hypo test results but hyper symptoms???

[Blue727]

Is it possible to have a low TSH, low Free T3 and low Free T4 and be hyperthyroid?  My body constantly feels revved up, bad behind the eye pain and my eyelids feel very heavy.

[AR-10]

You can't have a low T4 and a low T3 and be hyper. You can't have a low T4 and a low T3 and a low TSH unless you have a pituitary problem.

Maybe you're mistaken about one of your tests?
It would be helpful if you had a copy so you could post the results and the lab ranges used.

[Blue727]

Results: Ranges:

10/12/05:
TSH: 1.20 0.40 - 5.5 MU/L

2/21/06:
Free T4: 0.91 0.59 - 1.17 ng/dL
TSH: 0.94 0.35 - 4.82 uIU/mL
T-4, Total: 6.4 4.5 - 12.0 MCG/DL
T-3 Uptake: 34.6 25.0 - 35.0% Uptake

8/15/06:
TSH: 1.11 .34 - 4.82 uIU/mL

10/12/06:
TSH: 1.20 0.40 - 5.5 MU/L

6/21/07:
T-3, Free: 377 230 - 420 PG/DL
T3, Reverse: 0.19 0.11 - 0.32 ng/mL
Free T4: 0.73 0.71 - 1.85 NG/DL
TSH: 1.39 0.50 - 5.00 uIU/ML

7/17/07:
Here are the saliva test results;

fTSH 57 Normal
fT4 0.25 Normal Normal: 0.17-0.42 ng/dl
fT3 0.27 Borderline Low 0.21-0.27
TPO Positive
E2 (Estradiol) 9 Male (20-49 yrs): 1-3 pg/ml, Male (50-85 yrs): 1-5 pg/ml
P1 (Progesterone) 30 Male (adult): 5-95 pg/ml
TTF (Free Testosterone) 34 Male (20-30 yrs): 60-110 pg/ml

Cortisol:

7:00-8:00 a.m. 6 Depressed 13-24 nM
11:00-Noon 4 Depressed 5-10 nM
4:00-5:00 p.m. 3 Normal 3-8 nM
11:00-Midnight 5 Elevated 1-4 nM
Cortisol Burden 18 23-42

DHEA 4 Normal 3-10 ng/ml

My morning Cortisol blood test was 19.3 (Range: 4-22 MCG/DL).
Antibodies test was negative.

8/7/07:
TSH: 1.80 0.50 - 5.00 uIU/mL

9/12/07:
Free T4: 0.75 0.71 - 1.85 NG/DL
TSH: 1.27 0.50 - 5.00 uIU/ML

1/19/08:
Free T4: 0.66 0.71 - 1.85 NG/DL
TSH: 0.17 0.50 - 5.00 uIU/mL

1/30/08:
TSH: 0.95 Range: 0.50 - 5.00 uIU/mL

Estradiol, Serum <32

Estradiol Reference Ranges:
Male: <=54

It goes on to say no pediatric reference range established.

T-3 Uptake: 40.31 High Range: 25.0 - 35.0% Uptake

T-4, Total: 5.7 Range: 4.5 - 12.0 MCG/DL

Free Thyroxine Index: 2.30 Range: 1.12 - 4.20

T-3, Total: 93 Range 60 - 181 NG/DL

Testosterone, Total: 393 Range: 241 - 827 NG/DL

[AR-10]

Well, ask and ye shall receive!
I'll have to get back to you in about four hours.

At first glance it looks like secondary hypothyroidism, but I need to look some things up and digest the tests in sequence.

You keep very good records. :-)

[AR-10]

Your saliva cortisol test and your DHEA are low, indicating you may have a slight case of adrenal insufficiency.

Adrenal insufficiency can suppress the TSH. The Adrenal glands actually slow the thyroid down to a rate the adrenal glands can keep up with.

Getting diagnosed for a mild case of it can be difficult. If your adrenals are in need of help, it can mess up your thyroid numbers, and it can make your thyroid meds do strange things if you are taking any.

The other possible explanation for your TSH/T4/T3 readings is a pituitary problem that is causing the pituitary to not produce enough TSH. It's called Hypopituitarism, and it might be worth persuing that possibility.

My guess is, if you are feeling amped up all the time, your adrenal glands are waving the white flag. I would find a doctor that knows about both conditions and have a few more tests run, some you have had, and some you have not.

Read up on Adrenal Insufficiency, and see what you think. When it gets severe enough, it's called Addison's disease. But it can cause you grief at a milder stage that is hard to diagnose.

Adrenal Fatigue is a term being used for mild adrenal problems, but Medical textbooks do not recognize adrenal fatigue (I don't think). Sort of like Dr.s dislike the term "sub-clinical".  

You need thyroid support, but if your adrenal glands are the cause, you need to have them treated first.

The bouncing TSH could be from either condition.

When you get T4/T3 tests in the future, skip the total T4 and the total T3. They are old inacurate tests. Ask for the Free T4 and the Free T3. They tell you what level of hormone in your blood is actually useable.


But I'm just a bored unemployed patient in Limbo, so take it with a grain of salt. There's at least one mistake up there...

[Blue727]

Thanks for your help.  I am being treated with Cytomel and Hydrocortisone, but notice absolutely nothing at all.  I was hoping you could help me with a couple questions.

So could the adrenal insufficiency be suppressing my tsh to the point that I could be hyper and not hypo?

I have so much pain behind my eyes, my right eye actually becomes smaller than my left periodically and my eyelids feel very heavy.  Would it hurt to see if a doctor would give me something to treat hyperthyroid just to see if it works?

The thyroid expert doctor on this site told me it looked like subclinical hyperthyroidism to him and possibly a pituitary problem.  Would a pituitary problem be addressed differently than a thyroid problem and could a pituitary problem be causing me to feel hyperthyroid?  Could a pituitary problem cause my test results to look hypo, but actually be hyper?

Looking over my tests, do you think it could go either way...hyper or hypo?

I shake all the time and have almost every symptom of hyperthyroid, so I just wish I could try the other direction.  It's very hard when you have one saying hypo, one hyper, one pituitary, but really nothing is getting solved.  I can't even get a doctor to scan my pituitary gland, thyroid, etc...

Again...Thanks for all your help with this.

[AR-10]

Looking at your tests, there is only one time your Free T3 was above midline. All your other T4/T3/ tests were either low normal, or below limits.

Your TSH doesn't matter. Your hormone tests all indicate low levels and that is Hypo. To be Hyper your hormones would have to be high normal.

Your TSH drives the thyroid gland, but the hormones feed the body. A low TSH means something, but the hormone tests tell the story. In your case the TSH is being suppressed, somehow.

It just seems obvious to look at your tests the way you layed them out here and see that there is a problem with either your Adrenals or your Pituitary.

The Hydrocortisone may have something to do with your symptoms. I don't know about that. The hyper symptoms you feel may be from your hormones (and TSH) jumping around so much. Or it may be a reaction to the Hydrocortisone?

[Blue727]

I don't feel any difference being off or on the Cytomel or Hydrocortisone.  I just wonder if a pituitary problem isn't causing me to actually be hyper when the tests show hypo.  My body feels like it's constantly revved up and I'm visibly shaky to everyone.  I have been addressing the adrenals with an Adrenal Rebuilder, but honestly, I could stop all of it and not no the difference.

Is it possible the pituitary could be making my results look hypo?  Thanks again for all your knowledge on these issues.  It's a constant struggle.

[AR-10]

The Pituitary does a lot of different things. Acting as the thermostat for the thyroid is only one of it's jobs.

But in regard to the thyroid it's only function is to produce TSH when the Hypothalimus tells it to. The Pituitary cannot give false hormone readings or give you hyper symptoms.

I could be wrong, but it looks like your TSH should be be 5.0 or 10.0 when it tests at .95 or 1.25. Pituitary is the most obvious thing I can think of, or adrenals.

It certainly sounds like you are suffering hyper symptoms, and I can't explain why. I hope you find a doctor that can track down the problems for you.

[Blue727]

What do you mean when you say "it looks like your TSH should be be 5.0 or 10.0 when it tests at .95 or 1.25"?  Thanks!

[AR-10]

Your last test, on 1/30/08.
Your total T4 and total T3 are low normal. Your TSH should be around 5.0, but it's 0.95.

On the 19th, your Free T4 is below lab limit. It takes a lot to fall below limit. Your TSH should be around 10.0 or higher, but it is 0.17.

Normally if your TSH is 0.17, your Free T4 would be at the top of the range, making you hyper, but it is below the lower limit, indicating you are very low on hormone, Hypo. Your TSH should be 10.0 or 15.0, telling your thyroid to hurry up and make more T4.

Either your Pituitary is malfunctioning, or not getting a signal from the Hypothalimus, or your Adrenals are putting the brakes on for some reason.

[Blue727]

Do you think the Cytomel is what I need to be on?  What should I be trying to increase on my tests?  I have heard Cytomel really won't do anything but raise my T3 level.  Thanks Again...you have been a tremendous help!

[AR-10]

Cytomel will raise your T3, but short term, you need to have tests run to figure out why your TSH test is not reflecting your Free T4 test.

They should compliment each other, or show a high/low correlation. When your Free T4 is high, your TSH should be low.

9/12/07
Your TSH is perfect. your Free T4 should be between 1.4 and 1.6, but it is 0.75, very low. The TSH should reflect that by being higher.

The Cytomel may have something to do with it. You may be getting enough T3 from the Cytomel that your body is not calling for more T3, so your TSH is low, and your Free T4 is also low.  

I never have figured out what tells the pituitary to produce TSH. The T4, or the T3. Your tests show that your T3 is sometimes fine, and sometimes a little low.

[Blue727]

Thanks for all your help.  I have only been taking the Cytomel and Hydrocortisone for about 1 month and wasn't taking it prior to any of the thyroid tests.  With my low TSH and Free T4, but a high T3 Uptake...does that mean anything?  Any suggestions on how to go about finding the answers from here?  I saw an Endo who doesn't think there is a problem even though I presented him with all the tests I had.  Thanks!

[Blue727]

Sorry, but I was hoping you could help me with one more thing.  If I do in fact have a problem with either the pituitary or the hypothalmus, could that be causing me to have symptoms of both hyper and hypo?  Is it possible if there is a problem it could be making me feel hyper with hypo results?  Thanks Again!

[AR-10]

A T3 uptake test doesn't measure T3 at all. It measures the amount of binding proteins there are in the blood that interact with T3.

It is interesting data, but it has nothing to do with the amount of T3 you have.

The tests in your last thyroid panel were all bad tests. You don't need to know the total T4, or the Free Thyroxine Index, or the total T3. You need to know the Free T4, the Free T3, and maybe the Reverse T3. But especially the Free Ts.

Most of the T4 in your blood is bound by a protein and made useless. Most of the T3 in your blood is bound by another protein and made useless. It's a regulatory process. The body calls for a certain amount of hormones, and then turns over half of it into trash right away. Don't ask me why.

Twenty years ago they couldn't measure free Ts. Those other tests were the best they had. Sometime between then and now, somebody figured out how to measure the actual available, Free Ts that are floating in your blood.

If you have a Free T4 and a Free T3, you don't need the Totals and the Uptake and the Index. They're all guesses derived at by mathematics.

The other tests you had run were good to have done, but I'm just sayin', why run a Free T4 on the 19th, and then run all that thyroid mumbo jumbo on the 30th. A Free T3 would have been nice.


The first Endo I saw looked at my tests and told me there was nothing wrong with me. He's a very good Diabetes Specialist, but he is a poor Thyroid doctor.

Find another Endo.

[AR-10]

I just don't know what to say about your symptoms. I've been hyper, and what you describe sounds like hyper symptoms.

[lizyorke]

"I have so much pain behind my eyes, my right eye actually becomes smaller than my left periodically and my eyelids feel very heavy."

I just wanted to make the suggestion that you see an opthalmologist about the eye problem. Maybe you have something going on - I am no expert at all, but I wondered if the smaller eye and heavy lids could be Horner's syndrome. If so there would also be a small pupil that is non or slowly reactive to light. But an opthalmologist could tell you if this syndrome were present, or whether you have some thyroid related eye problem. It may or may not be related to the above discussion but i think it sould be checked out.

[mgal304]

I hope you still consult this post site. Please  Get checked out for MYASTHENIA GRAVIS.. This is autoimmune disease that causes muscle weakness and the first sign is often heaviness of the eyelids or one eye closing a little or a lot.  See a neurologist familiar with Myasthenia Gravis to check out your problem with your eyes. There is an increased incidence of this disease with thyroid disease.   I had episodes of eye pain that felt like extreme fatigue of the muscles around and behind the eye and lids that came down  and were heavy, that I thought was allergy. ALso have  hypothyroid. Interestingly my despite my levoxyl , I have low TSH and low Free T4 ( within range but at the very low range- go figure!-- This can also happen if you have another illness)  It  is very important to check out  whether you have MG and esp if you are treating the other with steroids, which can bring on full blown  MG, which can cause problems with breathing swallowing, hoarseness and weakness throughout your body. You can have a subtle case , but not knowing you have it canhave some serious complications esp if you undergo anesthesia for any thing or take a number of common drugs.