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hypothyroid symptoms but normal labs
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hypothyroid symptoms but normal labs

I have mulitiple hypothyroid symptoms but my blood work is normal.  excessive hair loss for at least eight months and I mean excessive!  I have lost most of my bangs.  my hair has decreased in thickness by half.  my hair is about as thick as a pencil.  heavy painful periods. tired most of the time. depression. anxiety. cold all the time.  I have my thermostat in the house set to 76 sleep with sweat pants and a sheet and a thick comforter because I am always cold.  I have taken my tempetature in the morning several times before I get out of bed and its between 96-97 degrees.  with all these symptoms why are my labs falling within normal limits?
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Without knowing what tests have been done and where the results fall within the ranges, it certainly seems that you are not being tested and treated properly.  If your doctor is one that has the "Immaculate TSH Belief" and tests no further , that is certain to keep you hypo.  If the doctor goes a bit further and only tests total T4 or, maybe free T4, but finds that your test result is in the low end of the so-called "normal" range and decides that nothing further is necessary, that will also keep you hypo.  

The most important thyroid test is for free T3, which is the most biologically active thyroid hormone.  FT3  largely regulates metabolism and many other body functions.  Studies have shown that FT3 correlates best with hypo symptoms, while FT4 and TSH did not correlate.  

So if you haven't been tested for FT3 and FT4, then I suggest that as a first priority. In addition, many hypo patients show dificient Vitamin D, B12, iron/ferritin, magnesium and selenium.  So try to get those tested also.  

In my opinion the best way to treat a thyroid patient is to test and adjust FT3 and FT4 with medication as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important to you, not TSH levels.  If your doctor is not willing to treat you clinically in this manner, then you will need to find a good thyroid doctor that will do so.  

Following are a couple of good links for you to read in preparation for discussion with your doctor.

If you already have some relevant test results and reference ranges, please post them.  If not, when you succeed in getting those tests done, I suggest that you obtain a copy of the lab report and post results and reference ranges so that members can help interpret and advise further..
lab results

tsh 1.28
white blood cell count 4.2
rbc 4.11
hgb 13.7
hct 40.2
mcv 98.0
mch 33.3
mchc 34.0
rdw 12.6
pt cht k/cumm 193
absolute neutrophils 1865
absolute lymphocytes 1970
absolute monocytes 252
absolute eosinophils 92
absolute basophils 21
gran 44.4
lymph 46.9
mono 6.0
eos 2.2
baso 0.5
glucose 81
bun 11
creatinine .70
egfr estimated 60
dhea 89
progesterone .6
estradiol 72
testosterone 3%  .58
testosterone free 2.3
testosterone 40

I am seeing a chiropractor who specializes in nutirional support.  He agrees that I have hypothroidism but cannot perscribe medication.  He has me on thyro cnv, magnessium and potatssium.  All natural, which has helped some.  He is not covered by insurance.  I have seen 2 endo, how can I find out if an endo will treat my symptoms and not my labs.  The one I am seeing now says its too dangerous to treat based on symptoms.  I am sick of paying for office visits and getting no where.
I can't believe that with all that testing and expense, and with your symptoms, the doctor hasn't done any thyroid tests other than TSH.  If you read through what I posted above, you'll see that the first priority for you should be to get tested for FT3 and FT4 (not total T3 and total T4), along with the TSH.  I would go back and insist on those tests and not take no for an answer.  When you get that done then get a copy of the lab report and post results and reference ranges so that members can help interpret and advise further.  While this is going on you do need to be looking for a new doctor that will treat you clinically as I detailed above.  If you will tell us your location, members may be able to suggest a good thyroid doctor in that area.  Lacking that there are other possibilities we can also try to help with.  So let's get started.  Your chiropractor doctor has been making lots of money from you and not helping you get well.   It's past time to move on.
I called the endo today and requested the recommended tests and am waiting to hear back.  I saw her for the first time yesterday and I asked her if she knew of a different test that was more accurate.  From her answer she doesnt believe in tests other than the tsh but maybe she will humor me.  I live in Ofallon Mo.  Endocrinologists are hard to come by here.  Thanks for your input.  I will keep you updated.
You don't really NEED an endo to treat your hypothyroidism; you only need a doctor who is willing to order the proper tests, then interpret them correctly and be willing to treat you in such as way as to alleviate your symptoms, without worrying about TSH.

The tests that have already been run are much more expensive than a TSH, Free T3 and Free T4 would be -- those tests would actually give you some information.......

If this endo won't agree to test properly, you will need to find another doctor to treat you or you will remain ill for a long time.  

Your chiropractor may not be able to prescribe med (you should find one that can), s/he can certainly order lab tests, right?  Get him/her to order the tests, then take the results to the endo........

To find a doctor who will treat symptoms, you should find one you are "interested" in, then call their office and talk to the nurse.  Ask which tests they routinely run, and whether or not they treat by symptoms, labs, or both, whether or not they are willing to test for Free T3 and Free T4, along with TSH........... Since many of us forget everything we want to know, the minute the doctor walks into the room, you should make a list of questions.........

gimel is an expert on the questions you should ask - both when interviewing the nurse by phone and when seeing the doctor.  
I just call the doctor's office and say that I am looking for a good thyroid doctor, but before making an appointment I'd like to ask one of the nurses a couple of questions.  That has never failed to get a nurse on the line.  Then I ask if the doctor is willing to test and adjust free T3 and free T4, as necessary to relieve symptoms, without being constrained by resultant TSH levels.  The second question is whether the doctor is willing to prescribe T4/T3 combo meds, and T3 meds, rather than T4 only. If the answer to either question is no, then you might as well just keep on looking for a good thyroid doctor.
That is great advice.....Thank you so much!
new lab results

FREE T3    3.3
FREE T4   1.2
TSH           1.0
Vitamin D, 25-0H   29
Vitamin D 25 OH D2   4
Vitamin D 25 OH D3     29

Could I have hypothyroidism?
What are the reference ranges for the Free T3 and Free T4?  These ranges vary from lab to lab, so must come from your own report.

Your vitamin D is very low.  Did your doctor start you on supplements? Your calcium seems low as well.  What's the reference range for that?
T4 FREE 1.2 0.8 - 1.8 ng/dL

CORTISOL, A.M. 14.2 mcg/dL
Reference Range
8 a.m. (7-9 a.m.) Specimen: 4.0-22.0

CALCIUM IONIZED 4.94 4.8 - 5.6 mg/dL

Vitamin D, 25-0H 29 30 - 100 ng/mL
Vitamin D 25 OH D2 <4 ng/mL
Vitamin D 25 OH D3 29 ng/mL

T3 Free 3.3 2.3 - 4.2 pg/mL


The Endo said to take 2000 of over the counter vitamin D

She didnt say anything about the calcium... could these deficencies be causing my hair loss?
Have you been tested for antibodies?  
No, it seems like everytime I get blood drawn, something important is missed.  I guess the T3 and T4 are normal levels?  I had a thyroglossal duct cyst removed when I was 3.  Could that in someway have affected my thyroid over the years?  Any information would be appreciated.
Besides the Vitamin D that Barb mentioned, I think you need to increase the level of your FT3, as necessary to relieve symptoms.  Scientific studies have shown that FT3 correlates best with hypo symptoms, while TSH and FT4 did not correlate very well at all.  Frequently we hear from members that symptom relief for them required that FT3 was adjusted into the upper third of its range and FT4 adjusted to at least midpoint of its range.  

The reason that FT3 results in the lower half of the range are suspect to me is that the range has never been corrected, like was done for TSH over 8 years ago.  At that time the AACE came to the conclusion that there were many more hypo patients than their old range limit predicted.  When they carefully purged their data base of suspect hypo patients,  and recalculated the limits, they changed the range from .5 - 5.0 down to .3 - 3.0.  This was a huge change.  With a bit of training in statistical analysis, I have estimated that if the same were done for FT3, the range would become more like 3.2 - 4.3.    So it is understandable to me as to why we hear from so many members with FT3 in the lower end of the range, yet they still have hypo symptoms.  

The ranges would not be so important if doctors used them as guidelines within which to adjust levels until symptoms are relieved.  Instead they use the ranges as a Pass/Fail decision, and don't want to medicate a patient with symptoms, as long as test results are within the so-called "normal" range.  I hope this helps a bit in understanding why patients with test results in the low end of the range, but with hypo symptoms, need medication to relieve symptoms.

Depending on how your doctor feels about treating you clinically by adjusting FT3 and FT4 as necessary to relieve symptoms, you may need to find a good thyroid doctor that will do so.  To help in any discussion about this with your doctor, this is a good link for you.  The letter is sent to the PCP of thyroid patients consulting from a distance, with the author.  It helps the PCP with direction for treatment of the patient clinically.

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