Thyroid panel. Help me understand the results?

[Tayjaytay]

24 year old female with weight gain, extreme intolerance to cold, thinning hair, loss of periods, fatigue, depression and anxiety. Mom and aunt have hypothyroidism.

thyroid stimulating hormone: 0.85 u[iU]/mL
triiodothyronine, serum 84 ng/dL
thyroxine, serum, total 5.9 ug/dL

I requested a free t3 and t4 but my doctor refused.
Please help me understand my results. I'm tired of feeling awful and I want answers.

[goolarra]

A month is a good timeframe.  It's pretty much impossible to predict what to expect.  We all react so differently to meds.  Your FT3 and FT4 are both very low, so my guess would be that you will increase after your next blood work.  Just a guess, as I said...  However, it's much better to start out low and increase as needed and as tolerated.  If you start out too high, you can have some very unpleasant hyper-like symptoms.  

The T3 portion of your meds acts quickly, but the T4 portion takes time to build in your blood.  It's a process, and it takes patience.  I hear Job was hypo...LOL  

[Tayjaytay]

65mg I believe. I go back in a month for more blood tests and a follow up. Do you know what I should expect change wise in just a month?

[goolarra]

That sounds like a successful appointment.  Westhroid is desiccated porcine thyroid.  It's almost the same as Armour, NatureThroid, Erfa, etc.  It contains both T3 and T4.  What dose did she start you on?

[Tayjaytay]

Update. I got in today, as they had a cancellation. The doc agreed my labs aren't optimal, especially with my symptoms. She got more labs done for free t3, t4, and reverse t3. Started me on westroid, which I've never heard of.

[goolarra]

Yes, hopefully she will.  Let me know how it goes...

[Tayjaytay]

I'm going back to my old primary care doctor. I went to a new one bc she didn't take my new insurance. She usually listens to what I feel, not just specifics on paper, so I'm hoping she will see the big picture.

[goolarra]

Secondary hypothyroidism is still hypothyroidism.  So, it is treated with replacement hormones just like hypo from any other cause.  There's no way to treat the pituitary to make it produce more TSH.  

You're going to have to find an enlightened doctor to treat you with such a "normal" TSH.  I'm not trying to discourage you.  I think you need treatment, but you should go in prepared to have to advocate for yourself.  What kind of a doctor are you seeing on the 10th?

[Tayjaytay]

My doctor is refusing to believe that anything is wrong and considered this case closed. I've made another appointment with a new doctor but can't get in til September 10th.

Do you know what the treatment usually is for a pituitary disorder?

[goolarra]

Your TT4 is at 19% of range, and many of us find that T4 has to be around 50% of range to relieve symptoms.  Your TT3 is at 8% of range, way below the 50+% recommended.  Your TSH looks good.  That might be unfortunate because many doctors never see beyond TSH.  Low TSH combined with low T3 and T4 can indicate secondary hypothyroidism.  This is actually a pituitary dysfunction; the pituitary doesn't put out enough TSH to stimulate the thyroid to produce hormone.

Has your doctor suggested treatment?

[Tayjaytay]

T3 range 76-181
T4 range 4.5-12.0

[goolarra]

Pleas post the reference ranges for your TT3 and TT4.  Ranges vary lab to lab and have to come from your own lab report.