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Thyroid Problem: Low FT4 with normal FT3 & normal TSH
Dear Sirs,
My mother who is 60 years old has had a notable weight-loss (about 15kg) - she also having painful mouth/throat sores.
The results of routine test eg: Complete Blood Count, Creatinine, Urea, Liver Function Tests, Uric Acid, C-Reactive Protein, LDH etc. are all NORMAL.
She has been treated by several physicians who have prescribed her with various gastro related and vitamin supplement medicine but the problem is still there.
Her recent thyroid testing, shows LOW FT4 with NORMAL FT3 & TSH; following are the results:
FT3: 2.02 pg/mL (normal range: 2.0 - 4.4)
FT4: 0.87 ng/dL (normal range: 0.93 - 1.70)
TSH: 3.03 uiU /mL (normal range: 0.27 - 4.20)
She is not taking any medicine.
I believe that she is suffering from hormone related problems but I am unable to find a good endocrinologist in my area - one physician has suggested to do CTscan for pituitary also - I am confused - would appreciate you experts' opinion on this.
Thanks a lot.
My mother who is 60 years old has had a notable weight-loss (about 15kg) - she also having painful mouth/throat sores.
The results of routine test eg: Complete Blood Count, Creatinine, Urea, Liver Function Tests, Uric Acid, C-Reactive Protein, LDH etc. are all NORMAL.
She has been treated by several physicians who have prescribed her with various gastro related and vitamin supplement medicine but the problem is still there.
Her recent thyroid testing, shows LOW FT4 with NORMAL FT3 & TSH; following are the results:
FT3: 2.02 pg/mL (normal range: 2.0 - 4.4)
FT4: 0.87 ng/dL (normal range: 0.93 - 1.70)
TSH: 3.03 uiU /mL (normal range: 0.27 - 4.20)
She is not taking any medicine.
I believe that she is suffering from hormone related problems but I am unable to find a good endocrinologist in my area - one physician has suggested to do CTscan for pituitary also - I am confused - would appreciate you experts' opinion on this.
Thanks a lot.
Lysine is an excellent help for canker sores and helps to moderate stress. It is an amino acid. Stomach problems are often associated with hypothyroidism. The good bacteria are called Pro-biotics and it's especially important to take them following a course of antibiotics.
Weight loss is more associated with having too high of thyroid. The blood tests would indicate the opposite. So some of the symptoms may be caused from something else.
However weight loss and canker (mouth) sores are both or can be associated with high stress. Also a lack of proper vitamins may cause canker sores. Not exactly sure which combination. But you might want to consider adding a good quality multivitamin a try.
Also with canker sores some people have found links to not having sufficient "good" bacteria in the digestive track. I think asodopholus (spelling??). This can be found in natural yogurt and even as a supplement in pill form in health food stores. I think here in the USA I've seen it at Walmart and Wallgreens pharmacy's.
However weight loss and canker (mouth) sores are both or can be associated with high stress. Also a lack of proper vitamins may cause canker sores. Not exactly sure which combination. But you might want to consider adding a good quality multivitamin a try.
Also with canker sores some people have found links to not having sufficient "good" bacteria in the digestive track. I think asodopholus (spelling??). This can be found in natural yogurt and even as a supplement in pill form in health food stores. I think here in the USA I've seen it at Walmart and Wallgreens pharmacy's.
Your welcome. I had to really think about how this all worked and that is the best analogy I could come up with.
Thyroid essentially tells the body's cells how fast to use energy. When the body uses energy, it produces heat. So when there is low thyroid, it doesn't allow the body to use energy at a very high rate. And thus it should be no surprise that a person who has low thyroid to have a low body temperature, lethargic, tired, fatigued and often accompanied by weight gain and depression like symptoms. Because the body is not converting the food to energy (which is primarily heat) and just stores it. They often describe themselves as "dead tired" Conversely when overactive thyroid, a person sweats, find it difficult to gain weight, is hyperactive and typically have high heart rate. They often describe themselves as "buzzing".
So Thyroid is also analogous to a throttle. Too little and a person is in the slow lane, too much and they are racing full speed ahead!
The trick is to get your individual body to be comfortably going with the flow of traffic.
Thyroid essentially tells the body's cells how fast to use energy. When the body uses energy, it produces heat. So when there is low thyroid, it doesn't allow the body to use energy at a very high rate. And thus it should be no surprise that a person who has low thyroid to have a low body temperature, lethargic, tired, fatigued and often accompanied by weight gain and depression like symptoms. Because the body is not converting the food to energy (which is primarily heat) and just stores it. They often describe themselves as "dead tired" Conversely when overactive thyroid, a person sweats, find it difficult to gain weight, is hyperactive and typically have high heart rate. They often describe themselves as "buzzing".
So Thyroid is also analogous to a throttle. Too little and a person is in the slow lane, too much and they are racing full speed ahead!
The trick is to get your individual body to be comfortably going with the flow of traffic.
Great!
Mr flyingfool, thanks for the detailed explanation.
Then, considering the symptoms i.e: the weight-loss and the TFT results, she should be treated as a HypoThyroid, no?
Best regards.
Mr flyingfool, thanks for the detailed explanation.
Then, considering the symptoms i.e: the weight-loss and the TFT results, she should be treated as a HypoThyroid, no?
Best regards.
Dear FF,
That is one of the BEST explanations of the thyroid process in layman's terms that I have ever read ! Thank you so much for that, I'm printing it out.
That is one of the BEST explanations of the thyroid process in layman's terms that I have ever read ! Thank you so much for that, I'm printing it out.
The lab tests from all I've learned here show that she is Hypo (low) Thyroid.
People posting show that most people get symptom relief when the TSH is near the very low end of the range. Also when the FT4 are AT LEAST mid range and the FT3 are in the UPPER 1/3 of the range.
The lab tests you provide above show to be at the extreme or even below the low end of the range for the FT3 & FT4. And the TSH towards the upper end. The exact opposite of where people seem to obtain symptom relief. So it appears definitely it would not hurt to get those number up higher at least into the mid range.
Keep in mind that the "normal" range is created by testing the general public. Then throwing out the upper 2.5% and the lower 2.5% of the test results. This then supposedly gives a "normal" range. Well that is a "normal" definition in terms of mathematical statistics. It absolutely does NOT mean that if your lab tests within those range that this is a normal situation or that it is healthy for any one individual.
You see, it is possible that upwards of 20% of the population has low thyroid and are symptomatic. However since only the bottom 2.5% are removed from the "normal" range, this means that what many Dr's and people believe to be normal results in about 17.5% of the hpopulation that are chronically low thyroid that Dr's refuse to treat because they fall within the "normal" range. Well is it a good thing that 20% of the population are "normally" chronically low in thyroid for their body to function properly??? I don't think so!
This explains why symptoms seem to fade away when people actually test above mid range because of the prevelance of hypothyroid people that make up the "normal" range. Because what the body needs and what the range say are two different things. This is why it is important to treat Thyroid based upon symptoms and backed up with lab tests.
Also know that if you are put on higher doses of a straight T4 medication, it can totally suppress (overcome) the TSH value. And many times a Dr's response to this very low TSH is to believe that the person has become Hyper (overactive thyroid) and thus want to cut back on medication. Which puts the person on a roller coaster ride of hell. However the TSH reading can be false and suppressed by the T4 meds. It is most important to track and monitor the FT 3 and FT4 levels. TSH then becomes more of an interesting bit of information but not hugely important but only a minor monitoring role.
If you don't know how the whole pituitary/thyroid system works I'll try to explain it at least how I think about it. I put it in terms of a homes heating system. TSH is a pituitary hormone. It tells the Thyroid to produce the thyroid hormones. TSH I compare to the signal from the thermostat in the house. It triggers the furnace to turn on. And the TSH hormone tells the Thyroid to turn on. The Thyroid if it is able then produces hormones. Both T3 & T4 but mostly T4. It is the "Free" T3 that the body actually uses. (free means that the hormone is unattached to a protein and can be used by the body. Once attached, that molecule is essentially useless) The body (mostly in the liver) converts the T4 produced by the Thyroid (or taken as a medication) into T3 so that the body can use the T3. Some people have a conversion problem where their body doesn't covert the T4 into T3 very well. This would be analogous to the furnace being kicked on by the thermostat, but just the fan starts but blows only cold air. Because the furnace doesn't light the burner to produce any heat. So in those individuals the medication used may have a component of T3. Most people convert just fine so the most common medication prescribed is a straight T4 med.
So what most Dr's tend to do is rely solely on the TSH test. But this is a pituitary (thermostat signal). It is only a trigger. It does very little really to tell what is happening to the furnace. You can have a properly operating thermostat and if the furnace doesn't work, the signal will get stronger and stronger. And this is what TSH measures. The strength of the signal. Because the pituitary senses that there is not enough "heat" in the house so it keeps asking for more by putting more and more TSH out!
As you can see, since the body uses only the free T3 and that is made from converting the T4 into T3, then you can see why it is so important to test for the Free T4 and Free T3. And since the TSH is only a trigger hormone and is not actually used, you can see why that is not quite as important. It can be initially as a indicator that something is wrong. (ie the thermostat says we need heat but the heat is not coming out of the vents). When the thermostat works correctly in your house but you still have no heat, you KNOW you need to get something fixed. But once the fix begins, It is more important to evaluate the RESULTS of the heat that is coming out of the vents (ie your symptoms and the measurement of the volume of air and the temperature of the heat actually coming out of the heat vents) This is what the Free T3 and Free T4 tests provide. Monitoring TSH (the thermostat) is OK to do, but what you are really after is monitoring the ACTUAL heat output.
I'm not a Dr. I'm just relaying what I've learned here.
You are lucky that you found a Dr. who was willing to do both Free tests. My wife has and continues to struggle and fight to get those tests done. The two Free (FT3 & FT4) tests are essential.
People posting show that most people get symptom relief when the TSH is near the very low end of the range. Also when the FT4 are AT LEAST mid range and the FT3 are in the UPPER 1/3 of the range.
The lab tests you provide above show to be at the extreme or even below the low end of the range for the FT3 & FT4. And the TSH towards the upper end. The exact opposite of where people seem to obtain symptom relief. So it appears definitely it would not hurt to get those number up higher at least into the mid range.
Keep in mind that the "normal" range is created by testing the general public. Then throwing out the upper 2.5% and the lower 2.5% of the test results. This then supposedly gives a "normal" range. Well that is a "normal" definition in terms of mathematical statistics. It absolutely does NOT mean that if your lab tests within those range that this is a normal situation or that it is healthy for any one individual.
You see, it is possible that upwards of 20% of the population has low thyroid and are symptomatic. However since only the bottom 2.5% are removed from the "normal" range, this means that what many Dr's and people believe to be normal results in about 17.5% of the hpopulation that are chronically low thyroid that Dr's refuse to treat because they fall within the "normal" range. Well is it a good thing that 20% of the population are "normally" chronically low in thyroid for their body to function properly??? I don't think so!
This explains why symptoms seem to fade away when people actually test above mid range because of the prevelance of hypothyroid people that make up the "normal" range. Because what the body needs and what the range say are two different things. This is why it is important to treat Thyroid based upon symptoms and backed up with lab tests.
Also know that if you are put on higher doses of a straight T4 medication, it can totally suppress (overcome) the TSH value. And many times a Dr's response to this very low TSH is to believe that the person has become Hyper (overactive thyroid) and thus want to cut back on medication. Which puts the person on a roller coaster ride of hell. However the TSH reading can be false and suppressed by the T4 meds. It is most important to track and monitor the FT 3 and FT4 levels. TSH then becomes more of an interesting bit of information but not hugely important but only a minor monitoring role.
If you don't know how the whole pituitary/thyroid system works I'll try to explain it at least how I think about it. I put it in terms of a homes heating system. TSH is a pituitary hormone. It tells the Thyroid to produce the thyroid hormones. TSH I compare to the signal from the thermostat in the house. It triggers the furnace to turn on. And the TSH hormone tells the Thyroid to turn on. The Thyroid if it is able then produces hormones. Both T3 & T4 but mostly T4. It is the "Free" T3 that the body actually uses. (free means that the hormone is unattached to a protein and can be used by the body. Once attached, that molecule is essentially useless) The body (mostly in the liver) converts the T4 produced by the Thyroid (or taken as a medication) into T3 so that the body can use the T3. Some people have a conversion problem where their body doesn't covert the T4 into T3 very well. This would be analogous to the furnace being kicked on by the thermostat, but just the fan starts but blows only cold air. Because the furnace doesn't light the burner to produce any heat. So in those individuals the medication used may have a component of T3. Most people convert just fine so the most common medication prescribed is a straight T4 med.
So what most Dr's tend to do is rely solely on the TSH test. But this is a pituitary (thermostat signal). It is only a trigger. It does very little really to tell what is happening to the furnace. You can have a properly operating thermostat and if the furnace doesn't work, the signal will get stronger and stronger. And this is what TSH measures. The strength of the signal. Because the pituitary senses that there is not enough "heat" in the house so it keeps asking for more by putting more and more TSH out!
As you can see, since the body uses only the free T3 and that is made from converting the T4 into T3, then you can see why it is so important to test for the Free T4 and Free T3. And since the TSH is only a trigger hormone and is not actually used, you can see why that is not quite as important. It can be initially as a indicator that something is wrong. (ie the thermostat says we need heat but the heat is not coming out of the vents). When the thermostat works correctly in your house but you still have no heat, you KNOW you need to get something fixed. But once the fix begins, It is more important to evaluate the RESULTS of the heat that is coming out of the vents (ie your symptoms and the measurement of the volume of air and the temperature of the heat actually coming out of the heat vents) This is what the Free T3 and Free T4 tests provide. Monitoring TSH (the thermostat) is OK to do, but what you are really after is monitoring the ACTUAL heat output.
I'm not a Dr. I'm just relaying what I've learned here.
You are lucky that you found a Dr. who was willing to do both Free tests. My wife has and continues to struggle and fight to get those tests done. The two Free (FT3 & FT4) tests are essential.
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