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normal TSH, low free T4
Below are my lab levels. I am on lithium carbonate. Please explain!
TSH 2.900 uIU/mL (0.450-4.500)
Thyroxine (T4) 3.9 LOW ug/dL (4.5-12.0)
T3 Uptake 27 % (24-39)
Free Thyroxine Index 1.1 LOW (1.2-4.9 )
T4,Free(Direct) 0.73 LOW ng/dL (0.82-1.77)
Triiodothyronine,Free,Serum 2.7 pg/mL (2.0-4.4)
Do you treat the T4 even if the TSH is normal? I have experienced 10lb weight gain in the past year in spite of eating better but perhaps this is a reflection of my age (35). No other symptoms really to report.
Thank you so much in advance.
TSH 2.900 uIU/mL (0.450-4.500)
Thyroxine (T4) 3.9 LOW ug/dL (4.5-12.0)
T3 Uptake 27 % (24-39)
Free Thyroxine Index 1.1 LOW (1.2-4.9 )
T4,Free(Direct) 0.73 LOW ng/dL (0.82-1.77)
Triiodothyronine,Free,Serum 2.7 pg/mL (2.0-4.4)
Do you treat the T4 even if the TSH is normal? I have experienced 10lb weight gain in the past year in spite of eating better but perhaps this is a reflection of my age (35). No other symptoms really to report.
Thank you so much in advance.
Hi Sarah,
There have been many studies that have shown that lithium inhibits thyroid function. In fact, it has been documented that many patients on long-term lithium will develop hypothyroidism. You might want to consider changing from lithium to another medication that doesn't negatively impact the thyroid.
Sarah
There have been many studies that have shown that lithium inhibits thyroid function. In fact, it has been documented that many patients on long-term lithium will develop hypothyroidism. You might want to consider changing from lithium to another medication that doesn't negatively impact the thyroid.
Sarah
She also didn't test FT3, which is not good.
In addition to Hashi's, there are several "temporary" or self-resolving kinds of thyroiditis. One of those, deQuervain's thyroiditis, is characterized by elevated TG. She probably tested TG to rule that out. If she hasn't tested TGab, she should. Some of us are TPOab positive, some TGab positive and some both.
In addition to Hashi's, there are several "temporary" or self-resolving kinds of thyroiditis. One of those, deQuervain's thyroiditis, is characterized by elevated TG. She probably tested TG to rule that out. If she hasn't tested TGab, she should. Some of us are TPOab positive, some TGab positive and some both.
Yes, having trouble with normal TSH; that is exactly the problem. Asked doctor a series of questions and she basically told me that she'd just like to "wait and watch." I will still pursue an Endo. I'm tired and still up 15 pounds, etc. Thank you for being so caring and informative. It really means a lot as this has been quite frustrating. What is the value of testing Thyroglobulin? Shouldn't she have tested more antibodies instead?
It definitely warrants treatment. FT4 is still below range, which indicates hypo. The problem is your TSH. Unfortunately, it's flat out "normal", and many doctors will look at that and tell you that you're just fine. So, finding an enlightened doctor is key.
How have you been feeling lately?
How have you been feeling lately?
Hello! So more testing was done.
The most recent values:
Free T4 - 0.6 Low (0.7-1.5)
TSH 3rd Gen - 1.68 (0.4 -4)
Thyroglobulin - 6.93 (1.6 - 50)
Thyroid Peroxidase Antibody 0.5 (0.0 -8.9)
Thoughts?! Does this warrant treatment? Trying to be patient.....
Thank you again!
The most recent values:
Free T4 - 0.6 Low (0.7-1.5)
TSH 3rd Gen - 1.68 (0.4 -4)
Thyroglobulin - 6.93 (1.6 - 50)
Thyroid Peroxidase Antibody 0.5 (0.0 -8.9)
Thoughts?! Does this warrant treatment? Trying to be patient.....
Thank you again!
I'd follow up on the D. For proper synthesis of thyroid hormones, D has to be well up into the range. Also, D is necessary for thyroid hormones to get into cells. We see some serious deficiencies these days, and doctors will put patients on as much as 50,000 IU per week until levels rise then back off to a maintenance dose. Iron/ferritin also figures into thyroid hormone synthesis and transport into cells.
I think it would be worth seeing an endo. Do you plan to interview them before making an appointment?
I think it would be worth seeing an endo. Do you plan to interview them before making an appointment?
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Total T4 and T3U are considered obsolete test of little value.
Your FT4 is below range, which means your thyroid isn't making adequate amounts. FT3 is in the lower third of the range, and it belongs in the upper half.
TSH is a pituitary hormone and as such is affected by many factors other than thyroid hormone levels. So, it's the least important of the thyroid tests, although doctors have been taught that it's the gold standard in thyroid testing. FT3 correlates best with symptom, FT4 falls behind it, and TSH does not correlate at all. So, the most alarming number there is your FT4, which is below range. It can be difficult to find a doctor who will treat FT4 and ignore TSH.
It's the lithium:
http://www.ncbi.nlm.nih.gov/pubmed/9827658
How long have you been on lithium? The study suggests that the hypothalamus/pituitary/thyroid axis might be "reset" when starting lithium.