Confused!! Free T4 level

[Tea83]

Hi all,
I have recently gone to the doctor as I have been experiencing fatigue, bad stomach problems, high blood pressure and stress.  I'm a 31 year old female from Australia. The doctor ordered bloods and my free t4 has come back high. I have been asked to re do the test in two weeks time and they will assess what happens next. I am all new to this and really confused as not many good reading material online. Could some one please help interperet my results. How high is high? Are my level just a little high and what treatment will I most likely receive? What are the chances my results are wrong hence having to do bloods again.  Thank you in advance

27/6/14
Free t4 15.8 pmol/l (10.0-19.0)
Tsh 2.81 miu/l (0.50-4.00)

11/12/14
Free t4 19.8 pmol/l (10.0-19.0)
Tsh 2.98 miu/l (0.05-4.00)

[irishmaid]

Hi I am a 57 year old fit Irish woman - I am on 75g of Eltroxin daily - I just got back my blood tests and it says Low TSH - please review
TSH 0.07        mU/L     0.0 -4.2
Free T4          19.0       pmol/L 12 - 22

totally confused
also  
cholesterol total     4.9      mmol/L  0 -5.0
triglycerides           1.00    mmol/L  0 - 1.7
cholesterol (HDL)   1.45   mmol/L   1.2  - 99
LDL cholesterol      3.00   mmol/L    0 - 3.0

Thank you

[Barb135]

Are you having symptoms of over medication, such as sudden weight loss, diarrhea, rapid heart rate, heart palpitations, etc?  

Did you have a Free T3 test done?  If so, could you please post that result?  

TSH is a pituitary hormone and only one part of the picture, with Free T3 and Free T4 being much more important, since they're the actual thyroid hormones.  Free T3 is that active thyroid hormone.

[Catherinero86]

Thanks gimel

[gimel]

As always good advice from goolarra.  I just happened to note that you haven't posted any result from a test for ferrritin, which is a form of iron that is very important.  You can read about symptoms of low ferritin in this link.  For women it is recommended that ferritin should be 60 at minimum.

http://articles.submityourarticle.com/symptoms-of-low-ferritin-levels-230015

[Catherinero86]

no she didn't check either of those, I think it's time to move doctor because I nearly had to beg for this tests.
I will start on some vitamin B my mum is a nurse so maybe she will be able to give me some vitamin b12 injections.
thanks so so much for your help

[goolarra]

That is an extremely low B-12 range.  In this country, it usually starts around 200 and goes to around 1,000.  Some people have to be at the top or over range to feel well.  In some countries, B-12 range starts at 500.  You might ask about supplementing B-12.  B-12 deficiency can cause the most unbelievable fatigue from what I've heard.  If you supplement orally, be sure to recheck levels to make sure you're absorbing it.  Pernicious anemia is the inability to absorb B-12 through the gut.  If you don't absorb oral meds, you'd have to get an injectable from your doctor.

Those are all hypo symptoms, but with D and B-12 so low, they could easily be blamed on one of those as well.  

Your doctor didn't test any thyroid antibodies?  TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies)?

[Catherinero86]

finding it hard to lose weight, dry skin to the point of it becoming more like a dermatitis and just a general brain fog kind of feeling. B12 is 502pg/ml (range 191 to 663)
Thank you so much for your reply, you are a wealth of information.

[goolarra]

Your FT4 level is at 38% of range, which is a little low of the 50% guideline.  However, FT3, which is the hormone that correlates best with symptoms, is at 75%, which is well into the upper half recommended.  TSH is on the high side of the 0.3-3.0 range, which indicates your pituitary would like more thyroid hormone present.  Prolactin can be elevated with hypothyroidism.

When FT4 is on the low side, we sometimes "over-convert" and make too much FT3.  That could be happening in your case.

Your numbers aren't too bad.  They're not perfect, but I wouldn't worry about them at all if you felt well.

FT3 and FT4 measure the levels of those hormones in the blood.  However, the hormones have to get into the cells to do there work.  There is currently no way to measure them at the cellular level.  However, we do know that there must be sufficient vitamin D in cells for thyroid hormones to get in.  Otherwise, you can be hypo on the cellular level with very nice looking FT3 and FT4 levels.

If I were you, I'd work on improving your vitamin D level and see if that helps.  If you get your D level to where it has to be for proper metabolism of thyroid hormones (I've read 50-70) and you still have symptoms, then definitely recheck thyroid.  

Do you have other symptoms besides fatigue?  Do you know your B-12 level?      

[Catherinero86]

Hi thanks for your reply

reference ranges
free T3 :3.1 to 6.8 pmol/L (me = 5.9)
free T4: 12 to 22   pmo/L  (me = 15.8)

Vitamin D is 36.5
folate test also 4.4 ng/ml ref range 4.6 to 18.7
prolactin 548 mIU/L ref range 102 to 496 (not pregnant or breast feeding)
wbc 12.6 ref range 4 to 10
rbc 5.06 ref range 3.8 to 4.8

[goolarra]

What are the reference ranges on your FT3 and FT4?  Ranges vary lab to lab and have to come from your own lab report.  Do you know your D level?

[Catherinero86]

Hi I am hoping someone can shed some light on this results? are they normal I have been feeling exhausted lately.

Free T4: 15.8 pmol/L
Free T3: 5.9   pmol/L
TSH: 3.42      mIU/L

also have a vitamin D deficency

[Tea83]

I just found out that I have Dientamoeba Fragilis and I think this is what caused the fatigue and stomach problems. I am being treated with antibiotics. I spoke to the dr again about my blood work and she said if the results are true I am hyper. My grandmother also has the hyper condition. So I will wait a few weeks and re do bloods. The dr said if come back same I will have to see a specialist. Thank you for all your help. It was good to talk to the dr again after doing some research. Have a lovely Christmas and new year.

[goolarra]

I think you have to insist on testing FT3.  With your high FT4, you shouldn't be having any hypo symptoms, so we have to see what FT3 is doing.  You shouldn't have to sleep so much with your high FT4.  Will your doctor order FT3 if you request it?

Have you had any vitamins and minerals tested?  B-12 deficiency can cause incredible fatigue.  Both vitamin D and iron (ferritin) are necessary for thyroid hormones to get into your cells and do their work.  Vitamin D deficiency is just about epidemic, especially in northern climates.

[Tea83]

I have put on weight and find it very hard to shift even though I eat reasonable well and excerise. I find a need a lot of sleep 10 hours is great if I can get it. I have problems sleep during the night and find if I can sleep during the day it's better. I have had high blood pressure since may 2014 just starting to get into stage one hypertension. I get a sick stomach a lot of the time and it's more diarrhea. I am also gluten intolerant. I have felt sick and run down for last few month And symptoms were getting worse. I crave a lot of sugar and often feel sick after eating. Thank for all help your explaination is fantastic.

[goolarra]

Usually, when FT4 is high, TSH is low.  However, FT3 is the other thyroid hormone, and we don't know what it's doing, so it could explain the apparent contradiction between FT4 and TSH.

Whether you are hypo or hyper also depends on what your FT3 is doing, so it's very important to get that tested next time you have labs.  TSH is nothing but a messenger from your pituitary to your thyroid to tell it to make more thyroid hormone.  TSH, low or high, causes NO symptoms.  FT3 correlates best with symptoms, FT4 not as well, and TSH not at all.

Tell me more about your symptoms, please.  Weight gain or loss?  Sleeping too much (without feeling rested) or insomnia?  Elevated BP and/or HR?  Constipation or diarrhea?  Hand tremors?  Anything else?

[Tea83]

Thank you goolarra for taking the time to reply.

What does it all mean with tsh being as high as it is and the ft4 being high? Am I hypo or hyper? Is it likely I need meds?

Over the last few months I have been a lot sicker constant fatigue and really bad stomach issues, so a lot worse since first test.

The dr has told me that after Xmas to do more bloods, the antibodies and t4. She hasn't put t3. Been told see what results hold and I might need to see a specialist.

Thanks again for you help. I don't understand this stuff so new to me.

[Tea83]

Thank you goolarra for taking the time to reply.

[goolarra]

Back in June, your FT4 was just a little on the high side at 64% of range (50% is the guideline).  However, as you can see, it's now over range.

Your TSH hardly changed between the two labs.  I'm surprised that with FT4 over range your TSH is still as high as it is.

Did your symptoms worsen between the two labs?

Have they done any antibody testing?  Has FT3 been tested?  Ultrasound?