TSH normal but feel bad

[ntfeelgd]

I've been feeling terrible for about 2 weeks.  I have Hashimoto's, and have been feeling light headed, hoarse voice (drink a lot of water), tingling in my extremities, ringing in my ear, and very low energy.  My Endo did a blood test and found:
TSH= 1.277, reference range 0.3 to 5.0
free t4 = 1.44, reference range 0.8 to 1.8
free t3 = 280, reference range 230 to 420
cortisol = 21, reference range 7 to 25
He told me I'm in the reference ranges and should feel fine.  Referred me to a neurologist.  Went to neurologist
who gave me an MRI and did an office examination.  MRI was clear and examination was fine.  Neurologist said I should feel fine.  However, I DO NOT feel fine.  Goodness knows I've been stressing about this also, which can't be good.  Anyone have any insights/suggestions?  Thanks.
feel fine.  I don't  

[gimel]

Sent PM with some info.  Just click on your name and that takes you to your personal page.  Then click on messages.  

[smallfry61]

HI THERE,

I LIVE IN PHOENIX, ARIZONA...DO YOU HAVE ANY DOCTORS TO RECOMMEND?  
THANKS,

NORMA

[gimel]

Sent PM with info.

[ntfeelgd]

I'm closest to Erie and Tunkhannock.  The current endo. I see is in Pittsburgh.

[ntfeelgd]

Thank you so much!

[gimel]

I have 6 doctors in Penn.  that were recommended by other members.  They are located in Erie, Tunkhannock, Westchester, Allentown, Collingswood, and Conshohocken.  If you are interested in any of those just tell me which ones and I will send names by PM.

[ntfeelgd]

Central PA

[gimel]

You don't necessarily need an Endo.  Many of them specialize in diabetes, not thyroid.  Many of them have the "Immaculate TSH Belief" and/or use "Reference Range Endocrinology".  You just need a good thyroid doctor as defined above.  

If you will give us your location, perhaps a member can recommend a good thyroid doctor based on personal experience.

[ntfeelgd]

Thanks.  I think I need to start looking for another endo.

[gimel]

Unfortunately your doctor either has the "Immaculate TSH Belief", or he uses "Reference Range Endocrinology".  Neither one works well for most hypo patients.  First because TSH is a pituitary hormone that doctors portray as an accurate reflection of the actual thyroid hormone: however, it cannot be shown to correlate well with either of the biologically active thyroid hormones, Free T3 or Free T4, much less correlate with symptoms, which are the most important consideration.  

Second because the ranges are far too broad to be functional for most hypo patients, due to the erroneous way they are established.  Based on a lot of experience and research, functional ranges for Free T3 and Free T4 would be more like the upper half of the current ranges, for most people.  Many of our members, myself included, say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.  Following is a quote from a scientific study that is linked below.

"High individuality causes laboratory reference ranges to be insensitive to changes in test results that are significant for the individual.

The width of the individual 95% confidence intervals were approximately half that of the group for all variables.

Our data indicate that each individual had a unique thyroid function. The individual reference ranges for test results were narrow, compared with group reference ranges used to develop laboratory reference ranges. Accordingly, a test result within laboratory reference limits is not necessarily normal for an individual."

Andersen S, Pedersen KM, Bruun NH, Laurberg P. Narrow individual variations in serum T(4) and T(3) in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab. 2002 Mar;87(3):1068-72.

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


Another thing to consider is that many hypo patients are also too low in the range for Vitamin D, B12, and ferritin.  If you haven't been tested for those, you should do so.

So, you have two options.  One is to try and present scientific data to your doctor and influence the doctor to change his treatment to clinical, as described in the link above.  If you don't find that to be possible, then you need to find a good thyroid doctor that will do so.