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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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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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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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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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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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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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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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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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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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please help, my tsh is 0.005, T3 is 15.9 and  T4 is 38.97
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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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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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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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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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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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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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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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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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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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My free throxine is 10 NR(9.0-20)
Tsh is 5.45 NR(0.30-5.00)
Am I suffering from thyroid?
I am not taking any medication
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Before commenting further on your limited lab test results, please tell us about symptoms, if you have any.
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I really liked your detailed descriptions..:) I am a 20 year old with test reports of hypothyroidism. The blood test reports say that i have T3: 1.73 ng/ml where the normal range is 0.85-2.02 ng/ml    T4: 7.33 microg/dL where the normal range is 4.6-12   TSH 9.68(high) microIU/ml where the normal range is 0.27-4.2.

Symptoms I face : -Feeling tired (fatigue) and sluggishness
-Weight gain(almost gained 10 kgs within a year & m not able to reduce it with exercising)
-Constipation(not everyday though)
-Puffy face
-dry skin
-Dry, thinning, or coarse hair(too much of loss.. going bald,almost)
-Brittle nails
-Depression(sometimes)
-Slowed heart rate
-Difficulty catching your breath (severe shortness of breath) when exercising
-Ears get popped out very frequently, sometimes my eyes used to blur out too, sometimes with headches(all of these almost accompany each other).. Had got a haemoglobin test n was found a small drop in haemoglobin, was given a tonic.. now i dont have blur outs but ears popping out and shortness of breath is seen sometimes.

Hope all this helps in the diagnosis. Thank You
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You do have a lot of symptoms often related to being hypothyroid.  Also, even though TSH is affected by so many things that it is not a very good diagnostic, your TSH is high enough to be an indicator that something is going on there.   Unfortunately, your thyroid tests are for Total T4 and Total T3, rather than the biologically active thyroid hormones, Free T4 and Free T3.  Scientific studies have also shown that Free T3 correlates best with hypo symptoms. So to be able to bet understand your thyroid status, you need to make sure they always test you for Free T3 and Free T4 every time you go in for tests.  

Can you get those tests done?  If so, please do so and post results and reference ranges and we will be happy to interpret and advise further.   If you would like more info on this subject, you can find it in this link written by a good thyroid doctor.

http://hormonerestoration.com/Thyroid.html
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Thanks a lot. I ll get it all done. And do i need to check for all the tests in the link? https://www.pinterest.com/pin/515662226059632577/
http://www.thyroidchange.org/doctor-tips--resources.html
Or is Tsh, free T3  and free T4 enough?
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If you can get all those done, great.  Most doctors are very reluctant to do all those tests to start, and want to run only the basics.  That is why I suggested only the Free T3 and Free T4 and TSH.  Testing for TPO ab and TG ab would also be good.  Also, for the cortisol, try to get saliva cortisol tested ( 4 tests over 24 hours.  
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I am a 33 year old male.
Recently done with my health checkup. Found out that my TSH - > 7.71 μIU/ml.
History------------------------
An year ago I had a left sided pleural effusion. I visited many doctors, few of them suggested me to go for Tuberculosis  medication without any confirming tests. I went for Montox, Sputum, Culture of the drained liquid etc. but no where it was evident that it was TB. I didn't take any medicines except for Banocide Forte (100 mg) (Di Ethylcarbamazine) and I was told by one doctor that its called Easnophilic plueral effusion. Later I did a CT scan  and a 1.3 cm fibrosis nodule was found in the left lung. Doctors told me to ignore it. In the mean time my IBS symptoms were worsening. I got my endoscopy done and was told that my LES is weak. So I need to change certain lifestyle and food habits. For both the above issues I took herbal medicines and did found great cure.
Coming back to my thyroid issue, I was feeling very tired, excessive fatigue, cognitive impairment, memory loss etc. hence I went for a TSH check and got it as  7.71 μIU/ml. There was a slight imbalance in my LDL:HDL ratio as well.
A month after my first check I went for a re test as per doc's suggestion and now :
TSH -> 6.4 μIU/ml
Free T4-> 1.5 ng/dL
(Again I am on herbal medicine for Thyroid)

Do I need to do any other test? Is this all related in some way?
If anyone has any clue please let me know.

Regards
Deep
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recently my wife check up her thoiroid values  actually she wants to check free T3 and T4 but by mistake she checked ONLY t3 and t4  the values in between  t3 = 103.0 ng/dl   range  55-175 ng/dl   and t4 = 7.28 ug/dl  range  4.65--10 ug/dl  TSH =  17.48  ulU/MI range 0.25--- 5.5  ulU/ml  how the T3 and T4 value converted into FT3 and FT4  weather these values affects TSH values pl explain and if high TSH what will happen to patient
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You can't convert TT3 and TT4 into FT3 and FT4.  They are two separate tests, and the totals don't necessarily correlate with the frees.

Your wife's TSH is elevated, which could indicate that she is hypo.  However, her TT4 is at 49% of range, which is just about perfect.  Her TT3 is at 40%, which is a bit on the low side.  I wouldn't expect TSH to be that high given here T3 and T4 levels.  Many factors can influence TSH other than thyroid hormone levels.

Is she on thyroid meds?

Does she have symptoms?
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Hello Everyone,
Seeking help of all respective Members of the Forum!
My Throid result came toda & my family Dr. is gone for some emergency case in UK.just wondering wit my results of reports what exactly it tells about my curent status of throid.

Throid Profile        Method       Result       Unit     Biological Refernce Interval

T3                         ELFA         0.46          nmol/L       0.62-1.63


T4                         ELFA          3.47         ug/dL        4.7-9.3



TSH                        ELFA        7.08         ulU/mL      0.25-5
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Hello Everyone,
Seeking help of all respective Members of the Forum!
My Throid result came toda & my family Dr. is gone for some emergency case in UK.just wondering wit my results of reports what exactly it tells about my curent status of throid.

Throid Profile        Method       Result       Unit     Biological Refernce Interval

T3                         ELFA         0.46          nmol/L       0.62-1.63


T4                         ELFA          3.47         ug/dL        4.7-9.3



TSH                        ELFA        7.08         ulU/mL      0.25-5
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TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones Free T4 and Free T3.  The best use of a TSH test is to distinguish between primary hypothyroidism (Hashi's) and central hypothyroidism.  

That said, your TSH is above range and indicative of primary hypothyroidism.  Your T4 and T3 tests appear to be Total T4 and T3, which are not nearly as revealing as Free T4 and Free T3.  So I suggest that in the future you should always make sure they test for Free T4 and Free T3 every time you go in for tests.  Both your Total T4 and Total T3 are actually below range, which is strongly indicative of hypothyroidism.  Also, please tell us about any symptoms you have.  
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Hello Everyone,

I went for test yesterday again & got the reports,would you please let me know is it the normal report ?

Test Name                                                  Result                       Units                      Normal Range / Method



Thyroid Peroxidase Antobody                       0.46                           IU/Ml                         <5.61(CMIA)
(Anti- TPO/ATMA)



TSH                                                           2.680                         uIU/ML                      0.270 - 5.350 (ECLIA)    


Free T3                                                       2.90                          pg/ml                        2.00 - 4.40


Free T4                                                       1.45                          ng/dl                         0.93 - 1.77 (ECLIA)



Throglobulin Antibody                                  1.35                            IU/ML                      <4.11
(Anti-Tg)
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Test Name                       Result                         Units                      Normal Range / Method

(Anti- TPO/ATMA)              0.46                           IU/Ml                       <5.61(CMIA)

TSH                                 2.680                         uIU/ML                      0.270 - 5.350 (ECLIA)  

Free T3                            2.90                          pg/ml                        2.00 - 4.40

Free T4                            1.45                          ng/dl                         0.93 - 1.77 (ECLIA)

(Anti-Tg)                           1.35                          IU/ML                      <4.11                                          
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What symptoms do you have, if any?
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I feel fatigue  & I m losing weight that's it.
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Symptoms are the most important indicator of possible hypothyroidism.  fatigue is a frequent symptom of hypothyroidism.  Weight loss can occur with hypothyroidism, but is unusual.  Your Free T4 result is is at a good level.  Your Free T3 is less than optimal for many people.  Before concluding hypothyroidism and considering thyroid med, I would first test for Vitamin D, B12 and ferritin.  Low levels of those can also cause symptoms, and D and ferritin are important for metabolism of thyroid hormone.  

So before anything further, I would get tested for Vitamin D, B12 and ferritin.  With those results we will be better able to advise you.
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I have been feeling unknown reason fatigue from time to time since 2010. It is not constant. It is like a flu or cold. After a couple weeks, I will get better. At that time, my blood test showed normal.
(2013 test result:
TSH W/REFLEX TO FT4 3.97 0.40-4.50 mIU/L NW)


Last November, annual physical exam showed elevated TSH.

TSH W/REFLEX TO FT4 5.67 H 0.40-4.50 mIU/L NW

T4, FREE 1.2 0.8-1.8 ng/dL NW

The doctor asked retest in a month, and the result showed normal:

Test Name In Range Out Of Range Reference Range Lab

TSH 3.02 0.40-4.50 mIU/L NW

T4, FREE 1.3 0.8-1.8 ng/dL NW

T3, FREE 3.1 2.3-4.2 pg/mL NW

Then the doctor thought I should be fine.

This year on 23/07, another physical test showed TSH 5.77 and the doctor ordered ultra sound neck area and blood test in two weeks.

The ultrasound shows:

FINDINGS:

RIGHT LOBE: 5.1 cm in cephalocaudad x 1.5 cm in AP x 1.4 cm in transverse dimension for a volume of 5.6 cc. No visible mass, cyst or calcification. Mildly increased parenchymal blood flow.

LEFT LOBE: 4.0 cm in cephalocaudad x 1.6 cm in AP x 1.5 cm in transverse dimension for a volume of 5.0 cc. No visible mass, cyst or calcification. Mildly increased parenchymal blood flow.

ISTHMUS: 3.0 mm in thickness. No visible mass, cyst or calcification.

OTHER: The thyroid parenchyma is moderately, diffusely heterogeneous in echogenicity. Mildly increased parenchymal blood flow is present.

There are normal appearing deep cervical chain lymph nodes bilaterally.

CONCLUSION:

Heterogeneous thyroid without focal nodules or masses, consistent with thyroiditis, likely Hashimoto's thyroiditis.

But the blood test two weeks back on 08/29 showed normal:
T4,Free 0.90 0.8-2.2
t3: 124 97-169
TSH:4.82

And since at that time I felt fatigue and back pain with puffy eyes. The doctored ordered urine test and blood test again. It turned out kidney function tests are fine but TSH was elevated again with

TSH: 7.07  (0.40-4.50)
T4, Free 1.0 (0.8-1.8)
Plus fasting glucose a little high
101 H (65-99).

The doctor said since my T4 free is normal so no medication needed. But anytime I felt sore or pain about neck, need to call him and he may let me take some steroid like medicine.

However, based on this thread, it seems that I need to start to take the medicine to adjust T4 now?

Thanks.




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TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  Your TSH results have fluctuated quite a bit, but typically on the high side which frequently is associated with Hashimoto's Thyroiditis.  The doctor's conclusion from your ultrasound test was also Hashi's.  Although you haven't always been tested for both Free T4 and Free T3, you should make sure they always do both in the future.   Free T3 has been shown to correlate best with hypo symptoms, while Free T4 and TSH did not correlate.

In the words of a good thyroid doctor, ""The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

So from your ultrasound results, your TSH tending high, and your symptoms and the results from your limited tests for Free T4 and Free T3, I would say that you are in the early stages of Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously determines that the thyroid gland is foreign to the body and produces antibodies to attack and eventually destroy the gland.  As this proceeds, the output of natural thyroid hormone is diminished and the TSH levels start to rise and symptoms start to appear.  To offset the loss of natural thyroid hormone, thyroid med is required in gradually increasing doses.  

Some doctors will not start a Hashi's patient on thyroid meds as long as test results are within the so-called "normal" ranges.  That is erroneous because the ranges are far too broad to be functional across their entire breadth for everyone.  Other doctors are willing to take a proactive approach and will start you on thyroid meds to keep your Free T4 and Free T3 levels high enough in the range to prevent hypo symptoms.  Needless to say, you know which doctor I would choose.  

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  

So hopefully you can use this info to get your doctor to start you on thyroid meds and gradually increase as needed to relieve symptoms.  Otherwise you will need to find a good thyroid doctor that will do so.  

Also, be aware that hypo patients often are too low in the ranges for Vitamin D, B12 and ferritin.  So you should test for those and supplement as needed to optimize.  D should be about 55-60, B12 in the very upper end of its range, and ferritin should be about 70 minimum.
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Total T3
Adult           : 0.60-1.81ng/mL
0.92
T4
Adult           : 4.5 -10.9 µg/dL
6.30

TSH
Adult           : 0.35-5.5 µIU/mL
7.94

I am 44 Years Male, kindly go through the lab reports and guide me what to do and how to get TSH reduced to normal level.
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Your doctor has tested total T3 and total T4.  Next time, request the FREE T3 and FREE T4 tests; they tell you the amount of hormone actually available for your body to use.

Both your FT3 and FT4 are low of the midpoint or above that they should be.  So, it would seem that a meds increase is in order.  What are you currently taking?

How do you feel?  Do you still have hypo symptoms?
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I am 40 M y lab results are as follows:
Thyroid function test
T3-1.14; t4-10; TSH 21.46;    
Lipids
Total cholesterol 314.3; Tryglycerides 618.5; VLDL 123.7
Creatine 1.1

I am diabetic - Sugarlevels - Fasting - 183;  PPBS - 350
I am also hypertensive but BP is under control with medication.

People around me are I believe overly and unduly concerned. Should I also be concerned
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I am 27 F  & pregnant lab results are as follows:
T3=5.05
T4=12.1
TSH =4.640

Please need help
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What are the reference ranges for your T3 and T4?  Reference ranges vary from lab to lab and have to come from your own report.  Also, can you tell us if those are Free T3 and Free T4 or is they are Total T3 and Total T4? Free T3 and Free T4 are the most important, while Total T3 and Total T4 are considered obsolete and not real useful.

How many months pregnant are you?
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I have been treated for Thyroid issues for the past 3 or 4 years, starting out on Synthroid.  I recently switched to a desiccated thyroid and my results are as follows:

TSH 3.31 - lab range 0.3-4.00
Free T3 5.8 - lab range 3.5-6.5
Free T4 15 - lab range 9-23

I have also had the 24 hour Saliva test done and found that my cortisol levels are less than 0.01.  My Naturopath path told me I should feel like a 90 year old with those cortisol levels and quite frankly I am pretty close to feeling that way!  I have also had both my antibodies tested and they both came back within range so he ruled out Hashi's.

My question is - since my Free T3 & T4 appear to be pretty normal, but my TSH is still higher than optimal - is my issue my Thyroid right now or do I need to focus on getting my Cortisol up and in turn that will fix my TSH levels?  

Thanks!
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Forget the TSH result.  TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.   When already taking thyroid hormone TSH is basically a wasted test, since it is so frequently suppressed to the low end of the range, or below when thyroid med dosage is adequate.  Note the words of a good thyroid doctor, " in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that
are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range."

Which raises the question whether you took your med before the blood draw for those tests?  Also do you split the dose into halves for morning and early afternoon doses?

Please post the actual cortisol test results and ranges shown on the lab report.
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I take the meds first thing in the morning and do not split them.  I had my blood drawn around lunch time so probably 5 hours after I took my meds.  I will post the result from the actual report for my cortisol once I get home - I don't have that information handy.  

I am not sure I completely understand the quoted text in your response but thank you for the quick and detailed response.
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TSH 3.31 - lab range 0.3-4.00
Free T3 5.8 - lab range 3.5-6.5
Free T4 15 - lab range 9-23

From this result your thyroid function is great and it should be and no need to make any change for thyroid medicine and dose and forget about TSH. Concerning low cortisol check for adrenal fatigue. Also look for vitamin D deficiency.
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T3 reaches peak effect on serum levels in about 3-4 hours and then diminishes over the next few hours.   For that reason it is best to always split the dose and take in the morning and early afternoon to even out the effect.  Also, if you have blood drawn as you did, then you will likely get a false high result.  So it is also best to defer your med until after blood draw.  

In view of the above you really can't be sure of what your thyroid levels are.  But as noted previously, most people on adequate doses of desiccated thyroid med have a TSH that is suppressed to low end of range or below and Free T4 around the middle of its range, and free T3 in the upper end of its range, or slightly above.  

So in view of your symptoms and how you feel, I expect that you need to get our med dosage raised.  You also need to get your cortisol level optimized into the upper quarter of the range.   The only way that will help your thyroid status is if the low cortisol has caused some "pooling of T3" in your blood and causing a shortage of T3 in the cells throughout your body.  Be aware that if you are started on cortisol med, you should make sure your DHEA-S level is good.  Otherwise you will need to supplement with DHEA also.  

What is your current thyroid med dosage?

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I have a T4 at 0.8 and a Tsh at 0.20 do I have a problem with the meds am on 125's
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TSH is a pituitary hormone that is a poor initial diagnostic for thyroid.  TSH is frequently low or suppressed below range when taking doses of thyroid med adequate to relieve hypo symptoms.  So that is the likely explanation of your low TSH.  Still you also apparently have a low Free T4 level.  What is the reference range shown on the lab report for the T4 test?  Also, even more important than test results, please tell us about any symptoms you have.

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