Avatar universal

FT3 elevated, normal FT4 and TSH


I've been feeling really tired and unmotivated for some time, so I had my blood levels checked in order to determine if maybe there was something wrong with my thyroid.
The results were as follows: TSH 2.41, FT3 4.5 (2.0-4.2) and FT4 1.3 (0.8-1.7). My doctor did another blood test of which the results were similar and which indicated that I have no antibodies. I now have a scintigramm scheduled for next week because apparently the blood test results are not really conclusive.
I've done some research and found out that apparently it is unusual for my FT3 level to be elevated while the TSH and FT4 are still normal. Does somebody know what the cause of this could be? And doesn't an elevated FT3 level indicate that I have hyperthyreosis? My symptoms are the complete opposite of what you usually associate with hyperthyreosis, I feel tired all the time, I get cold very easily, I find it difficult to concentrate, I get dizzy and often have this 'foggy' sensation in my head, my pulse and blood pressure are normal or low.

Thank you for reading!
3 Responses
Sort by: Helpful Oldest Newest
1756321 tn?1547095325
1. Lab error.

2. A reference range is where 95% of the normal population falls within. Your FT3 level might just be normal for you.  

3. Elevated FT3 only can be seen with a condition called T3 toxicosis however your symptoms don't point in that direction.

4. Your symptoms may be due to anaemia so rule that out as a cause.

5. Over conversion of T4 to T3. Tests you could request include TBG (thyroid binding globulin), testosterone, insulin. I never had elevated testosterone myself with insulin resistance though.

Milwaukee Thyroid - 6 Patterns Of Hypothyroidism...

"Pattern 4: Over Conversion

Pattern 4 is the opposite of pattern 3. The thyroid and pituitary are again working properly, but this time there is too much T4 converted to T3 (remember roughly 20% of T4 is conversted into reverse T3 which is inactive and excreted). High levels of testosterone is the cause which also has the added effect of decreasing the amount of thyroid binding globulin (TBG: the taxi that carries the thyroid hormones).

The high levels of T3 in conjunction with low TBG causes cells to become resistant to T3. They close the doors and do not allow anymore T3 into the cells. TSH levels will be normal even though the patient is showing signs of hypothyroidism.

This pattern is similar to insulin resistance. In fact, patients with thyroid over conversion often also present with insulin resistance and polycystic ovary syndrome (PCOS) which is also caused by increased testosterone levels. Managing blood sugar is extremely important. Since there is already to much T3, prescription thyroid medication will not help in this pattern."

Helpful - 0
Avatar universal
Hi! :)

Thank your for your reply!

I think a lab error can be ruled out. As I wrote above, my doctor did another test only three days later and the FT3 level was still elevated. It was normal a year ago, though. It's not actually that high, so I thought it might be an insignificant aberrance but my doctor seemed to think that the combination of high FT3 and normal FT4 is weird. My TSH level has been checked several times over the last year and it was slightly elevated sometimes (2.7, 3.05, 3.45), which according to my doctor pointed to possible hypothyreosis.
I had anemia last year and took iron supplements for six months. My iron levels were ok two weeks ago but my doctor said that I might need supplements again in a few months, since my levels are dropping again. (They are still well within the normal range, only my ferritin level has dropped from 59 in march to 27 in june. So I guess that can't be the cause of my symptoms since the levels are still fine.
The text says that over conversion is caused by high testesterone levels... but I guess I would have other symptoms then as well?

I will read a bit more about the things you wrote. Thank you! :)
Helpful - 0
I have similar results...
3 months ago my results were: TSF 3.43; FT4 1.51;FT3 3.04; anti TPO 1300.
I went to doctor for thyroid and she sent me to check the blood agsin and the new results are lower (but in normal range) FT4 1.23;  same with TSH 2.83; but high FT3 4.98.
Also ACTH & cortisol are normal and antiTPO she didnt checked. So I am interested about my case and what happened with you, did you found out what is the problem. Im 32 yo male btw :)
Thanks and hope you are well :)
1756321 tn?1547095325
Symptoms of high testosterone in women include hair loss; excess hair growth on the chin, face, abdomen and chest; acne; disturbances in their menstrual cycle.

Your ferritin is too low in the range. Research has shown that in people with chronic fatigue, iron supplementation increased energy dramatically in people with a ferritin under 50 mcg/L who were not anaemic.

I found this as well about high FT3...

"Even having a high Free T3 due to adrenal or iron problems can be the beginning of too much RT3." - Reverse T3 (also called Reverse Triiodothyronine).

Excerpt from Denver Naturopathic Clinic - Subject: The Normal Range used for interpreting thyroid tests misses many cases of hypothyroid disease...

"In 2002 the American Association of Clinical Endocrinologists suggested that the upper range for a normal TSH be lowered to 3.0. According to the National Association of Clinical Biochemistry, “ In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 because >95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 ”"
Helpful - 0
Have an Answer?

You are reading content posted in the Thyroid Disorders Community

Top Thyroid Answerers
649848 tn?1534633700
Avatar universal
1756321 tn?1547095325
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.