TSH Level going up, T4 Free going down?

[Jenny623]

You seem to know a lot about this stuff so here it goes.  I have been watching my blood work for years.  Apparently Thyroid problems run in my family.
      TSH Level -        T4 Free
2010 - 2.4                     0.8
2013 - 2.63                   0.7
2014 - 2.81                   0.6
The TSH levels are going up and the T4 Free levels are going down?  What does this mean?  Any insight is greatly appreciated.  I am 44.  Thanks!

[goolarra]

You need a new doctor, then.

I've had my FT4 at 0.6, so I know you must not be feeling well at all.

Can you refer yourself to a new doctor on your health plan?  You don't necessarily have to see an endo; an enlightened PCP can manage your thyroid condition.

This doctor is just going to keep you feeling terrible for another 2-3 months.  Don't put up with that...

[Jenny623]

Thank you for all your information.  I called my doctor and he said not to be concerned and if I was concerned, I should have my blood tested again in two to three months.

[goolarra]

High cholesterol is s symptom of hypothyroidism.  If you were on thyroid meds, your cholesterol would most likely go down.

I think your doctor is just looking at your TSH, even though he does order FT4.  TSH is a pituitary hormone, subject to many influences and a very indirect measure of thyroid function.  FT4 is the actual thyroid hormone and a direct measure.  He should be testing FT3 as well.  It's the active form of the thyroid hormones and correlates best with how you feel.  

If I were you, I'd sit down and discuss your FT4 level with your doctor.  It's clearly below range, and you have several symptoms of hypo...weight gain or inability to lose weight, fatigue, cold intolerance and high cholesterol.  If he won't start you on thyroid meds, I'd ask for a referral to an endo.  If he's anxious to lower your cholesterol, he should be more than willing to treat your hypothyroidism.

[Jenny623]

My general doctor doesn't say anything, all he says to do is lower my cholesterol.  Never even mentions the low ft.  The only reason I know is because I get a copy of my blood test results ever since my younger sister had to have her thyroid removed due to goiters.

[goolarra]

Your FT4 is way too low.  Because thyroid test ranges are very flawed, the guideline for FT4 is 50% of range (1.3 on your range).  This is based on where many of us have to be for symptom relief.  Many people are very symptomatic low in range, never mind below.  

Considering how low your FT4 is, I'd expect your TSH to be considerably higher than it is.  

I think you need to be on meds.  What does your doctor say?

[Jenny623]

The ft4 reference range is 0.8 to 1.8, so 0.6 is low.  As far as symptoms I am overweight and try to lose weight, but it doesn't happen as easily as it used to.  I am tired often but I have 4 kids, 5 if you include my husband.  I am either freezing or sweating but I figured that was just menopause beginning or something.  

[goolarra]

What's the reference range on your FT4?  Those number all look to be very low in the range or even below range.

TSH is counterintuitive.  The higher TSH is the lower your thyroid is functioning (hypo), and the lower it is the higher it's functioning (hyper).  

How do you feel?  Do you have hypo symptoms?

[Red_Star]

TSH will rise when T4 drops. There are exceptions but in your case the negative feedback loop is working fine. A TSH over 2.5mU/L is a warning all is not well. When I went in for testing due to my worsening of symptoms (already had cellular resistance problems) my TSH was mid 2 range. I also pushed for thyroid antibodies which showed I had Hashimoto's thyroiditis. This is an autoimmune disease that runs in families. The thyroid antibody tests are thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb).