Aa
What does a low T4 and normal TSH mean?
Went to the doctor in Jan. complaining of most hypothyroid symptoms, weight gain, fatigue, sleep problems, dry skin, enlarged thyroid, irresistibly etc. After tests came back my T4 free was .79 out of 0.82-1.77 range and my TSH was low.
It was retested after seeing a specialist about 2 weeks later and T4 free was even lower at .69, but the TSH was normal as well as my T3. The Cortisol was slightly high so we did a Dexamethasone Suppression test and it was fine so the doctor has said everything is good and nothing else needs to be done.
My question is that my T4 is still low and I still feel like crap. Is there anything else to do regarding that or is everything really fine and me not feeling well is something else?
It was retested after seeing a specialist about 2 weeks later and T4 free was even lower at .69, but the TSH was normal as well as my T3. The Cortisol was slightly high so we did a Dexamethasone Suppression test and it was fine so the doctor has said everything is good and nothing else needs to be done.
My question is that my T4 is still low and I still feel like crap. Is there anything else to do regarding that or is everything really fine and me not feeling well is something else?
Even though there may be lots of doctors there, believe me there are not many good thyroid doctors. I am sending you a PM with the name of a doctor that has been recommended by two other members. To access the PM, click on your name and then from your personal page, click on messages.
In diagnosing for possible hypothyroidism, the most important consideration is symptoms. Yes, symptoms can be non-specific, but there are some that occur much more frequently when hypothyroid. You have a number of those that you listed.
Second most important is the levels of Free T4 and Free T3, which are considered as the biologically active thyroid hormones. You have not even been tested for Free T3, and you should get that done; however, your Free T4 is extremely low. I say that because the range is flawed to the low end, due to the erroneous assumptions used to establish the ranges for both Free T4 and Free T3.
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 Free T4 and Free T3. A low TSH, along with hypo symptoms and Free T4 and Free T3 that are low in the range, is frequently an indicator of central hypothyroidism. Central hypothyroidism is a dysfunction of the hypothalamus/pituitary system.
Based on your doctor's comments that everything is fine, I am not too optimistic about his ability to diagnose and treat you adequately. A good thyroid doctor will treat a hypo patient clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. You can get some good info from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
Cortisol is an antagonist to thyroid hormone, so if high it can also add to the problem. I assume your cortisol test was serum cortisol, which is difficult to interpret, due to the huge swings in cortisol levels from morning to night. But if it were only slightly high, I would ignore at this point. Hypo patients are also frequently too low in the range for Vitamin D, B12 and ferritin. D should be about 55-60, B12 in the upper end of its range, and ferritin should be about 70 minimum. You should get those tested and supplement as needed to optimize to those levels.
You might try discussing all this with your doctor and ask if he will treat you clinically, as described. If not then you need to find a good thyroid doctor that will do so. If it gets to that, we can possibly help if you will tell us your location.
Second most important is the levels of Free T4 and Free T3, which are considered as the biologically active thyroid hormones. You have not even been tested for Free T3, and you should get that done; however, your Free T4 is extremely low. I say that because the range is flawed to the low end, due to the erroneous assumptions used to establish the ranges for both Free T4 and Free T3.
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 Free T4 and Free T3. A low TSH, along with hypo symptoms and Free T4 and Free T3 that are low in the range, is frequently an indicator of central hypothyroidism. Central hypothyroidism is a dysfunction of the hypothalamus/pituitary system.
Based on your doctor's comments that everything is fine, I am not too optimistic about his ability to diagnose and treat you adequately. A good thyroid doctor will treat a hypo patient clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. You can get some good info from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
Cortisol is an antagonist to thyroid hormone, so if high it can also add to the problem. I assume your cortisol test was serum cortisol, which is difficult to interpret, due to the huge swings in cortisol levels from morning to night. But if it were only slightly high, I would ignore at this point. Hypo patients are also frequently too low in the range for Vitamin D, B12 and ferritin. D should be about 55-60, B12 in the upper end of its range, and ferritin should be about 70 minimum. You should get those tested and supplement as needed to optimize to those levels.
You might try discussing all this with your doctor and ask if he will treat you clinically, as described. If not then you need to find a good thyroid doctor that will do so. If it gets to that, we can possibly help if you will tell us your location.
1 Comments
Thank you for the confirmation that I am not just going crazy. I will seek another doctors advice. I live in Houston so there are a lot of them.
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
