blood test results

[jmss47]

I have many of the symptoms of hypothyroid...fatigue, weight gain, cold all the time, etc...I also am perimenopausal, which can create similar symptoms to hypothyroid.  Additionally, I have suffered from depression for some length of time.  Upon the worsening of my depression, my doc ordered thyroid tests.  These are the results:
TSH: 0.82; Free T4:  0.69; T3 Total Serum:  89ng/dl; T3 Free Serum:  2.9 pg/ml.  
The internist says those are normal results.  The nurse practitioner I see for depression meds says they are low.  From what I've read, none of this makes sense, but am starting to wonder about pituitary involvement.  I don't want to call my doctor wrong, but would appreciate another opinion.

[jmss47]

Thanks....I haven't spoken with her...just messages and a letter in the mail with my test results.  I just don't want to be "one of those people" who's too pushy, but I do want to know whether there's more of a physical element to my symptoms than just depression.  I will ask for the lab tests, too.

[gimel]

You should make it a habit to always get a copy of your lab results, so that you will have a record of what the levels were when you were feeling bad, or good and can track the effect of med changes as well.  The doctor is required to give you a copy upon your request.

Assuming again that your lab's reference ranges are similar to those I see most often, then your FT4 and FT3 results are within the range, but are in the lower part of the range.  If your intern is one of those that believes that being anywhere within the range is "normal" and requires nothing further, then you are either going to have to change his mind or find a good thyroid doctor.

In my opinion the very best way to treat a thyroid patient is to test and adjust the levels of the biologically active thyroid hormones (FT3 and FT4), with whatever medication is necessary to alleviate symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important.  Many members here have reported that symptom relief required that FT3 was adjusted into the upper part of its range and FT4 was adjusted to at least the midpoint of its range.

The reason why this is necessary is discussed in my prior post.  I suggest that you discuss with your internist that you are still having symptoms and that you would like to be treated for you symptoms by testing and adjusting FT3 and FT4 levels.  You should also request testing for possibility of Hashimoto's disease, by testing for TPO ab and TG ab.  If those tests confirm Hashi's, then perhaps your internist would be more receptive to treating your symptoms.

[jmss47]

the doc didn't include lab references...I looked them up online, and it seems most are in agreement within a small margin.

[gimel]

Since reference ranges are lab specific, it would be very helpful if you will post the reference ranges your lab uses for those tests.  From your symptoms and those test results, however, I would say that you are hypo.  All of your test results are in the lower part of their ranges, or possibly below.  From what we hear so often here on the Forum, patients continue to have lingering hypo symptoms until FT3 is in the upper part of its range and FT4 is at least at the midpoint of its range.   In my opinion the reason for this is that the ranges for the Frees have never been purged of suspect hypo patient data, as was done for TSH 7 years ago.  As a result the ranges are far too broad and "normal" results should be in the upper half of the current ranges.

With those FT4 and FT3 results, I would expect that your TSH would be higher.  Even though it is a pituitary hormone that is affected by many variables, including the time of day when blood is drawn for the test, your level is low, indicating that you should also ask about testing of your pituitary function.

Here is a good link that might provide some insight into the need for higher FT3 and FT4 levels.

http://www.hormonerestoration.com/Thyroid.html