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Do my levels indicate hypothyroidism?
TSH=1.29, T3F=4.0, T4F=.77. My doctor said everything is normal, which technically, I suppose it is, but I suffer from almost every symptom of hypothyroidism. I also have been diagnosed with pernicious anemia and have been treated for low vitamin D on several occasions. My most recent vit d level was 15.4.
I expect that your doctor is really paying attention only to TSH and not the T3 and T4 test results. So when you see the doctor, if he tries to convince you that since your TSH is in range, you are okay, don't accept that. Point out to him that the graphs on page 24 of the link above show clearly that TSH does not correlate well with either Free T4 or Free T3. So TSH cannot be assumed to accurately reflect your thyroid levels. This is very clear since your TSH is relatively low in its range, and your Free T4 is right at the bottom of the range, and your Free T3 is only at 37% of its range. ( I mis-calulated it as 14% previously). The reason your Free T3 is higher in range than your Free T4 is that your body is trying to maintain thyroid function as best possible by converting more T4 to T3.
Your relatively low TSH most likely indicates central hypothyroidism. With central, there is a dysfunction in the hypothalamus/pituitary system which results in TSH levels that are too low to adequately stimulate your thyroid gland to produce thyroid hormone. So the doctor needs to pay attention to your many symptoms as the most important indicator, followed by your relatively low Free T4 and Free T3 levels. You might find useful the following link that lists 26 typical hypothyroid symptoms. I would circle those that you have, and give a copy to the doctor.
http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html
Your relatively low TSH most likely indicates central hypothyroidism. With central, there is a dysfunction in the hypothalamus/pituitary system which results in TSH levels that are too low to adequately stimulate your thyroid gland to produce thyroid hormone. So the doctor needs to pay attention to your many symptoms as the most important indicator, followed by your relatively low Free T4 and Free T3 levels. You might find useful the following link that lists 26 typical hypothyroid symptoms. I would circle those that you have, and give a copy to the doctor.
http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html
You sure do have lots of symptoms typical of hypothyroidism. In assessing a person for possible hypothyroidism, the most important consideration is symptoms that occur more frequently with hypothyroidism. when a person has those, then that needs to be confirmed with biochemical tests for Free T4 and Free T3, and sometimes Reverse T3. Contrary with what most doctors have been taught, TSH is useful as a diagnostic only at extreme values, and to differentiate primary from central hypothyroidism. Also contrary to what most doctors have been taught and follow, thyroid related test results within the reference ranges does not necessarily mean that all is okay.
Looking at your thyroid related test results I see that your Free T4 of .77 is right at the bottom of the range, which is inadequate for many people. Also your Free T3 of 4.0 is only at about 14 % of its range, which is also too low for many people. I say that because the ranges are far too broad due to the erroneous assumptions used to establish them. Further evidence comes from this quote from an excellent thyroid doctor. "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms." These ranges are different from yours, but the implication is clear.
A good thyroid doctor will diagnose and treat a potential hypothyroid patient clinically, by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. . Many of us have found this we needed Free T4 at least to mid-range, and Free T3 in the upper third of its range, and adjusted from there as needed to relieve symptoms. You can read all about this in the following link. I recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
Also note that hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin. Ferritin is a storage form of iron which seems to be a precursor to changes in iron levels. So you should also be tested for ferritin and then supplement as needed to optimize. Vitamin D should be at least 50 ng/mL, B12 in the upper end of its range and ferritin should be at least 100. All 3 are important for a hypothyroid patient.
If you are unable to get your doctor to treat clinically, as described, you might try giving him a copy of the link and ask him to read and reconsider. If that doesn't work, what options do you have for finding a good thyroid doctor?
Looking at your thyroid related test results I see that your Free T4 of .77 is right at the bottom of the range, which is inadequate for many people. Also your Free T3 of 4.0 is only at about 14 % of its range, which is also too low for many people. I say that because the ranges are far too broad due to the erroneous assumptions used to establish them. Further evidence comes from this quote from an excellent thyroid doctor. "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms." These ranges are different from yours, but the implication is clear.
A good thyroid doctor will diagnose and treat a potential hypothyroid patient clinically, by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. . Many of us have found this we needed Free T4 at least to mid-range, and Free T3 in the upper third of its range, and adjusted from there as needed to relieve symptoms. You can read all about this in the following link. I recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
Also note that hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin. Ferritin is a storage form of iron which seems to be a precursor to changes in iron levels. So you should also be tested for ferritin and then supplement as needed to optimize. Vitamin D should be at least 50 ng/mL, B12 in the upper end of its range and ferritin should be at least 100. All 3 are important for a hypothyroid patient.
If you are unable to get your doctor to treat clinically, as described, you might try giving him a copy of the link and ask him to read and reconsider. If that doesn't work, what options do you have for finding a good thyroid doctor?
1 Comments
Thank you for the information. I will check back in with my doctor to follow up.
Thyroid related test results and associated reference ranges vary from lab to lab, so in order to assess your test results we need to know the ranges shown on the lab report for those tests. Also, please tell us about the specific symptoms you have.
What are you doing for the pernicious anemia? Also are you supplementing for the low D? If so, what is the daily dose? Have you been tested for ferritin, or even a serum iron test?
What are you doing for the pernicious anemia? Also are you supplementing for the low D? If so, what is the daily dose? Have you been tested for ferritin, or even a serum iron test?
2 Comments
Some of the symptoms I experience are fatigue, weight gain, constipation, dry skin, joint pain, hair loss, depression and anxiety, dry eyes, bloating, headaches, cramping, heavy cycles. For the pernicious anemia I am taking 2000mu of B12 daily. For the vit D, I am currently on a mega dose 50,000 u/week. TheTSH ranges are .47-4.68. T3f are 2.7-6.2. T4f are .78-2.19.
My iron test results were Iron=56 (37-170), TIBC=404 (265-497) and Iron saturation=14 (11-46).
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