Thyroid normal ranges but still hypothyroid?

[Ninja82]

I have all the symptoms typical for hypothyroid, yet my results are in the normal reference ranges:

TSH (tested 3 times in past year):1.32 / 1.46 / 1.41 (ref: 0.5-5.0)
FT4: 13 (11.0-21.0)
FT3: 4.2 (3.1-6.0)
TPO Ab <5.0 (<34)
TG Ab 11.8 (<115)

Any help would be greatly appreciated!

[gimel]

I tried again.  Hope it works this time.  

[Ninja82]

Thank you for your response to my question. I will definitely look into those aspects you mention. Will see how my results come back next week and go from there...thanks again!

[Ninja82]

Thanks you so much for the info. Unfortunately I have not received any mail on my personal page. Could you try to resend it please? Many thanks for yr time!

[gimel]

Sending a PM with link to the best info I have seen regarding your question about starting treatment for hypothyroidism when adrenal fatigue is present.  Just click on your name and go to personal page.  Then click on messages.

[TheLightSeeker]

You may also need  to do a GI Pathogen Screen in light of your low cortisol levels.  Cortisol regulates the immune cells in our gut so when cortisol is depleted those cells become dysregulated, making us more susceptible to pathogens like bacteria, yeast, and parasites.
Adrenal imbalances take from a few months to a couple years to correct.
Were you tested & treated by a Holistic, Naturopathic or Functional Medicine Doctor or did you perhaps take this up on your own?
This is not "established" protocol in Endocrinology.
Look also  into Ovary,Adrenal/Thyroid Axis Imbalance and as gimel said,
your hypothyroid is likely secondary.
The approach is very delicate when the body is down-regulating energy
while at the same time attempting to treat the low thyroid function (up regulating energy). In my opinion the adrenals must be addressed first
before increasing the thyroid hormone, however you might find that you
are experiencing overall improvement when your adrenal function is improved, including your hypothyroidism.
Hope this helps.
Niko

[Ninja82]

I also wanted to ask, is it possible that being hypothyroid without adequate treatment over a prolonged time period can cause fatigue that is so severe and debilitating that people are unable to continue their normal day to day activities, and that this fatigue worsens when doing too much than the body can handle at that stage?

[Ninja82]

Hi Gimel

Thank you so much for your detailed and helpful response.

I am currently getting retested for all of the above tests as well as for iron. I will request the other tests you mention as well. I was borderline anaemic last year when my symptoms first started and treated it with supplements and my levels increased after several months though this had no impact on my symptoms. Got tested again a couple of months ago and it showed my ferritin had dropped substantially again. Will see what it is at now and discuss with my doc as well as the aspects of thyroid you mention.

I forgot to mention before, I had a saliva test showing I had very low cortisol levels and adrenal fatigue at the beginning of this year. I treated this with a number of things including supplements, life style and diet changes, meditating around 3 hours per day and reducing any type of stressors in my life. My symptoms did improve overall to some extent over the course of this year but not substantially which lead me to believe there is another underlying issue, particularly as my mother is hypothyroid.

Do you happen to know whether it is safe to treat hypothyroid when adrenal fatigue is present?

Thank you so much again for taking the time to answer me, I greatly appreciate it!!

[gimel]

From those symptoms and your test results I'd say that you have secondary (central) hypothyroidism, which is a hypothalamus/pituitary system problem.  That type of hypothyroidism is characterized by TSH well within the range and Free T3 and Free T4 in the low end of their ranges and lots of hypo symptoms, like you have. Before leaving the tests, I also wanted to mention that hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, so be sure to get those tested as well.

Not sure how you are going to convince your doctor, but you need to be on thyroid meds.  Maybe the best approach is to emphasize the symptoms by giving the doctor a copy of this listing of 26 typical hypo symptoms and highlight those you have.  

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

If the doctor wants to focus only on TSH, tell him that there is no scientific evidence that TSH correlates well with either Free T3 or Free T4, much less correlate well with symptoms, which should be the main consideration.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  here is a link on that.

http://informahealthcare.com/doi/abs/10.1080/13590840050043521

If the doctor wants to use "Reference Range Endocrinology" and tell you that any thyroid test result that falls in the "normal" range is  adequate, you can give him this info.  

"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

So, then you can give the doctor a copy of this last link, and ask to be treated clinically, as described.  If you are unable to get the doctor to do so, then you will need to find a good thyroid doctor that will treat clinically.  

[Ninja82]

Fatigue, exhaustion and low energy even with proper rest and worsenes after too much mental or physical activity
Weight gain
Feeling cold (especially hands and feet) even on warm days
Intolerance to heat and cold
Slow reflexes
Slow, weak pulse
Slowness of thought processes (brain fog)
Indecisiveness
Poor memory and concentration
Muscle weakness
mood swings and severe PMS
Thick, dry, coarse and itchy skin, even with regular moisturizer use
Creviced, cracking skin on heels, elbows and knee caps
prolonged and heavy menstrual cycle
Fluid retention (swelling of face)
Der/Brittle hair and nails
Hair loss
Waking at night around 3am with palpitations and unable to go back to sleep
Dizziness
Headaches

[Ninja82]

Fatigue, exhaustion and low energy even with proper rest and worsenes after too much mental or physical activity
Weight gain
Feeling cold (especially hands and feet) even on warm days
Intolerance to heat and cold
Slow reflexes
Slow, weak pulse
Slowness of thought processes (brain fog)
Indecisiveness
Poor memory and concentration
Muscle weakness
mood swings and severe PMS
Thick, dry, coarse and itchy skin, even with regular moisturizer use
Creviced, cracking skin on heels, elbows and knee caps
prolonged and heavy menstrual cycle
Fluid retention (swelling of face)
Der/Brittle hair and nails
Hair loss
Waking at night around 3am with palpitations and unable to go back to sleep
Dizziness
Headaches

[gimel]

Please tell us about those symptoms.