Thyroid disease possible with normal TSH, T3 & T4?
Is it possible to have a thyroid disease with normal TSH, T3 & T4? I have a positive ANA, muscle twithches, extreme fatigue (comes and goes like flare-ups), aches and pains. I have just recently started feeling a little pressure in the front of my throat- not problems swallowing or anything, just a sensation that something is pushing on my lower throat. In the past I have also suffered from palpatations and chest discomfort which all checked out okay with the cardiologist. The neurologist says the muscle twitches are benign and was thinking thyroid until he saw my TSH, T3 & T4 were all normal. Now to the rheumatologist to see what he can come up with. I don't really have lupus symptoms such as mouth sores, malar rash, etc.
From much experience, we have come to not accept the word "normal", when it comes to thyroid issues. Too many times we have found them not to be "normal" at all, after looking at the actual numbers. So if you will post the actual test results and reference ranges, our many experienced members can help evaluate.
I can see from the results why most doctor would send you home as "normal; however, there is more than ample reason to say that you are hypo and should be given at least a therapeutic trial dose of thyroid meds to evaluate the effect on your symptoms. There are multiple reasons for saying this.
First, the AACE recommended over 6 years ago that the ref. range for TSH should be lowered to .3-3.0. Many thyroid authorities have stated that anything over 2.0 should be suspect. In addition, TSH is a pituitary hormone that is only an indicator of thyroid hormone levels in the blood. It is affected by many variables, including the time of day when the blood was drawn for the test. Also, it does not correlate very well at all with hypo symptoms. Why the medical community continues to use the old test range and rely predominantly on TSH as a diagnostic, when it is not, is a mystery to most of us on the Forum.
The most important tests are for FT3 and FT4, which are the actual, biologically active thyroid hormones. Free T3 is actually four times as potent as free T4, and it correlates best with hypo symptoms. Many patients with hypo symptoms have reported the best result by adjusting FT3 and FT4 into the upper part of their ranges. Being in the reference ranges for FT3 and FT4 doesn't mean everything is okay. The ranges should really be considered as guides within which to adjust levels as required to alleviate symptoms.
If I were you I would read and absorb the info in this link and make a copy and take it to the doctor and try and get him to treat your symptoms by testing and adjusting your "Frees" with meds as required to alleviate symptoms.
I agree with all gimel has to say (today, anyway!).
I wrote the following to explain why so many are in reference range, but are still hypo. Disclaimer: not a doctor, just my opinion as a fellow patient.
Proper Use of Reference Ranges in Treating Hypothyroidism: Some Ideas to Discuss with your Doctor
Many hypo patients or undiagnosed hypo patients have an array of hypo symptoms, yet their lab work (free T3, free T4 and TSH) indicate that they are within the reference ranges that doctors erroneously refer to as “normal”. TSH is often high in the range (or maybe even above the range according to the latest standards of 0.3-3.0 which many labs and doctors still refuse use) and FT3 and/or FT4 are low in their ranges. Many doctors think that if labs are anywhere within ranges, their job is done...patient is no longer hypo, any remaining symptoms are not thyroid related, patient is fat and lazy. NOT TRUE.
Please see illustration below. Each of us has a personal reference range within the population reference range at which we are euthyroid (neither hypo nor hyper). A shift in lab values of the individual outside of his or her individual reference range, but still within the population reference range, is not normal for that individual. Many don't feel well until FT3 and FT4 are in the upper half of the ranges. After all, the population ranges of FT3 and FT4 are statistically determined distributions of patient results; by definition, approximately half the population will be euthyroid in the top half of the range and approximately half in the bottom. If you are one of the people whose personal range must be in the top of the ranges, and your doctor won’t treat you or won’t fine-tune your medication when your results are in the bottom of the range, you are left hypo. Your doctor may tell you your labs are "normal", but they are NOT “normal” for you.
Reference ranges of test results do not imply that everyone is going to be well as long as they are anywhere in the ranges. The ranges are broad (e.g. 0.6-2.0 for FT4). If your personal FT4 reference range was 1.6-1.8 when your thyroid was functioning properly, does it really make any logical sense at all that now that you are on replacement hormones, you should feel comfortable with an FT4 of 1.0? No, it doesn't. We all have a set point that is optimal for us...doctors should be finding it and adjusting medication to it.
If labs are within ranges, it's time for fine-tuning (or initiating a low dose trial)...increasing meds slightly if hypo symptoms are still present. This will move FT3 and FT4 up in the range and alleviate symptoms…that’s the goal. The ranges define the universe in which we can freely adjust medication; its entire breadth from lower limit to upper should be used for this purpose. The patient will still be in the reference ranges, but he or she will no longer be symptomatic.
0.6 1.0 [1.6……1.8] 2.0
|-----------------Population Reference Range-------------------|
With an FT4 of 1.0, patient is still hypo according to his/her personal reference range.
I found this website recently and wanted to comment on your question concerning normal TSH,T3,& T4 labs with symptoms. I had the same symptoms with inability to concentrate, (or feeling like I was in a box), cold hands and feet, palpitations and flutters in my chest with some anxiety. My TSH was 6.3 with normal thyroid panel results, otherwise. I am very healthy and athletic and it hit me 3 weeks ago. I was put on a low dose synthroid of 50 mcg and have taken it for 2 weeks. The strange thing is that my labs were repeated a week ago and I had a normal TSH level. I still get the palpitations, cold hands and aching joints, but not as severe. My doctor told me that as long as I felt better on the synthroid, to keep taking it with a repeat of labs in 6 weeks. I know it is possible to become hyperthyroid with the medication and wonder if I will have to be on this forever, or that my thyroid might "correct" itself and I might be able to get off of it alltogether. Nontheless, I know how you feel and it's very strange to have thes symptoms with normal thyroid lab results.
I was told by the doctor that everything repeated was "normal". I plan to get the test results from him next week and will post those. He told me to keep taking the 50mcg of Levothyroxine as long as I wasn't getting symptoms of hyper and will repeat thyroid labs 6 weeks after starting meds. I did start having irratability and new abdominal cramping the 17th day of dosing, along with muscle aches and palpitations, but alot of the other symptoms have subsided. I will f/u with an endo after the test results come back knowing that my only abnormal lab was my TSH of 6.3. It's all a balancing act and I'm just starting the process and learning much more from this panel than I ever learned in nursing school or being an ICU nurse. The endocrine system is very complex and I realize that now more than ever. Thanks!
With your training and experience I thought you might like to read one of my previous posts about FT3 and FT4 and why test results in the low end of the ranges are not really "normal". Since TSH is a pituitary hormone and affected by so many variables, I have little regard for its use as a diagnostic. At best it is an indicator, to be considered along with symptoms and the "Frees". In my opinion, the best way to treat a thyroid patient is to test and adjust FT3 and FT4 levels with meds, as required to alleviate symptoms. It should be all about symptom relief and not just getting test results somewhere within very broad reference ranges.
The reason the reference ranges for the "Frees" are called "normal", is that they are based on a large population of patients' test results. From that data base the decision was made that about 2.5 % of people would fall out of this "normal" range because they were possibly hypo or hyper. From this decision limits wereplaced at plus and minus two standard deviations (which correlates with plus or minus 2.5%) from the overall average and that was called the "normal" range, supposedly representing people who had no thyroid problems.
After many years of bad experience with this "normal" range for TSH, they finally acknowledged 6 years ago that there were a lot more patients out there with hypo and hyper problems, than previously accepted when they originally established the range.
After excluding from the data base those patients who were suspect for hypo and hyper, they again analyzed the remaining data base and established limits that included 95% of the total data base and called these new limits "normal". This changed the reference range from .5-5.0 down to .3-3.0, which is a huge change. Unfortunately this change hasn't yet been accepted or acknowledged by most labs and doctors.
Also, realize that the reference ranges for the "Frees" were established the same basic way. These ranges have never been reexamined and modified like the range for TSH. I am absolutely convinced that this is the reason why so many hypo people fall into the lower end of the ranges for FT3 and FT4 and are still told they are "normal".
In one my past lives I had a lot of training and experience in statistical analysis. Based on that experience, if I had to estimate what a revised range for FT3 would be if the data base were purged of suspect hypo and hyper people, like was done for TSH,then I would say it the FT3 range should change from 2.3-4.2 pg/dl up to about 3.2-4.3. And FT4 probably would change from .60-1.50ng/dl up to about 1.0-1.55. Quite a difference, huh? Think maybe that is why we hear from so many people that have hypo symptoms, yet they are in the "normal" ranges for the "Frees"? I'd bet my last dollar.
Also, if you haven't read this article, you may find it worthwhile.
Thank you for the response and I find it amazing how even in the ICU we look at the basic "normal" ranges with the thyroid panel and assume the pt is therapuetic..... and the intensivists will treat according to those "norms" I will be getting my hospital lab records and my f/u lab records from my GP next week. It will be enteresting to see where I fall with the FT3/FT4 results. My GP did say that I am probably on the low end of normal "for me", and did feel that a trial run of medication might help...and IT HAS! I am still having some PVC's, weird pains/rushes through my body and fatigue, with some anxiety on the 18th day of taking my Levo. It's very strange and so hard to explain how you feel to somebody.
The term, "subclinical hypothyroidism" must of come from the excepted reference ranges used for diagnosis. I had really not heard that term until now...when my GP told me he felt I had it. Your explanation of the lab values and the "normal" ranges explained it all very well to me. I was thinking..."am I just a NUT? LOL!!!! " My thyroid panel is "normal"...what's REALLY wrong with me?" (supposed to be plain and simple) It's really not that simple and I have learned alot from this website. Thank you for your time and knowledge....it is much appreciated. I will post my results when I get them.
It took a while just to get the results from my GP on my thyroid labs. I am still waiting for my hospital records (THS,T4,T3) results. According to your analysis on the Free T3,T4 labs....IT"S making sense. These are the results that I have right now.
8/14- doctors visit TSH 3.050
8/15- hospital TSH 6.8
8/19- f/u md TSH 2.240
All of these reults were prior to taking any thyroid meds. I had alot of PVC' (Premature ventricular Contractions) with slow heart rate 48-52 BPM at rest, and went to the ER. They kept me for 2 days with f/u echo and holter monitor ( All good results, just occasional PVC'S). I'm very athletic...so, they assumed that is why I was so bradycardic. I know different! They couldn't give me a Bet Blocker because my heart rate was too low and sent me out the door with 50mcg of levothyroxine . I must say...I'm NO drama Queen, but the night I went into the ER...I thought I was going to die. I'm on day 24 of the meds. Still get VERY fatigued with Brain fog..palpiations come around lunch and dinner time and last about 30-45 minutes. Resting heart rate is in the 60's with PVC'S now. I get this weird feeling in my chest and stomach and then the low palpiations hit followed with extreme fatigue and flu/like sx's. I HAVE to eat alot to feel good and I do. Otherwise, alot of the hypo symptoms are disapaiting. I know it takes time for the meds to regulate you (IF IT'S EVEN THE RIGHT ONE FOR YOU), and some litaratue states that it might take up to 8 weeks. I f/u with my GP for more labs Oct 2. I wake up every morning and pray I can feel good just to function and deal with my family. I will keep a good attitude and press forward. Any advise would be ppreciated.
Since you started on the 50 mcg of Synthroid 24 days ago, then you should already be over 90% of the maximum level you will see as a result of the meds. So by the time of the next testing on Oct. 2, that should give you a good idea of the total effect on blood levels.
You should realize, however, that symptom changes tend to lag changes in the blood levels of thyroid hormones. Although you should continue to notice improvement, alleviation of your symptoms may take a while, dependent on how long you have been hypo. So all I'm saying is to be patient and not expect all symptoms to disappear overnight when your thyroid hormones get up to the right level.
Glad to hear that you are making progress. Please keep us tuned in.
Unfortunately, your TT3 and TT4 tests are considered obsolete tests. They have been replaced by free T3 (FT3) and free T4 (FT4). However, TT4 is below the range indicating hypo, and your TT3 is too low in its range - it should be in the top half of the range.
You should ask your doctor to check TPOab and TGab. These are the antibodies that would indicate if you have Hashimoto's thyroiditis, and autoimmune thyroid disease that causes hypo.
I think you need to be on medication. What does your doctor have to say?
I feel sleepy. moreover i have put on 3 kgs weight since 6 months. Have joint pain and hair fall. Feel there is somthing in my throat and half the time I am hungry. I feel dizziness whenever i walk for 15 minutes or even if I am taking rest. Dont' know if these are related to hypothyroid.
Your symptoms are very hypo. I suspect your doctor does not know much about thyroid disease since he is ordering obsolete tests. He should be ordering free T3 and free T4. I don't know why he's waiting a month...you are just going to be miserable for another month. Is finding another doctor a possibility?
I was finally put on medication yesterday to see if it would help,i have sooo many symtoms of hypo,weight gain,hair loss, acne,chest pains,low end bp low temp hi cholesterol,fatigue but my tsh kept coming back "normal".it was in the 3's 2's last one was 1.92.i havent been getting my period and abdominal/pelvic pain,its been a nightmare.yesterday iasked for the antibody test and he said i was right we cant just focus on numbers when i have so many symtoms.so im doing a 6 week run on 50mg of synthroid.i feel like theres hope now!i want to be me again!!Lara
If your doctor hasn't tested you for the actual, biologically active thyroid hormones, free T3 and free T4, that needs to be done. Note that these are not total T3 and total T4, which are somewhat obsolete and not very useful. TSH is inadequate as a diagnostic because it is affected by so many variables. At best it is an indicator, to be considered along with more important indicators such as symptoms and levels of FT3 and FT4.
FT3 is actually the most important test because FT3 is four times as active as FT4, plus studies have shown that FT3 correlates best with hypo symptoms. Frequently we hear from members that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range. Symptom relief should be the focus of the doctor's efforts, not your TSH level.
Hi, I'm reading you post and feeling like I'm reading about my life. My Dr. is telling me the same things about my blood work is within normal range, but I know this is not normal. Extreme fatique, acky bones and noints, always hungry, irritability, and I went from 112 lbs. to 154 lbs. in one year and have been climbing ever since. My Mom, Aunt and Grandmother (All on the maternal side) have had this and where told to have all the females checked. I have been checking for 10 years with the same answer "All bloodwork is within normal range" I just insisted on a ultra sound and a nodule was foundm hurray, finally he called to tell me I was right. Now, I need to get the right treatment. I want myself back again. Will that be possible with the right meds.???? A biopsy is sceduled, hoping it comes out neg for canfcer, then will I be able to loose this extra person that I have become? Please give me hope....Rusty
When you see the doctor again, insist on being tested for the levels of free T3 and free T4 (not total T3 and total T4), along with the TSH they always check. Don't take no for an answer, after all you are the customer and you want to get well. I explained above why these tests are so important. FT3 largely regulates metabolism and many other body functions.
You might also start talking to your doctor about whether he is going to be willing to treat your symptoms, by testing and adjusting FT3 and FT4 levels, rather than by TSH level. If the doctor is unwilling to let go of TSH and treat your symptoms, then you likely will need to find a good thyroid doctor that will do so.
When test results are available, make sure to get a copy of the lab report and write on there how you were feeling at the time and what meds you were taking. The doctor is required to provide a copy upon your request and they become a very valuable reference for future. When you get the copy, please post results and reference ranges from the lab report and members will be happy to help interpret and advise further.
I am in the same boat with a little different spin, but I know about the FT4, FT3, and TSH and they are all normal, but I had an ultrasound done of my thyroid and that has shown 3 hypoechoic nodules on 10/21/2010 and I just had a thyroid uptake scan done today 10/28/2010 and I am waiting to here on that due to thyroid cancer in my family, as my father passed away from anaplastic thyroid cancer, but nonetheless I have 3 solid-appearing nodules and dysphagia, neck swelling, neck stiffness, extreme fatigue, palpitations, dizziness and they are just making me wait, test, wait, test, etc, my recent blood work from 10/19/2010 shows some pretty scarry numbes i.e. hemoglobin 9.2, hematrocrit 31.5, MCV 77, MCH 24.9, platelet count 426 (yeah 426), iron serum 31, iron binding capacity 485. I am getting very scared and want some answers. I know my thyroid is the problem, especially since they did find 3 solid nodules and they still are not giving me anything until this darn thyroid nuclear scan results come in. The waiting is killing me.
I am hyper and hypo on 25mg levothyroxine, had all the test done eventually, it took a surgeon to tell my doctor to have a biopsy done and i should be on t3 and t4, biopsy was negative for cancer. will find out rest at a follow up.
I feel no different on the med. only been 2 weeks thou so will give it a few more. tsh "normal", t3 t4 high goiter and nodules. i am weird or so i thought come to find out i am one of a lot of people with this problem
I have read your posts about thyroid issues and I too have found to no avail after being sent to many different specialists that there is nothing else wrong. I have been diagnosed with Fibromyalgia and because of all of these things going on here in Canada decided to go to the U.S to this Fibro & Fatigue Center. I saw a doctor who took many blood vials and also said to me have they ever test my reverse t3 and I said no this has never been done. I too have been suffering for over a year and half or more with a thyroid that we've tried to introduce Cytomel t3 medication, which worked for a while, then I started to feel terrible side effects from this same medication. Dr. Vereen thinks that it could very well be that it's a problem with reverse t3 and I've googled this and it's called the Wilson's Syndrome. It's a bit complicated as our bodies are no longer able to convert t4 into t3 via the liver and even when using t3 medication this only works for a short time. What will need to be done is taking only T3 medication a time released kind for a length of time until the body is able to get back to converting T4 into T3. This is what I read. I'll keep writing when I find out what my situation presents of itself. All I know is that currently I'm taking 100 mcg of Synthroid and every morning when I take it I start to feel my heart racing and my head feels out of sorts as well. Throughout the day I also feel strange at the times I eat and late in the day dizzy. I saw a endocrinologist about this issue and he seems to think that I am fine cause my blood levels are right in the range. All I can say is I thought we were supposed to be treated not the lab tests. Doctors need to listen to their patients more and dig to find the problem. I had a MRI to rule out a pituitary tumor, (adenoma) and relayed this over to Dr. Vereen as well. Here in Canada I had given up and went to the States to get help with my health issues as no doctors here know what to do for Fibro either. I await my test results and will be in contact with this Dr. March 15 ,2011.
Hey I have the exact same issue and visited this doctor at BetterLiving MD in atlanta. I orginally went to the fibro and fatigue center ut they were doing to charge me $6000. Dr. Cuddapah actually worked at the atlanta fibro and fatigue center and now has his own practice which is a 1/3 of of the cost. He is amazing.
i was a thin person, worked out and always ate right. 8 years ago i started gaining weight even with working out 5 days a week and still eating right. since then i have gained 100 pounds. i have been tired all the time, i suffer with anxiety and panic disorder. i also get heart flutters. all my thyroid tests are normal. i underwent a thyroid scan a few years ago and was told there is a nodule and had a biopsy which was fine. i am constantly dieting and excercising but cannot shed this weight. i recently joined weigh watchers a month and a half ago and lost only a pound and a half. i told my doctor, her reply is maybe thats not a diet for you. no one listens, i dont feel good, im tired, im depressed! my mom suffered from all these symproms when she was my age but too was told there is nothing wrong until she had a goiter growing out her neck that had to be removed with half her thyroid! she now has hoshimoto disease. why dont these doctors listen? im tired of being fat when i shouldnt be! i have no control is what it feels like. please help. elena
I also have the same problem my doc says thyroid functions are normal from blood test...I have been having extreme heart palpitations,trembling hands,anxiety issues(I have past history of hyperthyroidism and graves disease)! So how it disappear with all these symptoms according to blood test??????!!!!!!..
t3 -- 0.93
thyroidism is in which stage, is this is hypothyroidism,
am using thyroid medicine from 1month,
now my periods missed, i'm feeling hungry, headache, bacheache, fatigue,
dullness, feeling sleepy in the morning time , and i have got pregnency test -ve , but im getting doubt that im i pregnent, is there any chance, even though we use condoms may get pregnent! please tell me..
My husband needs help...he has so many symptoms pointing to thyroid problems.
Here are his lab results...
12/9 TSH 5.98 (.27-4.20)
12/16 TSH 2.16
FT4 1.25 (.93 - 1.70)
FT3 3.6 (2.0-4.4)
Can anyone please help us figure out what is wrong with him?
He is getting the run around...told he is just lazy and fat...only 10-15 lbs over.
His symptoms are so bad...he is getting depressed.
You've attached your post to a very old thread. You will get lots more response if you will start a new thread under your own name. Just click on the orange Post a Question button at top of page and enter your post again.
Thanks for the informative and well researched information regarding optimal thyroid levels. I currently have a preliminary diagnosis of Hashimoto's thyroiditis, based on appearance of multiple small nodules on ultrasound. However, my TPO and TGB antibodies are negative.
I also have a very strong family history of hypothyroidism, as well as a child who had transient neonatal hypothyroidism.
I have a long standing personal history of alternating hypo and hyper symptoms... Extreme drowsiness, fatigue, coldness, and bradycardia, alternating with insomnia, (also with fatigue), tachycardia, palpitations, and hyperhidrosis. Along with variable orthostatic intolerance, muscle spasms, tremors, widespread peripheral neuropathy, brain fog, hypoglycemic episodes (with LOW insulin levels), elevated LH and testosterone, allergy symptoms, and intermittent, severe, exercise induced vasomotor rhinitis that will not respond to any type of antihistamine.
I also have GI symptoms with alternating constipation, diarrhea, and bloating.
I have also had unexplained lymphadenopathy, and multiple symptoms suspicious for some type of subtle autoimmune disorder.
I have also had irregular menstrual cycles, with severely heavy bleeding, and 3 early miscarriages.
I have been diagnosed with ADHD (inattentive only) and depression. And have been on Adderall and an SSRI for several years. They help, but I have to be very careful. A little too much Adderall and not enough sleep, and I have severe side effects. And how much is too much varies from one day to the next. I often cut my adderall in half and go slow. Other times it simply will not work. I can take a full dose and still have a very difficult time staying awake, much less focused.
In recent years, the hyPER spells have dwindled, and fatigue has gotten progressively worse.
My primary care physician has started low dose levothyroxine to see if it would help. However the endocrinologist is very opposed. Declaring that my levels are "just perfect". She DOES think I have Hashi's (and that son's transient hypo state was probably due to gestational hypothyroidism), but insists that there is absolutely no benefit in treatment unless levels are out of range, and that it will likely be ineffective or throw me into a hyPER phase. (I also have a family history of severe osteoporosis, and personal history of stress fractures).
After doing some extensive research, I am reasonably convinced that I might find some relief from both extremes by taking enough replacement therapy to lower my TSH and thereby suppress my own unruly thyroid gland. I also do not believe that my levels are anywhere near "perfect".
TSH 2.1 (has been over 3 within past year)
I am seriously considering taking an OTC desiccated thyroid product such as that available from http://www.nutri-meds.com/
Does anyone have any experience with this?
We have to have reference ranges for all lab results, because ranges vary lab to lab, so you have to post the ones from your report. We also need to know if the T3 and T4 are Free or Total. They aren't the same tests. If "Free" isn't specified on your lab report, the tests will be for Total T3 and Total T4.
Hi, I am trying to determine what is wrong with me.! Always thought I had thyroid issues but have been within normal ranges. History of thyroid problems with my mother. Recent tests:
T3 reuptake 24
calcium ionized serum 5.4
I have a history of insulin resistance, low vitamin D, MVP, and Arthritis.
So tired of feeling like something is wrong but being within normal.
I keep reading these posts and I have yet to read of any of you getting your cortisol levels checked. If anyone has had this done, please post your findings. I firmly believe that if the adrenals are out of whack so will all your thyroid symptoms be. Get the adrenals straightened out and probably everything that is wrong with your body will eventually get in sync. But try to convince a doctor of that is just impossible.
I started losing weight during my pregnancy but it was not diagnosed. The day I delivered I lost 14 kilos all my muscle tone, stomach dropped and wrinkled, breasts sagged and my milk stopped. I then went and got a blood test and it was hyperthyroid but did not take medication as it self corrected. I keep getting it tested and it is normal. 22 years later I am still losing weight and hair and have insomnia but my thyroid tests keep coming normal. Could it still by hyperthyroid ?
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