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TSH levels high but T3 and T4 normal, am I hypo?
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TSH levels high but T3 and T4 normal, am I hypo?

I went in to the Dr. because I was having GI problems and I was tired all the time. I mentioned that I also get cold very easily in comparison to others. He said it sounded like IBS.
Tests come back and my TSH is a 12 (twelve). A week later I take T3 and T4 tests. They start me on 50mcg levothyroxine after the test.
Four days after starting the pills I am told to stop taking them because my T3 and T4 levels are normal and that my first TSH test must have been a lab error.
I didn't even know what hypothyroidism was when this all started, but now I've found out that my mother (whom I don't speak with regularly) has had hypo since she was 40. I'm 22 now, am I hypo, are the tests wrong, should I see a specialist?
Thank you for any suggestions, I'm really confused.
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18 Comments Post a Comment
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Avatar_m_tn
TSH is a pituitary hormone that is affected by so many variables that it is totally inadequate as a diagnostic for thyroid.  At best it is an indicator, to be considered along with more important indicators such as symptoms, and also the levels of the biologically active thyroid hormones, Free T3 and Free T4.   Note that these are not the same as Total T3 and Total T4.  Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have also shown that FT3 correlated best with hypo symptoms, while TSH and FT4 did not correlate.  

If you will post actual test results and reference ranges shown on the lab report, members will be glad to assess the adequacy of your testing and treatment.  Be aware that having T3 and T4 results just in the lower end of their ranges does not mean that is adequate for YOU.  The ranges are far too broad for that to be the case.  Many of our members, myself included, find that symptom relief required that Free T3 was adjusted into the upper part of its range and Free T4 adjusted to around the midpoint of its range.  

A good thyroid doctor will treat a thyroid patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  If you want to know more about clinical treatment, this is a good link.  The letter is written by a good thyroid doctor for patients that he consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.

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

A good thyroid doctor does not have to be a specialist, just one that will treat you clinically as described above.  In fact, the specialists seem to be less inclined to treat hypo patients clinically.



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Avatar_n_tn
First TSH was 12 (range .4-.4.5)

Second test TSH was 3.08
t-4 Free was 1 (range .8-1.8)
T3 Free was 2.6 (range 2.3-4.2)

The second test seems normal right? Should I follow this up, or not worry too much?
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Avatar_m_tn
Have a look through this listing of typical hypo symptoms and I expect that you will find that you have a number of the 26 shown.  Hypo symptoms are often associated with having FT3 and FT4 that are low in the range, like yours.

Note again, this statement in the letter I gave you above.  

"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.

I think you are going to have to take a copy of the list of symptoms, marked up with the ones you have, and also a copy of the letter, and discuss with your doctor and find out if the doc is going to be willing to treat you clinically as described.  If not, then you will need to find a good thyroid doctor that will do so.

  
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Avatar_m_tn
You are within the so called "normal" range.  However that has absolutely NOTHING to do with whether you are Hypo (low Thyroid) or not.

Most people seem to be symptom free when their FREE T4 is about MID range.  AND their FREE T3 is in the UPPER 1/3 of the range.

your test show that you are not low in BOTH cases.

Mid range FT4 is 1.3 you are testing 1.  Upper 1/3 for FT3 is 3.57 and you are testing 2.6.  you are at the very lower part of the FT3 range. There is absolutely little doubt why you have Hypo symptoms.  Even your TSH is relatively high. The AACE recommends a normal range of TSH be 0.3 to 3.0. Yet almost no laboratory's use this new recommended range.  Really any TSH over 2.0 I would be very suspicious of being Hypo.

You need to start on Thyroid meds. everything points that you are Hypo.
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Avatar_m_tn
Sorry, upon reading this thread again, I noticed that I omitted the link to typical hypo symptoms.

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html
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Avatar_f_tn
my TSH level is approx 43 but my T3 and T4 levels are in normal range....
the normal range of TSH as mentioned in my report is between 0.3-5.5.....
is my condition critical? am i suffering with hypothyroidism???
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649848_tn?1357751184
This is a very old thread and you'd get more response if you start a new one of your own.  You can do that by clicking the orange "Post a Question" button at the top of this page, then type your question and click the green "Post a Comment" button at the bottom.

A TSH level of 43 is not "critical", however, it does sound like you are hypo, and should get treatment.

You said your T3 and T4 are normal.  Are those Free T3 and Free T4 or totals?  Total T3 and Total T4 are considered obsolete and of little value. We need to know what your FT3 and FT4 levels actually are.  Be sure to include the reference ranges, since those vary lab to lab, so you have to post them with results.  
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Avatar_m_tn
Also the "normal" ranges are FAR to broad with the lower half of the ranges being questionable.

many people in order to feel well need thier Free T4 to be in the MIDDLE of the range if not even higher.  AND they need their Free T3 to be in the UPPER 1/3 (66.7% of the range) range or so to feel well.  As you can see these values are WELL up into the ranges.

many Dr's will tell a patient with rock bottom level of the range that they are "normal" and therefore dismiss the patient's symptoms and everything else.
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Avatar_m_tn
please help, my tsh is 0.005, T3 is 15.9 and  T4 is 38.97
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Avatar_m_tn
My TSH in the month Aug. 2011 was 7.52 Ref Range(0.30-5.5) and hav been taking eltroxin 25mcg. But I could still feel the symptoms such as lack of concentartion, not able to remember properly, palpatation, extreme fatigueness etc.

It after one year in Aug,2012 I got my self again tested for Thyroid Profile and the results received were extremely alarming as given below:

TSH 46.71 Ref(0.30 - 5.5)----------> Very High
T3 81 Ref(60 - 200)------------------> Normal
T4 5.5 Ref(45 - 12)-------------------> Normal

my TSH before starting staring medicines was just 2 points higher than ref range. I tough it is lab error got it done again with the same sample available with the lab alongwith with FT3 & FT4 results are as given below:

TSH 47.15 Ref(0.30 - 5.5)----------> Very High
FT3 2.3 Ref(1.7 - 4.2)----------------> Normal
FT4 0.68 Ref(0.70 - 1.80)----------------> Almost Normal

Now after showing these results to the doctor he simply increased my dosage of thyroxine sodium to 100mcg once a day.

Can u please give me second opinion as to what is happeing to me metabolic system?

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Avatar_f_tn
When only TSH levels are affected, but not T3 o T4, the condition is known as subclinal hypothyroidism. you could, and should, get medication for it.
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Avatar_f_tn
Hi

I am currently having subclinical hypothyroism, where doctor suggested me to take medicine for a month. After taking the medicine for a month, i took the blood test once again and my result came out
T3 1.6 (normal range 0.69-2.02)
T4 6.4 (normal range 4.8-11.6)
TSH 6.4 (normal range 0.3-4.0)
at this point my TSH level is way higher than others.
Last time my result showed that T4 is high T3 is low and TSH is normal, but this time other way around.
I am really anxious and i feel threatened by this results. I still experiencing certain problems like arrogance, anxious, and sometimes fatigue (specially after during and after my period). Last month, I went and consulted with specialist, and she asked me to take TG-Ab and TPO-Ab test instead of FT3 and FT4.  At that time result shocked and scared my hell out.
Both were over 200 and TPO was even higher around 750. 6 months after taking L-Thyroxine, she advised me to check my TG and TPO once again so i am waiting for that moment to come.
So now what should i do? please advise me on this matter.
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Avatar_m_tn
First thing we need toknow if your dosage of L-Thyroxine.  Second thing is that we need to confirm if those tests are for Total T3 and Total T4, or free T3 and Free T4.  For best assessment we also need to know the reference ranges that go with those tests.  This is because Total T3 and T4 includes the total amount of those hormones in your blood.  Most of that is bound up with protein molecules and rendered inactive.  Only the small portions that are free of protein, thus called Free T3 and Free T4, are biologically active.  For the future you should make it a point to always get tested for Free T3 and Free T4, not the Totals.  

The TPO ab and TG ab tests indicate Hashimoto's Thyroiditis.  Hashi's is the most prevalent cause for diagnosed hypothyroidism.  with Hashi's, the autoimmune system erroneously identifies the thyroid gland as foreign to the body, and produces antibodies to attack and eventually destroy the thyroid gland.  As this is progressing, your TSH level rises, in response to the thyroid gland being unable to produce enough thyroid hormone.  When the level of Free T3 falls low enough in its range, hypo symptoms begin to be noticed.  

Having already confirmed Hashi's, there really is no need to keep testing for the TPO and TG antibodies.  What you do need to always test is Free T3 and Free T4.  Also, since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, those should be tested also.  Further, you should not wait for 6 months  for a return to the doctor.  Thyroxine will reach over 90% of its final effect on your blood levels in about 4 weeks.   Most doctors here request the patient to return in about 6-8 weeks for followup tests and then to adjust med dosage as necessary.      

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.  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 after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

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



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Avatar_m_tn
2.34                    120                  102                        T3
0.74                     10.1                      9.1                      T4
      98.47                    6.102                          10.265                  TSH

21-05-2013 19-07-2013 20-09-2013

These are my reports and I am taking thyroxin 75 mg. Please advise what should I do. My fasting sugar is also 135 but HB1Ac is 6.2%
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Avatar_m_tn
Hi,

TOTAL TRIIODOTHYRONINE (T3) C.L.I.A 93------- ng/dl 60 - 200
TOTAL THYROXINE (T4) C.L.I.A 5.7  ------------------μg/dl 4.5 - 12.0
THYROID STIMULATING HORMONE (TSH) C.L.I.A 23.34 -----μIU/ml 0.30 - 5.5

Can someone help me as to what does this values & ranges denote.... Really very confused as to what needs to be done..

Rgds.
SOG
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Avatar_m_tn
It would have been far better if you had been tested for Free T3 rather than Total T3.  Free T3 correlates best with hypo symptoms, while Free T4 and TSH do not correlate at all.  So you should always make sure they test for Free T3 and Free T4 each time you go in for tests.

Both your Total T3 and Free T4 results are in the lower half of their range, which is frequently associated with having hypothyroid symptoms.  Also, even though TSH is a pituitary hormone that is affected by so many things that it is a poor diagnostic for thyroid issues, your TSH is high enough over the range that it also is an indication of hypothyroidism, likely due to Hashimoto's Thyroiditis.  Hashi's is the most common cause for diagnosed hypothyroidism.  With Hashi's the autoimmune system erroneously determines the thyroid gland to be "foreign" to the body and produces antibodies to attack and eventually destroy the gland.  Along the path to destruction the output of thyroid hormone is diminished and must be replaced with thyroid medication.  

You haven't mentioned any symptoms you may be having.  Symptoms are the best indicator of hypothyroidism.  If you look at this link showing 26 of the typical hypo symptoms I expect that you will find some that you are experiencing, or will experience in the near future.  Please tell us about any symptoms you are already having.

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

Most important for the future is for you to keep in mind that 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.  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 after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

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

When you see the doctor next, I suggest that you should discuss the info above and find out if the doctor is going to be willing to treat you clinically as described.  If not, then you will need to find a good thyroid doctor that will do so.  Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, I suggest that you should get those tested also.
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Avatar_f_tn
ive recently seen my pcp to get refill on meds and he looked at my thyroid levels from last year and wanted to test me again. so he tested me ane my TSH-6.110,T3-87,FREE T4-0.94,T4-5.4,T3free serum-2.3 my doctor said I should be on synthroid because my TSH is high but have no symptoms of hypothyroidism and mt T3and T4 levels were good . did he jump the gun?
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Avatar_m_tn
I am somewhat surprised that you say you have no symptoms, with those test results, particularly the Free T3 level.  That is near the bottom of most ranges I see for Free T3.  If you have the ranges for each test, please post them.  It is always best to compare results to the specific ranges from that lab.  

Understand that I am not trying to talk you into having symptoms, but I suggest that you should look through this partial listing of symptoms that can be hypothyroid related.

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

Keep in mind that doctors like to think that TSH tells them all they need to know about a patient's thyroid status.  In reality TSH cannot be shown to correlate well with either Free T3 or Free T4, much less correlate well with symptoms, which should be the primary concern.  So, a TSH in the higher end of the range and over does not always indicate a concern.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all. That is why I mentioned specifically your low Free T3.

For info, there are a few members who seem to do well with Free T3 and Free T4 levels that would be problematic for many of us.  Also, there are  other things that can affect how your body metabolizes thyroid hormone.  Among those are cortisol, Vitamin D, and ferritin levels.  When those levels are very good, people may tolerate lower levels of thyroid hormone without suffering with hypo symptoms.

The bottom line should be that if you feel good, and have no symptoms, then you don't need to worry about your thyroid levels at present.  I would suggest that at next opportunity you should request to be tested for the possibility of early Hashimoto's Thyroiditis, which is the primary cause of diagnosed hypothyroidism.  The definitive tests for Hashi's are Thyroid Peroxidase and Thyroglobulin antibodies, usually shown as TPO ab and TG ab.  Many times symptoms are early indicators of Hashi's;, however, if you should find that you have Hashi's, then thyroid levels will continue to drop and you will eventually notice symptoms.  If no Hashi's is found, and you continue to feel good, then ask the doctor why you need thyroid med.  
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