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What should my tsh be?
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What should my tsh be?

What should my tsh be around if my free t4 is .8 (.8-1.8)? Anyone have a free t 4 like mine? Could you post your tsh? Also anyone think that a free t4 like mine is normal or ok?
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27 Comments Post a Comment
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Avatar_m_tn
My advice would be to stop being concerned about TSH.  TSH is a pituitary hormone that is affected by so many variables that it is a very poor diagnostic.  TSH causes no symptoms directly.  FT3 and FT4 are much more important tests, but the only thing that really matters is symptom relief.  Whatever level of FT3 and FT4 required to relieve symptoms is what you need. Test results for FT3 and FT4 are best used as markers of progress toward symptom relief.  Those levels vary from patient to patient.  As such there really is no "normal" levels, just the levels that work for you to relieve symptoms.  For example my TSH has been about .05 for over 25 years while taking a full daily replacement dosage of T4 meds.  I still had lingering hypo symptoms until learning about the importance of FT3 here on the Forum and getting my meds changed to include a source of T3.  Now I feel best ever.
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1448748_tn?1312959808
I completely understand that, however I feel as though I might have to educate my doc that the relationship  between my free t4 levels and tsh is not normal. He thinks my symptoms are unrelated to my thyroid because my tsh is low. I want him to test for pituitary issues but want to be able to tell him that usually the tsh should be much higher like near ________., when my free t4 is this. Therefore maybe its pituitary related and thats why my tsh is so low compared to my free t4.
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Avatar_m_tn
A low TSH would indicate (Just a rule of thumb) that your thyroid is secreting to much hormone (Hyper), a high TSH would indicate your thyroid is not secreting enough hormone (hypo) so either high or low would indicate some sort of thyroid problem, how he could state it is unrelated to your thyroid is crazy. Good thyroid MD's treat by Free T3 and Free T4 Levels, If you have these results and the ranges given, post them here to give members a better picture of where you are at. If your ranges are far from normal it would be time to find a different MD that is more familiar with thyroid. Good Luck FTB4
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1448748_tn?1312959808
Free t4 is .8 (.8-1.8)
Tsh is 1.0 (.4-4.0)
Free t3 is 3.25 ( 2.3-4.5)
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1448748_tn?1312959808
I will also add that my free t4 keeps dropping and so does my tsh . If my free t4 is dropping my tsh should rise.  I am not sure about my free t3 because I've only had that tested once.
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1448748_tn?1312959808
Ive was simply wondering if an average mildly hypothyroid person with lots of hypo symptoms would have a tsh of like 3, 6 , 9, 30? When their free t4 is at .8 .lowest part of"normal" range. I know it shouldn't be at 1 with low free t4, just not sure how high it would most commonly be in relating to a free t4 like mine.
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Avatar_f_tn
Hi Jennifer
My last tests about a month ago showed my free t3 at 2.70 (free t4 1.24 and TSH 2.38) and my new doc thought it was too high. I'd been on Synthroid for 2 years and after no changes have found a doc who's more willing to look at symptoms than test results.  He follows the "functional medicine" philosophy.  I've started on Armour Thyroid.  We'll see if it works.  After reading Stop the Thryoid Madness, I'm really hoping to see much better results.  I'd say you should find a doc who is willing to listen to YOU and not be so concerned about the test results.  Each of us is different and the so called "normal" is different for each of us.  Noone with Hypothyroid will fall into the same "normal".  I'd strongly urge anyone whose doc is looking for them to fit into the "normal" range to find a new doc.   Good Luck!!!
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1448748_tn?1312959808
Oh, and I cannot switch Doctors, or I might. I have Medicaid, which is insurance for low income people.  It is very limited in who I can see.  Even if the providers accept medicaid, I cannot find anyone who is accepting new patients with medicaid.  I had one appointment with the only other doctor accepting new patients, and he was absolutely terrible. For the most part my doctor is a great doctor, usually listens to me and tries new things. I think he just doesnt know much about thyroid and has no clue about pituitary issues or what they look like on a test, and I have been doing some research, and the criteria for having pituitary issues is very vague.  I only found one site for the diagnosing criteria and it said that dr. believes that a TSH below 1.0 (.3-3.0)and a free t4 below .9 (.8-1.8) would definitely indicate hypo pituitary. but, I am at 1.0,  not below it and at .8 in those same references, so I am unsure if that includes me or not, and how to convince my dr. to do further pituitary testing. He gave me some synthroid 25 mg, as a medical trial to see if it would help, but I am very tolerant of anything I am given as far as medicine, and am afraid I don't think that low of a dose will make that much difference, but it does give me hope that he is willing to listen to what I have to say.  So I am just looking for some kind of clues as to whether a free t4 of .8(.8-1.8) would usually show a higher tsh than 1.0(.3-3.0) because right now, he looks at the tsh and says, oh your tsh is good, that means you are not hypothyroid even if you have every symptom imaginable, it must not be the thyroid because your tsh is so good. Most people with a tsh of 1.0 feel fine.  I don't. I wish I had had thyroid tests done in the past when I felt normal, so I could compare them to now. Then I might have a better clue.            



SOOOOO.

If you all could post  your low free t4 results with the corresponding tsh values, that would be very helpful for me.  Please .  I understand that everyone is different, but I am trying to just get a general idea.  Thank you guys very much.
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649848_tn?1357751184
There is no rule of thumb; my latest FT4 was 1.8 (same range as yours), with a TSH of < 0.01.  An earlier FT4 was 0.6, with TSH of < 0.01.  Am not hyper with FT4 of 1.8, but was hypo with FT4 of 0.6, even with low TSH.

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1448748_tn?1312959808
my free t4 is low at     .8    not  1.8.   all HYPO symptoms.
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1448748_tn?1312959808
Do you have hashi's or pituitary issue, or just normal hypothyroid?
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Avatar_f_tn
I hear your frustration, but I think you're picking apart your symptoms and labs to the point where responses are only going to further confuse you.  People have to have the bigger picture available, and it's very time-consuming to have to go back and read all your previous posts.

My personal feeling is that your low FT4, combined with your low TSH, is a huge red flag indicating secondary (hypopituitary) hypothyroidism.  Add to that that you are showing symptoms of female hormone imbalance...another red flag (the pituitary is the master endocrine gland that controls thyroid, female, adrenal, etc. hormones).  You suffered a head injury and a seizure...the third red flag.  The pituitary can suffer damage with head trauma.  Forgive me, there may be other issues, but this is what I remember.

Now, although no ONE of these things might be TOTALLY convincing as to pituitary involvement, it seems that the three together speak for themselves.  Start by getting a full pituitary panel.  Even if your doctor is not particularly talented in reading pituitary results, he is going to have a hard time ignoring "abnormal" results.  Start there, take it one step at a time, the next step being guided by the results of the previous one.

I think what Barb (who has Hashi's, btw) is trying to illustrate is that when HER FT4 was 1.8 (the upper limit of the range, and bordering on hyper) and when hHER FT4 was 0.6 (below range and hypo), her TSH was the same...<0.01.  The two numbers do not correlate, not just for her, but statistically.
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1448748_tn?1312959808
Thank you for your help. I just want to feel better and understand this stuff.  
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1448748_tn?1312959808
I think I misunderstood you.  I think I will just demand to have a pituitary panel done and antibodies.  That should help me understand what is going on with me right? I'm worried what happens if it all comes out normal?  I am just so tired of hurting and want my life back :(
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Avatar_f_tn
I know you do, and I want you to, also.

I just think that people need more background information on you in order to provide specific answers.  Otherwise, you are going to get the "generic" answer.  I feel your condition is much more complex than most, so often the generic answer does not apply and might even add to your confusion, not help it.  

I'm not chastisizing you, just trying (in my own way) to get some more background and your personal history into this thread.  I can see your frustration jumping off the screen, and I sympathize with you completely (I want to wake your doctor up!).  I hope you don't mind too much if I'm a mother hen and try to steer this a bit so that you get the best advice, specific to you.  

Best wishes...
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Avatar_m_tn
I agree that your low FT4 along with the relatively low TSH is indicative of a pituitary problem.  So your plan to get testing for that is a good idea.  
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1448748_tn?1312959808
I don't mind you being a mother hen type at all :) at least someone is, haha., I don't have a mom, so I miss that.
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1448748_tn?1312959808
So here is my detailed history in case anybody wanted to know:



I have had a long haul here. I had a grandmal seizure almost a year ago this march. It resulted in a major concussion where I didn’t remember anything for 15 min not even my name.  My memory returned to normal ( well more normal) I cannot remember a lot, like why I am going to another room) and nobody could ever find the cause. I found out I have factor 5 lieden and protein s def. which means my blood clots easier but that is about it everything else seemingly normal.  So about 2 months after, I began getting so tired I could not drive TO work even after 12 hours of sleep. Tried everything to see if it would help for 2 months. Nothing so I saw a dr. did thyroid tests and a barrage of other tests with everything seemingly normal.  My lipase was high, albumim was low, mean platelet high, but dr.s were not concerned about those levels.  I have every hypo thyroid symptom out there and my pain is especially bad. I have to take percocets to function. It seems as though the only test I haven't done is hormonal tests I asked my obgyn and she said there is no need if I am not missing my period completely.  My complete list of symptoms is( I took most of this from a list of symptoms and deleted the ones I didn’t have of stop the thyroid madness.com):

-I have been for 10 months now been experiencing extreme fatigue, I can't even drive myself home from work unless I take an energy drink first to keep me awake. I can't lose weight even though I'm exercising 5 times a week at an hour and a half (800-900 cals burned)  & eating right foods ( 1800 cals or less per day, 6 small meals per day),

- Less stamina than others
- Less energy than others
- Long recovery period after any activity
- Inability to hold children for very long
■Arms feeling like dead weights after activity
■Chronic Low Grade Depression
■Suicidal Thoughts
■Often feeling cold
■Cold hands and feet
■High or rising cholesterol
■Plaque buildup
■Hard stools
■Constipation
■Dry Hair
■Hair Loss
■White hairs growing in
■Dry cracking skin
■Nodding off easily
■Requires naps in the afternoon  
■Air Hunger (feeling like you can’t get enough air)
■Inability to concentrate or read long periods of time
■Forgetfulness
■Foggy thinking
■Inability to lose weight
■Always gaining weight
■Inability to function in a relationship with anyone
■NO sex drive
■Moody periods
■PMS
■Excruciating pain during period
■Nausea
■Swelling/edema/puffiness
■Aching bones/muscles
■Bumps on legs  
■Hives
■Exhaustion in every dimension–physical, mental, spiritual, emotional
■Inability to work full-time
■Inability to stand on feet for long periods
■Complete lack of motivation
■Slowing to a snail’s pace when walking up slight grade
■Extremely crabby, irritable, intolerant of others
■Internal itching of ears – wow this happens all the time, but I didn’t think anything of it.
■Broken/peeling fingernails
■Dry skin or snake skin
■Major anxiety/worry
■Ringing in ears – rarely but it happens
■Joint pain
■Carpal tunnel symptoms
■Blood Pressure problems – Low almost always, when I am in lots of pain, high.
■Varicose Veins
■Dizziness from fluid on the inner ear
■Low body temperature
■Tightness in throat; sore throat
patients)
■Headaches and Migraines
■Sore feet (plantar fascitis); painful soles of feet
■irritable bowel syndrome
■painful bladder
■Extreme hunger, especially at nighttime
■Dysphagia, which is nerve damage and causes the inability to swallow fluid, food or your own saliva and leads to “aspiration pneumonia”. –This happened to me only once for about 2 days.

I have taken 3 thyroid tests now to date.  One in September , One in October and then one in December. I will post them.  If my TSH is going down, then shouldn’t my free t4 be rising?  That is not happening with me.  They are both droppping My TSH is dropping slightly faster than my free t4 , but both still dropping. And should they be changing this much in a matter of 3 months? Here are my test results, please help me decipher these tell me what you think.

09/07/10

TSH - 1.83 (.4-4.5)All Tests Had these reference ranges.
Free T4- 1.1 (.8-1.8
NO FREE T3 Done

10/13/11

TSH - 1.48(see above)
Free T4- 1.0

11/2
Tested for Cortisol levels.  it was 16.2 at 4 pm (No reference Range, but found something online saying 23 is high end at 9am and 13 is high end at midnight? so I am not sure what a 4pm readout should be for cortisol but I am assuming this is normal or a little high?

12/03

TSH 1.0 (.4-4.5)
Free T4 - .8 (.8-1.8)
Free T3 - 3.5 (2.3-6.9)Dr. Said this is very good.  

Everything I have read says that TSH should go up if your frees are low... and why would my freet3 be more normal /higher than my free t4?  

Any help would be greatly appreciated.  I am hurting so bad, I seriously think there is no possible way that a thyroid disorder could cause this much joint pain and muscle pain.  My soles of my feet hurt in the morning and I am so stiff I can hardly walk.  I am dizzy and recently started experiencing blurred vision. I could starve my self for 3 days and not lose a pound (I have only done this once, just to see) my whole body feels like the flu as far as achiness and nausea every day.  Could I have like Hashi's and its just beginning? or does that not correlate with my TSH dropping?

I also have recently developed a sore throat and scratchy voice like I lose my voice if I talk too much.  I never had this symptom before a couple of days ago.

And are there any further tests I should be asking for? and how should I ask him?
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Avatar_m_tn
Regardless of the cause of your TSH being low along with low FT4 and somewhat low FT3, with that extensive list of hypo symptoms, I have no doubts that you need to be treated clinically by testing and adjusting your FT3 and FT4 levels as necessary to relieve symptoms, without being constrained by resultant TSH levels.  A good thyroid doctor will treat you in this manner.  Many of our members report 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.  To give you a little more confidence in this being the right approach, this is a copy of a letter that was written by a good thyroid doctor.  He frequently consults with patients who live some distance away.  He then sends the letter to their PCP to help guide them in treatment of the patient's hypothyroidism.



For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.
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1611319_tn?1378621999
I am very concerned for you!  You mentioned sucidal thoughts as one of your symptoms and that has me very worried.  I too live in constant pain and have most of your symptoms.  I have Hashi's and have had a pituitary tumor removed in 2005 (my second one).  I am addressing this bc i want you to be acutely aware that there are so many other reasons that can cause your exact symptoms,   Now i am not suggesting that you have any of these nor that you do not have a thyroid problem, just to let you know that all of us care and want you to receive the care that you deserve.  Some things that mimics those symptoms are Sjogerens Syndrome, (have it)Chronic Fatigue, Fibromyalgia,(have it) Lupus and even MS.  
Because the endocrine system is so complex with each gland feeding off the other and dependent that they all cooperate, minor glitches in one can cause another to look like it is in a frenzy.
I do believe that knowledge is power and sometimes when I am frustrated I too research, but keeping in mind that 1st- I have never been to medical school and 2nd I have to take a lot of what we find on the internet with the knowledge that not everything is accurate and although I am intelligent , I still do not have the ability to comprehend some of the medical jargon.  Ha, sometimes I say that I know enough to be dangerous (only with my imagination running away with me).  I want you to do your research and print out what really means the most to you or makes sense and take it to your doctor.  I think your doc also needs to know the level of your frustration and has a grasp of your symptoms.
I know you have to be miserable with your fatigue and pain.  You sound like you are trying very hard to do all that you can do to help yourself.
I am on .88 mcg of levothyroxin (levothyroxine) at this time,  pretty much everytime i am tested they increase my meds.  
at this time my TSH is 6.66
Free T-4 is 1.2
Free T-3 is 2.3
my TPO is >1000
FSH is 49.9
LH is 26.2
Cortisol, A.M. is 8.0
I have an active growth on my thyroid gland and am awaiting an ultrasound, my endocrinolgist has already suggested a biopsy too.
Again, even though these are my readings at this time ..they will change!!
Are you seeing a regular General Practioner? You can request to be seen by a specialist. And I think you should.
I really do understand what you are going thru and hear your questions as well as your frustrations.  Just keep in mind that there are possibilties that it may not be your thyroid causing all of these symptoms.  And then again it could....sadly, we just don't have the answers.  
I wish that I could help you more.  
Blessings To You,
Sass
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Avatar_f_tn
i have alot of your symptoms and my levels are almost exactly as yours.  general doctors and even 2 endo's tell me there is no thyroid problem because my tsh is in normal range.  i dont believe thats true though from what ive read that many other people say it can be hypo and or pituitary.  im so afraid i have a pituitary problem because i have low esrogen also with normal fsh.  i feel like im going to die all the time from this.  i am going to see an endo soon i hope you get to feeling better and get answers.
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649848_tn?1357751184
This is a very old thread and jenniferk86 hasn't participated in the forum in a very long time, so it's unlikely she will respond.

You should start  a new thread, containing your own information, so members can help assess your testing/treatment.  

You can start a new thread by clicking the orange "Post a Question" button at the top of this page or you can see/respond to other posts by following the link below to the Thyroid Forum home page:
http://www.medhelp.org/forums/Thyroid-Disorders/show/73?controller=forums&action=show&id=73&camp=msc
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Avatar_f_tn
Anyone still around here?  My TSH3 is 7.988 should I be alarmed.  MD sent lab results saying that everything was normal but this is higher than the normal range indicated (0.320-5.500).
I am having a very hard time losing weight despite diet and exercise.  
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649848_tn?1357751184
This is a very old thread; your situation would get much better attention if you start a new thread of your own, instead of posting on the end of such an old one.

You can start a new thread, by clicking the orange "Post a Question" button at the top of this page, type your question, then click the green "Post a Comment" button.

You can also start a new thread from our home page, which is:
http://www.medhelp.org/forums/Thyroid-Disorders/show/73?controller=forums&action=show&id=73&camp=msc    then follow the same directions as listed above.

Be sure to add all relevant lab results, including Free T3, Free T4, TSH, antibody testing, etc.  Make sure you also post all reference ranges, since these vary lab to lab and must come from your own report.  
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Avatar_f_tn
thank you
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Avatar_f_tn
ask you what tsh stand for and what normal should be I need to know as I can make call and ask them about the thyroid because my paper said 0.904 uu/ml what is that it that too high ????? I need know for sure this is all mess up I don't get it   thanks pls send me message thanks !! have great day !
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649848_tn?1357751184
TSH stands for Thyroid Stimulating Hormone, which is a pituitary hormone that stimulates the thyroid to produce its own hormones, T3 and T4.

Your level of 0.904 is not too high, since the accepted range for TSH is 0.3-3.0.  

Is TSH the only thyroid test you had done?
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