known thyroid condition in control before getting pregnant.  If your thyroid hormones are not adequate, it can impact fetal development.

[cat4720]

Thank you for the information, I truly appreciate it. Right now I am still having symptoms of fatigue, however they are much better than the past. I am also still struggling with getting regular menstrual cycles, however that is improved more as well. Meaning out of the last four cycles I have gotten three. Where before I had about two in six months. I guess I would also say that my bowel movements are still not regular either and I haven't been able to lose any of the weight that I have gained since having this thyroid problem. Like I said before, I am feeling better, but not 100% better.
Therefore, I am going to see a different doctor who is more of a specialist in this department vs. the doctor that I am currently seeing. Maybe she will be able to help me.

[goolarra]

Your symptoms sound like you are still hypo to some extent.  I think getting another opinion is an excellent idea.  Your FT3 is really very low.  Ideally, FT3 should be higher in its range than FT4 is in its.  Your profile is "upside down" (FT4 = 71%, FT3 = 25%).  If you convert well, we'd expect to see something like FT4 = 50%, FT3+ 75% (just an example, not hard and fast numbers).  

Good luck with the new doctor, and let us know how it goes...