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Battle with Doctors ..and Hypo problems

I am very concerned about my health. I made an appointment last year with an Endocrinologist. I had lab work and my TSH was 3.4 (considered normal on lab corp ranges) but when doing research online and my primary doctor, they said 3.4 is high on what it should be consider the new "normal". My LDL Cholesterol was also high. Well after a year of very good nutrition ..research about thyroid, gym, exercise. I asked my doctor to also check my Free T3 and Free T4 plus Reverse T3, basically I did this because of my research.

Labwork came back TSH 5.8 (out of the normal for Labcorp) but my doctor said it was fine again. Free T3 low and he said it was fine. Reverse T3 a little on the high end. Base on research when Free T3 is low it can affect Cholesterol (well when thyroid is underactive) and then Both thyroid and Cholesterol affect my free testosterone which is low now.

He just gave me medicine for the cholesterol. I went to another doctor and this one tells me he only considers HYPO someone with TSH higher than 10. Completely different than all information online and books. He said my cholesterol is high but HDL ratio to triglycerides was good. (which is true base on my research). He thinks I may be the exception and have a problem with a 5.8 TSH and wants to give me Synthroid.

I am planning to go to another doctor. Because the more books and research I read. This is not right. My tsh is high.. my free t3 is low. it can be a conversion of T4 to T3 problem. Therefore in order to solve it I need Armour or Armour+Cytomel but both doctors I saw think my TSH is fine and they believe TSH is the important part, when everywhere doctors keep repeating to check FT3 and FT4 ! and Reverse T3.

I need more opinions. I put the references number on the side. Last year TSH was 3.4 and T4 was 1.5 but no T3 or Reverse.

Cholesterol is higher than last year..only LDL and Testosterone was normal last year.

Results:

Lipid Panel

Total Cholesterol - 334 mg/dL ---High 100-199

Triglycerides - 59 mg/dL 0-149

HDL - 84 mg/dL >39

VLDL - 12 mg/dL 5-40

LDL - 238 mg/dL 0-99

Thyroid

Free T4 1.25 ng/dL 0.82 - 1.77

TSH 5.8 uIU/mL 0.45 - 4.5

Reverse T3 20.2 ng/dL 9.2 - 24.1

Free T3 1.5 pg/mL LOW 2.0 - 4.4

SHBG 55.9 nmol/L 16.5 - 55.9

Free Testosterone (Direct) 5.3 pg/mL LOW 9.3 - 26.5

Total Testosterone 471 ng/dL 348 - 1197
6 Responses
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Avatar universal
It appears that you have a number of issues that are related to being hypothyroid.  Your hypothyroidism is due to your low Free T3 level.  Due to the erroneous procedure for establishing ranges, Free T3 and Free T4 in the  lower half of the range, is cause for suspicion of hypothyroidism.  Your Free T4 is slightly below recommended level, and your Free T3 is actually below the range.  I don't remember ever seeing someone with such a low Free T3 when Free T4 is near the middle of the range, so it appears there is a conversion problem.  

There is more to discuss, but before going further, please tell us about any symptoms you have.

Helpful - 0
2 Comments
Thank you for the response. The symptoms I have is.. fatigue, dry skin..weight gain or hard to maintain weight. But Im not sure if is my diet that is causing this T4 not to convert. to T3. I read that this conversion process needs carbs, and I do Low Carb diet. If I increase and start eating carbs, I blow up and gain easy. Then maybe I'm eating to low in calories and this is why my T3 is low. But if I increase calories, I gain weight too. This is frustrated.
Thank you for the response. The symptoms I have is.. fatigue, dry skin..weight gain or hard to maintain weight. But Im not sure if is my diet that is causing this T4 not to convert. to T3. I read that this conversion process needs carbs, and I do Low Carb diet. If I increase and start eating carbs, I blow up and gain easy. Then maybe I'm eating to low in calories and this is why my T3 is low. But if I increase calories, I gain weight too. This is frustrated.
Avatar universal
Those symptoms are frequently related to being hypothyroid.  So that is further evidence of hypothyroidism.  In diagnosing hypothyroidism, symptoms are the most important indicator, followed by Free T4 and Free T3 levels.  

If you want  to do some reading on hypothyroidism, following is a link.  I highly recommend reading at least the first two pages and further if you want to delve into the discussion and scientific evidence supporting all the recommendations.  You can also note on page 7 the main factors affecting conversion of T4 to T3.  Note that carbs are not included as a factor.  

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

I think you need to do some further tests.  Specifically, you need to follow up on the increased TSH by testing for the antibodies of Hashimoto's Thyroiditis.  Specifically those are Thyroid Peroxidase antibodies and Thyroglobulin antibodies.  Tests are shown as TPO ab and TG ab.  In addition, it would be good to test for Vitamin D, B12, ferritin, selenium, zinc,  and cortisol.  You will find most of these listed in Suggestion 6 on page 2.  

After those tests I think it will be clearer as to what should be done for treatment.  You will at least need a good thyroid doctor that will treat clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  

In case you whould have trouble finding such a doctor, if you will tell us your location, perhaps we know of a doctor in your area that has been recommended by other thyroid patients.  
Helpful - 0
3 Comments
Thanks for all the  information. I live in Cliffside Park , NJ (United States) I really need help with doctors.
I live in Cliffside Park, NJ (United States) I need help finding a good doctor.
Btw that link with the PDF doesnt open. It seems it needs some permissions to be available.
Avatar universal
I don't understand about the link.  I tried it several times and it worked fine.  Maybe try this link and then look for the article on the right hand side, in a small box by itself.  Diagnosis and Treatment of Hypothyroidism.  


http://www.thyroiduk.org.uk/tuk/
Helpful - 0
1 Comments


After using T3.. this are my test results!! WOWW Cholesterol dropped! dramatically!.. my T3 increased to normal.. but TSH is low.. (which we knew it was going to happen plus I read it's suppose to happen). T4 also dropped because the body is not doing it since it already has sufficient T3. I know in a perfect world I will want TSH, T4, T3 all normal. but this is the best I felt in a long time. I dont even need a pre workout anymore.

look at my results

https://s24.postimg.org/xaytsiz85/screen_shot_2016_12_16_at_8_56.png
Avatar universal
Glad that you are doing much better.  From your latest test results the T3 med has suppressed your TSH, and with little TSH stimulation of your thyroid  gland, your body is producing very little thyroid hormone.  From that your Free T4 is below range, which is not advisable.  You need to add a source of T4 to your meds and get your Free T4 to at least the middle of the range.  

Have you tested for Vitamin D, B12 and ferritin?

When did you start on T3 med?  What is your daily dosage?
Helpful - 0
1 Comments
I have not tested for Vitamin D, B12, or Ferritin. I started T3, about a month ago. and the daily dosage was 25mcg and now 50mcg since I take my temperature and still in the 97s..
Avatar universal
I highly recommend testing for Vitamin D, B12, and ferritin and then supplementing as needed to optimize.  D should be at least 50, B12 in the very upper end of its range, and ferritin should be at least 70.  All three are very important, and frequently deficient in hypothyroid patients.  

I also would not recommend taking such a big increase in T3 all at once.  It could cause you to have a hyper reaction.  I would recommend that you add T4 to your med dosage, and get your Free T4 to at least mid-range.  Along with that Free T3 should be in the upper third of the range, and adjusted gradually, as needed to relieve hypo symptoms.  Body temperature is affected by a number of things other than thyroid, so it is NOT a good idea to dose yourself by temperature alone.  

If you want some insight on this subject, please read the first two pages of the following link, and also read further if you want to get into the discussion and scientific evidence for all that is suggested on page 2.  Note that recommended tests include cortisol also.  Cortisol levels have a big effect on body temperature.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

I really suggest that you find a good thyroid doctor that will treat clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results.  
Helpful - 0
Avatar universal
Gimel is giving great advice.

It is great that you are following up and treating your thyroid levels and I recommend you continue to do so and also get those other vitamin levels checked.

I think however that it is very important that you do NOT forget about your Low Testosterone level.  That too can have a dramatic affect on your weight issues as well as energy levels (fatigue and stamina) and muscle tone etc.

I do not know what your age is. But unless you are like an 85 year old man, your Testosterone levels are probably lower than an 85 year old man.

I'm not exactly sure how Testosterone may or may not affect thyroid or the metabolism of thyroid. But it has a huge factor on a man's overall health.

I think there is another forum under sexual health that has or is a place to discuss testosterone hormone issues. So you may also want to check that out!
Helpful - 0
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