Aa
confusted about T4 and TSH levels
recently I had blood work done and my TSH was 1.994 and my free T4 was 0.2 (out of reference range for t4). I have a lot of problems, pcos, heart palpitations, skin tags, problems with weight loss...now is .2 cosidered hyper or hypo? and is it possible to have a thyroid problem with normal TSH but out of range T4? I'm requesting my free T3 be done too. any help or suggestions would be great.
San Diego is 3 hours away w/o. Traffic. Thank you so much but think the drive would be insane using the worst freeway in the US; 405 fwy. You would think that there is an endocrinologist closer Los Angeles. There was one in Santa Monica but he wanted 1500.00 for just the labs before first visit. He is well-marketed in saying he only treats thyroid; poorly marketed as he is truly for the rich and famous! There is yet another with heavy marketing, offering free seminars on weight gain, losing weight, WTH!!! How about just feel "normal" first. I think these guys prey on the sick and tired. I will continue your reading list and learn more. Better health in better knowledge. Thanks for your care and direction. I look forward to your posts.
Unexpelled gas affecting test results for T3, T4 and Free T4????? I swear that doctors sometimes just make up things on the fly to justify some of their lack of knowledge about thyroid. I have heard a lot of excuses but that beats them all.
Anyway, I'm sending by PM links to some good info on this subject. I think you will find even more than you want to read, but they are very comprehensive and include extensive references to scientific studies that support what is said.
For over 4 years I have been gathering a list of doctors recommended by fellow members. Unfortunately I only have one in Southern Cal., in San Diego. Are you close enough to be interested at all?
Anyway, I'm sending by PM links to some good info on this subject. I think you will find even more than you want to read, but they are very comprehensive and include extensive references to scientific studies that support what is said.
For over 4 years I have been gathering a list of doctors recommended by fellow members. Unfortunately I only have one in Southern Cal., in San Diego. Are you close enough to be interested at all?
Interesting thought; makes perfect sense. I need to find a caring doctor who treats people respectfully by allowing them to participate in their own good health. If I am euthyroid, I can feel it! Is it just me or do the rest of you feel the difference when you go up or down?
sorry, meant 'out of network' or in my case paying cash to private doctor or use Kaiser, my health provider in SouthernCal. I used to be bluecross and they never listened to my symptoms. 15 years.......geeze. Endocrinology is dedicated to Diabetes due to higher health risk. They could care less unless you have thyroid cancer. I have had blood drawn for thyroid what I thought was a panel, it was only TSH; when I questioned my dr as to why he didn't run a panel, he explained that TSH is the most sensitive test. He even went as far to say that if I has gas (unexpelled), it could blow the test results for T3, T4, freeT4. What?!?!?!
I am almost ready to treat myself based on my own feelings.
I am almost ready to treat myself based on my own feelings.
When you said "go private" that made me think that you may be in the UK or Canada, or Australia? Is that correct? If not, please tell us your location and perhaps a member can recommend a good thyroid doctor.
Your bitter attitude is directly related to the exact problem of relating or relying upon TSH in particular as the holy grail of thryoid function.
Doctor's continued reliance upon TSH or even FT4 and FT3 ranges as being the be all end all is the PROBLEM.
As I pointed out above the ranges are developed in error. and then are relied upon as perfect. And that is what is causing many people to continue to feel like crap because Dr's won't get a clue.
And why won't the ranges change? Well my theory on this is pretty simple. Follow the money. The big Pharma companies are the ones who do much of the research and also donate lots of money to the medical schools. And low and behold if they don't contiue to push TSH and reference range endocrinology. Why?
Well think if a person has 6 symptoms the big drug companies can sell you 6 different drugs to mask all 6 symptoms. Many of which are proprietary and very profitable. OR they could sell you a single generic (read low profits) thyroid hormone that would solve all 6 symptoms. Now which one would you continue to push if you are in business to make money? Would you go and do research to change the reference ranges to prove that you don't need 6 profitable drugs and instead need only a single cheap generic hormone? I don't think so.
Doctor's continued reliance upon TSH or even FT4 and FT3 ranges as being the be all end all is the PROBLEM.
As I pointed out above the ranges are developed in error. and then are relied upon as perfect. And that is what is causing many people to continue to feel like crap because Dr's won't get a clue.
And why won't the ranges change? Well my theory on this is pretty simple. Follow the money. The big Pharma companies are the ones who do much of the research and also donate lots of money to the medical schools. And low and behold if they don't contiue to push TSH and reference range endocrinology. Why?
Well think if a person has 6 symptoms the big drug companies can sell you 6 different drugs to mask all 6 symptoms. Many of which are proprietary and very profitable. OR they could sell you a single generic (read low profits) thyroid hormone that would solve all 6 symptoms. Now which one would you continue to push if you are in business to make money? Would you go and do research to change the reference ranges to prove that you don't need 6 profitable drugs and instead need only a single cheap generic hormone? I don't think so.
Thank you for your clarity. My comments were given w/o knowledge of patient history. I am assuming and standardizing. I agree that after hypo; whether it be from post-ablation as in my case or any other way you became a hypothyroid patient; it is all about symptom relief and not the numbers. My doctor refuses to treat symptoms not supported by clinical testing. If the test say "within normal ranges", he will do nothing. I have been to several doctors and have yet to find an endo that gives a sh*t as to how I feel rather than test results. (my bitter attitude is showing). And poor Maegen, she has the test results and her doctors will not refer? Telling her to exercise more? This could hurt her, don't you agree? You appear extremely knowledgable about Thyroid and I defer to your advice and suggestions but as a Grave's Disease patient of 15 years, I still have questions and would like to learn more. The health system ***** unless you have the $$ to go private. Thank you for your link. Looking forward to your comments.
Just wanted to clear up a few things that might cause some confusion otherwise. First, TSH is supposed to be the most sensitive test for thyroid problems; however, in reality it cannot be shown to correlate well with either Free T3 or Free T4, much less with symptoms, which are the most important consideration. The following link shows the best correlation of TSH to Free T3 and Free T4 that I have ever been able to find. Yet, if you look at the graphical data, it is very clear that the correlation of TSH to Free T4 is poor, and the correlation to Free T3 is even worse.
http://www.clinchem.org/content/55/7/1380/F2.expansion.html
From the graphs, there is no way that a TSH test result can accurately predict levels of Free T3 or Free T4. So, the main value for TSH is really to distinguish between primary and central hypothyroidism. Beyond that TSH is only an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, FreeT3 and Free T4.
Further, there are numerous studies showing that when a hypo patient is already taking thyroid med, TSH frequently becomes suppressed below the range, without attendant hyper symptoms, and with Free T3 and Free T4 still well within the ranges. So when taking thyroid meds, TSH has little value in further treatment.
Not sure what you meant that "Thyroid hormone is difficult to measure due to many causes." In years past, thyroid hormone tests were less reliable, but today's test methods have been developed to the point that it seldom is even a topic of discussion any more. But test results are not vital anyway, just indicators, because hypo patients should be treated clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Patients are all different and their thyroid hormone requirements to feel well also vary significantly. So, symptom relief should be all important, not just test results and certainly not TSH results.
http://www.clinchem.org/content/55/7/1380/F2.expansion.html
From the graphs, there is no way that a TSH test result can accurately predict levels of Free T3 or Free T4. So, the main value for TSH is really to distinguish between primary and central hypothyroidism. Beyond that TSH is only an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, FreeT3 and Free T4.
Further, there are numerous studies showing that when a hypo patient is already taking thyroid med, TSH frequently becomes suppressed below the range, without attendant hyper symptoms, and with Free T3 and Free T4 still well within the ranges. So when taking thyroid meds, TSH has little value in further treatment.
Not sure what you meant that "Thyroid hormone is difficult to measure due to many causes." In years past, thyroid hormone tests were less reliable, but today's test methods have been developed to the point that it seldom is even a topic of discussion any more. But test results are not vital anyway, just indicators, because hypo patients should be treated clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Patients are all different and their thyroid hormone requirements to feel well also vary significantly. So, symptom relief should be all important, not just test results and certainly not TSH results.
Pls know that the TSH test (yes, pituitary hormone) is the most sensitive test for thyroid problems. When your TSH is below .35, it means that there is enough thyroid hormone in the blood and there is no need for the pituitary (the chief) to secrete TSH. Thyroid hormone is difficult to measure due to many causes. Sometimes, when taken with certain medicines, it can block absorption. As well, you should take your pill with as little water as possible and eat/drink nothing for two hours. I set my alarm early so I can take my medication; so early, I fall back to sleep. It has been very helpful in trying to stablize by eliminating absorption problems.
By all accounts, your primary care physician should not have a problem referring with the very obvious contradiction in the test results you posted. Labs make mistakes. Your PCP can reorder test (Thyroid Panel) within 6 weeks of previous labs. In the mean time, your hypo.......you know it; what can you do about it? You need more hormone, outside labs don't write RX's and most doctors will not prescribe without using their chosen lab for results. Maybe you can call early for same day appointment with test results in hand. Or try Urgent Care; can they refer you? Please let us know how you doing. Take care, rest up until you get more hormone. God bless
By all accounts, your primary care physician should not have a problem referring with the very obvious contradiction in the test results you posted. Labs make mistakes. Your PCP can reorder test (Thyroid Panel) within 6 weeks of previous labs. In the mean time, your hypo.......you know it; what can you do about it? You need more hormone, outside labs don't write RX's and most doctors will not prescribe without using their chosen lab for results. Maybe you can call early for same day appointment with test results in hand. Or try Urgent Care; can they refer you? Please let us know how you doing. Take care, rest up until you get more hormone. God bless
I agree that you are hypo. When my FT4 was that low I could barely function. What area do you live in? Maybe someone on here has a recommendation for a good dr. Have you asked your current drs if they would be willing to give you a referral for a second opinion?
I'm going to keep trying. I called my 3rd place today and just laid it out and had my blood work sent to them. I'm definitely going to look into that order your own stuff thing. Thank you for all the info you've given me. Hopefully I can get started on some meds and make my workouts count more and shed this weight I've put on. I knew I wasn't lazy and I'm tired of the doctors telling me to eat less and workout more. If I ate any less I'd be even more tired than I already am.
There are a number of online labs, but some of our members have had very good luck with healthcheckusa. They send you to a local lab for the draw then send the results to you. FT3, FT4 and TSH are $85 altogether. They were very prompt. If you don't like them or they don't service your area, there are many other labs available as well. Just google online lab tests.
There's no arguing that your FT4 is "normal". It's way below range. I would think that one of the doctors could refer you on that basis. You might have to be insistent.
There's no arguing that your FT4 is "normal". It's way below range. I would think that one of the doctors could refer you on that basis. You might have to be insistent.
I've called 2 endocrinologist offices and they tell me that I need to be referred despite having a ppo. They said that either my Ob/gyn who orginally ordered the blood work and told me all my number were normal or my family doc needs to refer me if they feel there is a problem. I feel very stuck right now! It's getting ridiculous.
I agree with goolarra.
RUN do not walk away to find another Dr.
TSH is just short of a completly worthless test. It is a screening tool at best.
And at worst Dr's relianec upon TSH is keeping many, many people feeling just like you do. Like crap but they will tell you that you are depressed or lazy. The medical industry seems happy as clams to hand out anti-anxiety and anti-depressants by the handfulls on a whim. But are reluctant to even test for nor learn the first thing about the research on thyroid which shows that TSH is a nearly totally unreliable indicator of true thyroid status.
Think about this and tell me how stupid this sounds.
Your body at the cellular level uses ONLY the Free T3 Hormone. Yet many if not most Dr's won't even test for it. Where does the vast majority of the Free T3 in your body come from? Well from the conversion of the Free T4 hormone of course, But many Dr's won't test for free T4?
Does that make any cotton picking sense to you? Instead of actually testing for the ACTUAL hormones that your body uses, they insted test for not even a thyroid hormone. TSH which is a pituitary hormone. This is absolutely insane!
To make matters worse, the develop the reference or so called "normal" ranges by taking the people who have been tested for these thyroid hormones and then throw out the highest 2.5% and the lowest 2.5% and call the rest of the 95% "normal".
Now think about this a second. My first statement I made said that they take the total number of people being tested for thyroid to base the 'normal' range.
So the first rational and logical question that comes to mind is; Who are the people who go to the lab to get thyroid blood tests done? And the obvious answer to this questions is; "people who are highly probable or at least are having suspicions about having thyroid problems".
In other words, they are basing what is "normal" based on a population of test data from highly probably sick people due to thyroid problems.
Does that make ANY sense to ANY rational human being with two brain cells to rub together???????
And yet we have Dr's who use the reference range like it is perfect science.
Then when a person falls into the "normal" range that is so poorly established from sick people they have the nerve to diagnose you as being perfectly "normal". And pump anti-depressants into you and call you lazy for gaining weight or that you "Cheat" on your diet.
It is maddening!!!!!!
RUN do not walk away to find another Dr.
TSH is just short of a completly worthless test. It is a screening tool at best.
And at worst Dr's relianec upon TSH is keeping many, many people feeling just like you do. Like crap but they will tell you that you are depressed or lazy. The medical industry seems happy as clams to hand out anti-anxiety and anti-depressants by the handfulls on a whim. But are reluctant to even test for nor learn the first thing about the research on thyroid which shows that TSH is a nearly totally unreliable indicator of true thyroid status.
Think about this and tell me how stupid this sounds.
Your body at the cellular level uses ONLY the Free T3 Hormone. Yet many if not most Dr's won't even test for it. Where does the vast majority of the Free T3 in your body come from? Well from the conversion of the Free T4 hormone of course, But many Dr's won't test for free T4?
Does that make any cotton picking sense to you? Instead of actually testing for the ACTUAL hormones that your body uses, they insted test for not even a thyroid hormone. TSH which is a pituitary hormone. This is absolutely insane!
To make matters worse, the develop the reference or so called "normal" ranges by taking the people who have been tested for these thyroid hormones and then throw out the highest 2.5% and the lowest 2.5% and call the rest of the 95% "normal".
Now think about this a second. My first statement I made said that they take the total number of people being tested for thyroid to base the 'normal' range.
So the first rational and logical question that comes to mind is; Who are the people who go to the lab to get thyroid blood tests done? And the obvious answer to this questions is; "people who are highly probable or at least are having suspicions about having thyroid problems".
In other words, they are basing what is "normal" based on a population of test data from highly probably sick people due to thyroid problems.
Does that make ANY sense to ANY rational human being with two brain cells to rub together???????
And yet we have Dr's who use the reference range like it is perfect science.
Then when a person falls into the "normal" range that is so poorly established from sick people they have the nerve to diagnose you as being perfectly "normal". And pump anti-depressants into you and call you lazy for gaining weight or that you "Cheat" on your diet.
It is maddening!!!!!!
A doctor who is only concerned about TSH is one to run, not walk, away from. If he won't really look at FT4, why did he order it? What about being so far below range doesn't bother him? I can't tell you how irresponsible I think it is to ignore your FT4 level for a month. I'm sorry, but these guys make me MAD!
Unfortunately, just because a doctor is an endo doesn't guarantee that he's a good thyroid doctor. Many endos are only interested in diabetes and don't really keep up on thyroid, either. You might try calling the office before making an appointment and asking to speak to a nurse. You can ask her how much emphasis the doctor puts on TSH versus FT3 and FT4. Some will fully admit that TSH is all they care about, so the worst of the worst can be sifted out.
If your doctor won't order FT3, you can order it yourself online (insurance doesn't cover this). However, I think it's important for you to be on meds, so you shouldn't delay seeing a doctor. Your FT4 level should be more than sufficient to get you started on meds. You can request FT3 next time around.
Unfortunately, just because a doctor is an endo doesn't guarantee that he's a good thyroid doctor. Many endos are only interested in diabetes and don't really keep up on thyroid, either. You might try calling the office before making an appointment and asking to speak to a nurse. You can ask her how much emphasis the doctor puts on TSH versus FT3 and FT4. Some will fully admit that TSH is all they care about, so the worst of the worst can be sifted out.
If your doctor won't order FT3, you can order it yourself online (insurance doesn't cover this). However, I think it's important for you to be on meds, so you shouldn't delay seeing a doctor. Your FT4 level should be more than sufficient to get you started on meds. You can request FT3 next time around.
I have an appointment next month. The nurse that I talked to said the doctor won't really look at the FT4, that he is more concerned about my TSH. I'm no moron, it didn't sound right to me so I called an endocrinologist and will probably tell the doc I want an FT3 done and then see what comes of that and then see the endocrine doc. I feel like I'm getting blown off. I've been telling family doc for over a year that I'm so tired I can barely function, my body aches esp in back and feet, I'm growing skin tags like crazy. The nurse also said your FT4 isn't the reason for your weight. I told her I go to the gym 5 days a week and eat well.
With an FT4 of 0.2 (bottom of range 0.7), I'm kind of surprised you're walking! LOL You are VERY hypo. TSH is a very unreliable marker of thyroid status. Yes, you can be hypo with "normal" TSH. With your FT4 so low, we would expect your TSH to be much higher. You might want to do some research on secondary (also called central) hypothyroidism.
FT3 would be great to see. If at all possible, have FT4 and TSH repeated on the same blood draw.
Has your doctor suggested thyroid meds?
FT3 would be great to see. If at all possible, have FT4 and TSH repeated on the same blood draw.
Has your doctor suggested thyroid meds?
I want to add that .7 is the bottom of range for t4 and I am .2. my lab work a year ago was TSH 1.86 on a .35-4.0 range and my T4 was 1.12 a year ago. so what is going on? I feel so crappy all the time.
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