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Hypothyroid - Normal TSH, Low T4
Hello,
I'm a 27 year old female and I have recently been tested for a thyroid condition and the result was hypothyroid, however, the endocrinologist has said that my thyroid is not "off" enough to cause any of the symptoms I have been experiencing. I will soon post the actual results, but I know my TSH was "normal" but my T4 was low. Below are some of my symptoms:
-fatigue
-feeling "feverish" most days in late afternoon
-difficulty concentrating
-headaches
-dry, brittle hair
-scalp dermatitis/inflammation
-hair thinning
-some graying of hair
-dry eyes
I'm not sure what to do at this point. I've seen a rheumatologist, and am awaiting test results. The only condition the rheumatologist has suspected is Sjogren's, but that is all. Also, both my mother and sister are hypothyroid. My mother does have elevated TSH.
Any help is much appreciated.
I'm a 27 year old female and I have recently been tested for a thyroid condition and the result was hypothyroid, however, the endocrinologist has said that my thyroid is not "off" enough to cause any of the symptoms I have been experiencing. I will soon post the actual results, but I know my TSH was "normal" but my T4 was low. Below are some of my symptoms:
-fatigue
-feeling "feverish" most days in late afternoon
-difficulty concentrating
-headaches
-dry, brittle hair
-scalp dermatitis/inflammation
-hair thinning
-some graying of hair
-dry eyes
I'm not sure what to do at this point. I've seen a rheumatologist, and am awaiting test results. The only condition the rheumatologist has suspected is Sjogren's, but that is all. Also, both my mother and sister are hypothyroid. My mother does have elevated TSH.
Any help is much appreciated.
Thyroid tests measure hormones in the blood, but there's one more crucial step to go...hormones have to be able to get into cells to do their work. In order for that to happen, vitamin D and ferritin both have to be present in sufficient quantity (not just on the bottom of the range). You might consider having those tested to see if you need to supplement.
There's also a rare condition called thyroid hormone resistance (THR). It's a genetic mutation in which concentrations of thyroid hormone in the blood have to be extremely high before T3 can get into cells.
Prolactin and TSH are both pituitary hormones. Since both are elevated without explanation, you might also consider some pituitary testing.
There's also a rare condition called thyroid hormone resistance (THR). It's a genetic mutation in which concentrations of thyroid hormone in the blood have to be extremely high before T3 can get into cells.
Prolactin and TSH are both pituitary hormones. Since both are elevated without explanation, you might also consider some pituitary testing.
2 Comments
Thank you! I did have vitamin D tested, 37.7 (>=30). I did not, however, have ferritin checked. If ferritin comes back normal, should I look to see if this could possibly be THR? Is that something that is difficult to diagnose?
Originally, I thought I had a pituitary issue as the prolactin was elevated and I have the unexplained headaches. My insurance would not cover an MRI because prolactin was not high enough. The the elevated TSH I wonder if that may help warrant a reason for further pituitary testing.
Is THR hereditary? I'm wondering if my mother was to also have high T3 and T4 with her elevated TSH is this could mean something.
In your opinion, should I also be looking at iodine, zinc, magnesium, and B12?
Sorry for all of the questions. I really appreciate your insight.
Originally, I thought I had a pituitary issue as the prolactin was elevated and I have the unexplained headaches. My insurance would not cover an MRI because prolactin was not high enough. The the elevated TSH I wonder if that may help warrant a reason for further pituitary testing.
Is THR hereditary? I'm wondering if my mother was to also have high T3 and T4 with her elevated TSH is this could mean something.
In your opinion, should I also be looking at iodine, zinc, magnesium, and B12?
Sorry for all of the questions. I really appreciate your insight.
I just went through the lab work again and I see sex hormone bind glob 291 (17-124). She didn't mention this to me. It's flagged as being high. Does this mean anything?
Thanks again for all of your help here.
Thanks again for all of your help here.
A diagnosis for potential hypothyroidism should not be based on TSH anyway. TSH is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms, and Free T4, Free T3, and even Reverse T3. There are many different processes and confounding variables that affect tissue thyroid levels and effects, so there is far more to diagnosis than just a TSH test. You can read 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 supporting all that is recommended.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
A good question to ask is which tests the doctor customarily orders for his hypo patients. Any doctor who orders only TSH should be avoided like the plague!
In my opinion, this is all interrelated. A disturbance anywhere in the endocrine system will cause things to go off elsewhere in the system.
If your mother's doctor balks, she can order those tests online without a doctor's order and get the results sent directly to her. I know of people who have used the online lab healthcheckusa and found them to be accurate and prompt. However, if you search, you will find many other labs that also do it. Just be sure that both T3 and T4 are FREE.
Sorry to be slow getting back to you...I had a work crisis yesterday.
In my opinion, this is all interrelated. A disturbance anywhere in the endocrine system will cause things to go off elsewhere in the system.
If your mother's doctor balks, she can order those tests online without a doctor's order and get the results sent directly to her. I know of people who have used the online lab healthcheckusa and found them to be accurate and prompt. However, if you search, you will find many other labs that also do it. Just be sure that both T3 and T4 are FREE.
Sorry to be slow getting back to you...I had a work crisis yesterday.
Yes, exactly, estrogen can cause T3 to bind. So, your FT3 might be low even though your TT3 is high.
There are a couple of sites that list endos, but not having used them myself, I'm reluctant to recommend them. I added my endo's name to one of them at one point, and somehow he got classified as a nurse practitioner. I wrote them to tell them about the error, and it was months before they fixed it. You'd probably want to find one who specializes in pituitary issues. You can try posting a new thread here to see if anyone knows someone in your area. You can try interviewing some of them on the phone before you make an appointment. You can ask a nurse how much emphasis the doctor puts on TSH.
No, I'm not a doctor, no medical training whatsoever. I ended up doing a lot of reading because I have a pituitary issue, which keeps my TSH up around 20.0 all the time. With so many doctors so fixated on TSH, it's hard to get anyone to listen to you. I picked up a lot of information along the way, and I've been on this forum for a long, long time!
Definitely, if your mother has a pattern similar to yours, it's time to get really serious about researching THR.
It takes T4 meds 4-6 weeks to build in the blood. So, if she's only been on meds a week or two, there will have been some change due to the meds, but it won't have reached its potential yet.
There are a couple of sites that list endos, but not having used them myself, I'm reluctant to recommend them. I added my endo's name to one of them at one point, and somehow he got classified as a nurse practitioner. I wrote them to tell them about the error, and it was months before they fixed it. You'd probably want to find one who specializes in pituitary issues. You can try posting a new thread here to see if anyone knows someone in your area. You can try interviewing some of them on the phone before you make an appointment. You can ask a nurse how much emphasis the doctor puts on TSH.
No, I'm not a doctor, no medical training whatsoever. I ended up doing a lot of reading because I have a pituitary issue, which keeps my TSH up around 20.0 all the time. With so many doctors so fixated on TSH, it's hard to get anyone to listen to you. I picked up a lot of information along the way, and I've been on this forum for a long, long time!
Definitely, if your mother has a pattern similar to yours, it's time to get really serious about researching THR.
It takes T4 meds 4-6 weeks to build in the blood. So, if she's only been on meds a week or two, there will have been some change due to the meds, but it won't have reached its potential yet.
1 Comments
Great, thank you soo much!! I didn't realize I could even ask how the much emphasis the doctor puts on TSH, or any other factor for that matter. And that's great because she's going to call her doctor tomorrow and request FT3&4 along with TSH testing. I'm hoping they agree to it. As far as looking for an endocrinologist that specializes in pituitary issues, other than the elevated TSH and prolactin, does the high SHBG have to do with this or is this more relevant for thyroid only?
Thank you again!!
Thank you again!!
I was going to say wait for your next labs to get FT3, but then when you said you were on BCPs, I changed my mind! Estrogen is a thyroid hormone antagonist. It binds T3. Total T3 is the total amount of T3 in your blood, bound and unbound. FT3 just tells what's unbound (free and available to your body for use). So, if a significant amount of your TT3 is bound, it could be causing symptoms.
Low D could be causing symptoms. It's an easy fix, so it's worth a try. No, I don't think low D is causing your high TSH. That's a separate issue. Personally, if it were me, I'd probably try a number of things, like supplementing D and getting the other vitamins and minerals tested and supplementing as necessary before pursuing the pituitary issue. However, with your headaches, it might not be as wise to take my "wait and see" approach. I do think, however, that you're right and finding a good doctor is going to be a challenge.
Another alternative would be to sit down with your current doctor again and go over your results and really pin her down for explanations of both the high SHBG, prolactin and TSH and the disparity between your T3, FT4 and TSH.
No, your mother could still have FT3 and FT4 tested. It's nice to get a truly un-medicated version initially so you know where you started from and can really evaluate the effects of the meds on levels. However, better late than never! FT3 and FT4 should be tested every time blood is drawn for TSH. Managing meds on TSH alone is usually a disaster. Your mother is on some form of levothyroxine (Synthroid, Levoxyl, generics, etc.)?
Low D could be causing symptoms. It's an easy fix, so it's worth a try. No, I don't think low D is causing your high TSH. That's a separate issue. Personally, if it were me, I'd probably try a number of things, like supplementing D and getting the other vitamins and minerals tested and supplementing as necessary before pursuing the pituitary issue. However, with your headaches, it might not be as wise to take my "wait and see" approach. I do think, however, that you're right and finding a good doctor is going to be a challenge.
Another alternative would be to sit down with your current doctor again and go over your results and really pin her down for explanations of both the high SHBG, prolactin and TSH and the disparity between your T3, FT4 and TSH.
No, your mother could still have FT3 and FT4 tested. It's nice to get a truly un-medicated version initially so you know where you started from and can really evaluate the effects of the meds on levels. However, better late than never! FT3 and FT4 should be tested every time blood is drawn for TSH. Managing meds on TSH alone is usually a disaster. Your mother is on some form of levothyroxine (Synthroid, Levoxyl, generics, etc.)?
2 Comments
Thank you!! Just to make sure I understand, because birth control can cause T3 to bind, I should probably check FT3 as total T3 may be high but free T3 may not be. Is this correct?
I will start a vitamin D supplement and look to have vitamins/minerals tested. I will try to find an endocrinologist that's willing to help look into this. Out of curiosity, are you a doctor? Do you know of any forums or sites that may suggest endocrinologists?
Okay. I'm going to see if my mother can have her free T3 and free T4 checked along with TSH. She is on levoxyl 50 mg. she just started 1-2 weeks ago. If she has similar high TSH with high FT3&4 then I may be more concerned with the rare thyroid resistance issue you mentioned.
Thank you again for your help.
I will start a vitamin D supplement and look to have vitamins/minerals tested. I will try to find an endocrinologist that's willing to help look into this. Out of curiosity, are you a doctor? Do you know of any forums or sites that may suggest endocrinologists?
Okay. I'm going to see if my mother can have her free T3 and free T4 checked along with TSH. She is on levoxyl 50 mg. she just started 1-2 weeks ago. If she has similar high TSH with high FT3&4 then I may be more concerned with the rare thyroid resistance issue you mentioned.
Thank you again for your help.
Levothyroxine 50 mcg is her medication.
D at 37.7 isn't sufficient for proper thyroid health. I've read you want D in the 50-70 range. That could be part of the cause of your symptoms since D deficiency can have some of the same ones as thyroid (or can cause a secondary thyroid deficiency at the cellular level).
THR is very rare. You'd probably want a really good thyroid doctor if you suspect it. I think you're right, though, you want to be sure your vitamins and minerals are right before you go there.
Your elevated TSH might warrant further pituitary test. The important thing here is that there's a contradiction between your relatively high T3 and FT4 results and your relatively high TSH. With T3 and FT4 well up in the ranges, we'd expect your TSH to be considerably lower (I'd say below 1.0 or even close to zero, but that's a guess). There has to be an explanation.
It would be interesting to see what your mother's FT3 and FT4 are. THR can be hereditary.
With your FT4 so high, I doubt you have an iodine deficiency since iodine is one of the building blocks of T4. Zinc and magnesium are worth looking into. B12 deficiency can cause fatigue beyond belief. Once again, B-12 has to be well up into the range. Many people need it near or over the top. Our range in this country usually starts at about 200, which is ridiculous. Anything below 500 should probably be considered seriously deficient.
High levels of thyroid hormones can increase SHBG. In light of everything else going on, I'd think it would be significant.
THR is very rare. You'd probably want a really good thyroid doctor if you suspect it. I think you're right, though, you want to be sure your vitamins and minerals are right before you go there.
Your elevated TSH might warrant further pituitary test. The important thing here is that there's a contradiction between your relatively high T3 and FT4 results and your relatively high TSH. With T3 and FT4 well up in the ranges, we'd expect your TSH to be considerably lower (I'd say below 1.0 or even close to zero, but that's a guess). There has to be an explanation.
It would be interesting to see what your mother's FT3 and FT4 are. THR can be hereditary.
With your FT4 so high, I doubt you have an iodine deficiency since iodine is one of the building blocks of T4. Zinc and magnesium are worth looking into. B12 deficiency can cause fatigue beyond belief. Once again, B-12 has to be well up into the range. Many people need it near or over the top. Our range in this country usually starts at about 200, which is ridiculous. Anything below 500 should probably be considered seriously deficient.
High levels of thyroid hormones can increase SHBG. In light of everything else going on, I'd think it would be significant.
2 Comments
Great, thank you! I think I will request my doctor order blood work for B12, ferritin, magnesium, and zinc. Should I also be asking for free T3 at this time?
In your opinion, if these all come back okay, could vitamin D alone be causing this? Would you suggest I see another endocrinologist in the mean time regarding the pituitary? Or, could low vitamin D cause the elevated TSH and/or prolactin issue? I have a feeling it will be difficult to find a "good" endo, one that will not pass me off like the previous one but also will not push treatment without clear explanations.
Unfortunately my mother started thyroid hormone about a week or so ago and my sister is also on this. I assume this will not allow for an accurate measure of their FT3 and FT4.
As always, thank you so much for your help.
In your opinion, if these all come back okay, could vitamin D alone be causing this? Would you suggest I see another endocrinologist in the mean time regarding the pituitary? Or, could low vitamin D cause the elevated TSH and/or prolactin issue? I have a feeling it will be difficult to find a "good" endo, one that will not pass me off like the previous one but also will not push treatment without clear explanations.
Unfortunately my mother started thyroid hormone about a week or so ago and my sister is also on this. I assume this will not allow for an accurate measure of their FT3 and FT4.
As always, thank you so much for your help.
I should have mentioned that I'm on birth control and have been since I was about 16 (due to acne). I think this could cause high SHBG.
I just posted an answer that seems to have gotten lost. Let's see if this post will "push" it out.
Thank you very much for your response, I appreciate it. I think the T3 was not free T3, so I may need to have that checked. The doctor did confirm hypothyroid, not hyper. She also said that none of my symptoms could be from my thyroid being off as it is not "off" enough. My symptoms include being fatigue, tired even when I receive adequate sleep, difficulty getting out of bed in the morning and extreme tiredness in late day. I also have difficulty concentrating and I do get headaches that my neurologist has not been able to explain. My periods have always been light but a couple of months ago I had my "period" for roughly 8 days in the middle of my cycle. I should mention that I also have anxiety. I'm often cold, although I'm thin. I am not underweight, however. I've always been thin, I'm 5'4 around 110 lbs and my mother is as well. Recently I've noticed my hair is thinning. I believe this has been going on for some time but I am now just seeing it. Almost all of the hair that falls out is much shorter than my hair length. My hair has also become dry and I have coarse, wiry hairs now when my hair had always been very fine. My mother was diagnosed with hypo thyroid years ago, although I do not know if she had a full thyroid panel done originally or not. She has extreme fatigue and couldn't make it through her day without excessive amounts of caffeine. All of her symptoms are that of hypo with the exception of her weight. My sister also has hypothyroid.
I don't know if this is relevant, but I also had elevated prolactin, 22.42 (4.79-23.3) and this was the second test showing this as the doctor said this can be sensitive. The antibodies are:
Thyroglobulin ABS <1 (<2)
Thyroid Perox ABS 1 (<9)
Thank you again for your help, I really appreciate it.
I don't know if this is relevant, but I also had elevated prolactin, 22.42 (4.79-23.3) and this was the second test showing this as the doctor said this can be sensitive. The antibodies are:
Thyroglobulin ABS <1 (<2)
Thyroid Perox ABS 1 (<9)
Thank you again for your help, I really appreciate it.
1 Comments
I should mention that I recently have extremely dry eyes. I've seen an eye doctor and was prescribed lotomax which has helped but once I finished the prescription my eyes went back to being extremely red and inflamed. A rheumatologist is testing for schrogrens.
Your FT4 is at 68% of range, which is high of the 50% guideline. Total T3 is at 77% of range, which is well into the upper half of range recommendation. So, both are a little on the high (hyper) side.
When T3 and FT4 are high, TSH should be low and vice versa. So, we have a contradiction here that might need explaining. At the very least, it would warrant a retest in a month or so to see if it was a glitch or if it repeats.
Total T4 (T4 on your report), T3-uptake and total T3 (T3 on your report) are considered obsolete tests. FREE T3 and FREE T4 should be tested. Your doctor also ordered TSH w/reflex to FT4. What this means is that the lab should test TSH. If it's in range, they go no further. If it's not, they test FT4. A thyroid panel should always include FT3 and FT4. Luckily, your TSH was out of range, so FT4 was tested. Ordering obsolete tests and TSH w/reflex makes me wonder how good a thyroid doctor yours is. It indicates to me that he is too focused on TSH, when FT3 and FT4 are really much more important.
Which antibodies did they test?
Did the doctor tell you that you were hypo, or do you think you misunderstood?
Tell me more about your symptoms. Are you tired despite adequate, or even excessive, sleep? Would you describe the "feverish" feeling as intolerance to heat, i.e. you are hot when others are comfortable or cold? Any other symptoms...weight gain or loss, diarrhea or constipation, elevated or lowered BP and/or HR, changes in menstruation, etc?
Your mother should be sure her doctor tests her FT3 and FT4 before she starts meds, too.
When T3 and FT4 are high, TSH should be low and vice versa. So, we have a contradiction here that might need explaining. At the very least, it would warrant a retest in a month or so to see if it was a glitch or if it repeats.
Total T4 (T4 on your report), T3-uptake and total T3 (T3 on your report) are considered obsolete tests. FREE T3 and FREE T4 should be tested. Your doctor also ordered TSH w/reflex to FT4. What this means is that the lab should test TSH. If it's in range, they go no further. If it's not, they test FT4. A thyroid panel should always include FT3 and FT4. Luckily, your TSH was out of range, so FT4 was tested. Ordering obsolete tests and TSH w/reflex makes me wonder how good a thyroid doctor yours is. It indicates to me that he is too focused on TSH, when FT3 and FT4 are really much more important.
Which antibodies did they test?
Did the doctor tell you that you were hypo, or do you think you misunderstood?
Tell me more about your symptoms. Are you tired despite adequate, or even excessive, sleep? Would you describe the "feverish" feeling as intolerance to heat, i.e. you are hot when others are comfortable or cold? Any other symptoms...weight gain or loss, diarrhea or constipation, elevated or lowered BP and/or HR, changes in menstruation, etc?
Your mother should be sure her doctor tests her FT3 and FT4 before she starts meds, too.
Different people are effected at different TSH levels so he may be wrong. Drs don't understand everything about everything and sometimes say things to keep you from worrying or because they dont know. Always go with your gut and get a second , third, opinion if needed
1 Comments
Thank you. I will have to find another doctor to get a second opinion. I know that my mother also has elevated TSH, slightly higher than mine. Her doctor has agreed to put her on thyroid hormone.
FT4 in the lower half of the range is always suspect for hypo. Post your results and reference ranges when you get them, and we can be more specific. Did they test FT3?
3 Comments
I apologize, the doctor told me my results over the phone and I must has misunderstood. Below are my results:
T4: 10.99 (5.1-14.1)
T-uptake: 1.14 (.8-1.3)
THS w/reflex: 4.30 (.27-4.20)
Free T4: 1.45 (.93-1.7)
T3: 1.72 (.8-2)
Also, I did not have positive antibodies.
Thank you for your help!
T4: 10.99 (5.1-14.1)
T-uptake: 1.14 (.8-1.3)
THS w/reflex: 4.30 (.27-4.20)
Free T4: 1.45 (.93-1.7)
T3: 1.72 (.8-2)
Also, I did not have positive antibodies.
Thank you for your help!
You are hypothyroid in my book! Most labs have changed what they call normal for a TSH, some to as low as 3.5. If no one is willing to admit you are hypothyroid YET, you will probably only continue to get worse and your TSH will hit the "magic number" needed for a medical diagnosis. Waiting for this inevitability is cruel, and I would never treat my patients in this manner. I would call the results you have listed above "a mere snapshot in time of numbers as a patient develops hypothyroidism". All things considered, especially with one as symptomatic as you, I would have treated you much sooner!
You are hypothyroid in my book! Most labs have changed their "norms" on the TSH, some to as low as 3.5. If no one is willing to admit you are hypothyroid YET, you will definitely continue to get worse and your TSH will hit the "magic number" needed for a medical diagnosis. Waiting for this inevitability is cruel, and I never treat my patients in this manner. I call the results you have listed above a mere snapshot in time of numbers as a patient develops hypothyroidism. I would have treated you much sooner!
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