Thyroid Disorders Community
TSH W/REFLEX TO FT4
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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TSH W/REFLEX TO FT4

This test was done and the results are 2.69. I am 51 yo and suffer from a major depressive disorder,so the last 4 years I haven t been on my medication and my quality of life was/is nothing.Ive gained easy 60 lbs. I guess I was hoping I would just die.I finally accepted I was not going to die and went to the doctors.I did get copies of my lab work especially when the dr told me everything was fine that nothing jumped out at him.Can you please tell me is this a normal range as there was no normal range  posted. the test was done by Quest Diagnostics-west hills,ca.
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649848_tn?1357751184
As far as it goes, it's a "normal" result, but it really means very little and is not sufficient to determine whether or not you have a thyroid condition.

When a doctor orders TSH w/reflex to FT4, s/he's telling the lab to run TSH and if TSH is abnormal, they should then run FT4, but if TSH is normal, they should stop testing.  Your TSH is normal so the lab did what your doctor told them; they stopped testing.  This tells me your doctor does not know a whole lot about thyroid.  I'll explain........

TSH (Thyroid Stimulating Hormone) is a pituitary hormone that stimulates the thyroid to produce thyroid hormones.  If TSH is normal, it's presumed that the thyroid is functioning properly.  There are some problems with that.  One is that TSH can often be in the normal range, but the thyroid isn't really producing adequate hormones. Also, TSH fluctuates greatly, even over the course of a day.  Another is that most labs are using outdated TSH ranges.  The current recommended range for TSH is 0.3-3.0 (the range Quest uses is 0.4-4.50).  Another is that TSH does not correlate with symptoms.  One has to wonder why they even bother to do it.  

The thyroid produces T3 and T4 hormones, mostly T4.  The body doesn't use T4, directly; it has to be converted to T3, which is what the individual cells actually use.  Of the total T4 in your blood, some will be bound by protein and some will be "free". The Free T4 (unbound) is what's available for conversion to T3.  Of the T3 in the blood, some of it, too, will be bound by protein and will be unusable. The Free T3 (unbound) is that which is available for use.  

Free T3 and Free T4 should be tested every time TSH is tested.  The FT4 tells us what's available for conversion (most of the conversion is done in the liver); the FT3 tells us what's actually available for the individual cells to use. Too little of either and one can have hypo symptoms, because we're all different and we all need different amounts.

Then, there's the issue of antibodies and Hashimoto's Thyroiditis.  Sometimes the body sees the thyroid as foreign and produces antibodies to destroy it.  Hashi's is the most prevalent cause of hypothyroidism in the developed world.  The disease is progressive and as the antibodies destroy healthy thyroid tissue, the thyroid produces less and less of the necessary hormones. As this progresses, typically, the thyroid produces less hormones, so the pituitary puts out more TSH to stimulate the thyroid.  With Hashi's, it's not unusual for symptoms to show up before labs indicate a problem.

The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab).  You need them both, because both are markers for Hashi's and without them, you could be misdiagnosed.

I suggest that you go back to your doctor and ask for the TSH, Free T3, Free T4, TPOab and TGab.   Then you can make a real determination as whether or not you have a thyroid condition.  If you don't, we can make other suggestions.
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Avatar_f_tn
I believe I smiled just now. I commend you. I actually understood your reply, and I see my Dr. tomorrow and I am eager to request these tests as suggested.
I have so many questions to ask about my lab results, I do not have any confidence in this Dr already. I was really hoping to find someone who actually cared about helping me live and not totally about the cost.
Thank you.
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Avatar_f_tn
my dr appt was for my glasses. my next appt isnt until the  24th of july but i will get these test as suggested.thank you
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649848_tn?1357751184
I missed your June 30 response, so I'll just say that I'm happy that I was able to explain things so it made sense...... .

Neither do I have confidence in that doctor.   LOL   But keep in mind that some doctors will do the right tests, once the need is pointed out to them.  If s/he still refuses, find someone else.

Will look forward to hearing how your appointment goes on the 24th and whether or not you get the tests suggested above.

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