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Hypo or not...borderline....do I treat?


About a month back or so I went into the doc for standard blood workup...  Suprised after results came back and showed my TSH at 8.95.  Well, obviously the doc wanted to see me back.  Today I went in and discussed with her and I got a prescription for Synthroid and she sent me in for a round of tests again..the results which just came in...

T3 Free - 3.3   ( Range 2.3-4.2 pg/mL )
T4 Free   1.1   ( Range 0.6-1.6 ng/dL )
TSH - 4.22           ( Range 0.40-4.0 uIU/mL )

Everything seems to have come down to almost normal in  4 weeks.  Seems like TSH dropped a bunch with no help at all.  I would note that 3 days after my 8.95 test, I came down with a pretty severe sore throat....not sure it could have caused some problems...which messed my first test up?

In either case, my doc still wants me to go on Synthroid even after the current results... 3 months on and then more checks.  I am starting at only .25 as I was concerned about getting hyper since I do have anxiety issues at times.

I will probably take the docs advice since things seem high still ( albeit barely ) but...just concerned cuz things dont seem so bad...

12 Responses
Avatar universal
Uh oh, sore throat and fluctuation TSH! You'd better get the TGab and TPOab antibody tests for Hashimoto's. I have it. Yes, the throat gets sore as the antibodies swell up the thyroid. I would fluctuate from normal, to hyper to hypo and all over the chart. Some weeks, I'd feel like I was recovering, then my thyroid nodules would leak hormone, and I'd go crazy hyper. Then the antibodies would eat another chunk of thyroid and I'd go hypo. Crazy!

I didn't start feeling better until I took my Synthroid. And, I had to keep bumping up every month. Now, I'm on 150 Synthroid and 5 Cytomel. Many of us need a T3 drug like Cytomel added to our Synthroid to relive ALL of the other hypo symptoms like constipation and sore legs. If you do have Hashi and you don't get on some thyroid hormone, you will get worse. I wouldn't doubt that you do have Hashi, the leading cause of hypothyroidism in the US and developed countries. If so, you need a thyroid ultrasound to determine if nodules are causing you to go hyper. The thyroid hormone shrunk my nodules, so I don't go hyper anymore.

Also, at some point, get those adrenals checked. Sometimes they can burn out trying to do the work of the thyroid.

Next, if you have Hashi, get those vitamins, particularly D3 and B12 checked.  Hashis tend to be low in that area.

Finally, if you have Hashi, an auto-immune disease, be aware that some things can triggger that antibody attack (sore throat and swelling in neck and pain in ears) . For me, it's stress, caffeine, gluten and sugar. For others it can be different.

Below were my symptoms prior to treatment.

These symptoms slowly appeared and worsened after birthing an infant (who was also premature)

Hypo problems:
Mild weight gain even while dieting
Extreme fatigue in the morning and throughout the day/napping
GERD/Heartburn/chest pain
constipation Abdomen swells for no apparent reason
forgetfulness/brain fog
Neck/jaw pain/swelling/pressure
Scratchy voice
Very cold feet and hands and sometimes a feeling like ants are biting my feet
Endometriosis (2 years ago – cured after one year of birth control)
Irregular/heavy periods and menstrual-like cramping in between periods
Voice is sometimes hoarse
Knee/joint pains – finger swelling and pain
Rash or scaly skin on neck, hands, chest, chin, nose, right armpit down to waist
Dry, gritty eyes
Muscles in legs sometimes go wobbly and weak when I am standing
Body temp ranges 97-97.5
Hair clumps in shower
Decreased sex drive
Aches all over body like the flu
Enlarged lymphnodes in neck and armpit
Legs feel heavy and swollen at times
Pain in the soles of my feet like muscle cramps

Hyper Problems:
Weight loss when not dieting
GERD/Heartburn/chest pain
Abdomen swells for no apparent reason
Neck/jaw pain/swelling/pressure
Scratchy voice
Migraines, dizziness and back of neck/head pain
Ear pressure/pain
Rash on back of head
Voice is sometimes hoarse
Sore eyes
Hot flashes
Night throbbing/pounding in ears that wakes me
Toe nails feel painful and brittle
Tingling feet/hands/lips
Shaky hands
Stabbing pain below right ribcage
Pain in kidney and lower back area
Increased thirst, urination and a feeling like I have a bladder infection
Blood pressure changing
Feeling like heart is beating fast
Enlarged lymphnodes in neck and armpit
Legs feel heavy and swollen at times
Pain in the soles of my feet like muscle cramps
Increased sex drive

:) Tamra
Avatar universal
It is like reading my medical history...thank you for listing that. I for one feel less crazy when I read all those symtoms and realize they can be attributed to the thyroid. Makes the puzzle all come together.
Avatar universal
Do you have hypo symptoms?  If not, I agree with you that your FT3 and FT4 look good at the moment (they're both right at midrange, not even close to borderline), and I'd be concerned about starting treatment.  My inclination would be to re-test in three to six months and have antibodies tested at that time to determine if you are in the early stages of Hashi's.  Of course, if you do become symptomatic in the interim, it would be best to go in for re-testing at that point.  

Your TSH is a bit high, but TSH is a pituitary hormone and not nearly as important as the two thyroid hormones, FT3 and FT4.
Avatar universal
Koyuk, you are 38, and I will be 38 in a few months. I don't feel well with thyroid levels as low as yours. My mom is 75. For  her, your levels would be normal. For those in our age group, usually we need to be in the top 1/3 of the range. You still have some room to go up, so I  agree with your endo to treat you with low level thyroid hormone.

You say that you don't feel that bad, but compared to what? My suggestion is to get the Hashimoto's antibody tests now rather than later.

Here's a wonderful article explaining why people with Hashi need preventative treatment even if their levels are 'normal':


:) Tamra
Avatar universal
I am so glad that my post helped you. It took a long time to remember some of those symptoms because I wrote them back in the brain fog days. :) Tamra
Avatar universal
I just can't agree with TamraW on this one.  I believe there's a difference between the "ideal" levels for someone on meds with a diagnosed thyroid disease and someone who has not been diagnosed with a thyroid disorder, never mind a disease, and is not on meds.

Yes, the recommendation for those of us on meds for FT4 is midrange, FT3 is upper half to upper third.  However, for the population at large, about 50% of people with a normally functioning thyroid are going to fall within one standard deviation each side of midrange.  Koyuk is right at midrange on both.  According to population statistics, these are almost "perfect" numbers.

I think that we, on meds, often have to have FT3 and FT4 higher because we no longer have "on demand" thyroid hormones.  We get our thyroid hormones once or twice a day, so we have to have a little surplus to compensate for the "unnatural"  timing of input of thyroid hormone to our bodies.

Koyuk's doctor is reacting to TSH...period.  Treating on the basis of TSH, when TSH is "abnormal" is just as big a sin as not treating when TSH is "normal".  Koyuk's doctor is ignoring FT3 and FT4, only looking at TSH.

I still maintain that I'd give it a few months, retest with antibodies, and go from there.
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