Hypothyroid symptoms, low t4 free, normal TSH and T3 free

[Danikeyser222]

Hi everyone,
I am new to the forum so please bare with me if this question has been asked before. Since I had my son, about 2.5 years ago (2nd child), I have the following symptoms (which have been in overdrive for the last 6-8 months):

- weight gain- Ive gained 10 lbs over the last couple of months (after running 25 miles per week and dieting) I have always been thin and usually could lose weight just thinking about it

- extreme fatigue - so hard to get out of bed in the am but I thought it was because I had a hard time falling asleep and staying asleep

- dry skin

- swelling- face and hands, water retention and bloating in belly

- foggy and memory loss. I couldn't remember parts of conversation that I had just the night before and just felt like I was on a cloud throughout the day

- anxiety because of all of the symptoms

- very low libido

I'm sure there is more that I just can't remember right now :/

I've been to a GI Dr. for my chronic constipation, weight gain despite exercise and diet, and water retention and bloating - NOTHING

I was diagnosed with PCOS about 3.5 years ago while having difficulty trying to conceive my son. It took 2 IUI's before we became pregnant.

I went to ENT for dizziness and foggy feeling thinking it was related to sinus issues. NOTHING

My primary sent me for an ultrasound of my gall bladder (because of the GI issues) and said to have them look at my thyroid too because he felt it looked larger than usual. Gall bladder was fine but the found 2 complex cysts. Followed w/ u/s 3 months later and the one shrunk and the other grew so I had a biopsy 2 days ago. Waiting for those results.

I am just seeking treatment now because I am a nursing student and thought that my symptoms were due to stress but they have worsened and the weight gain is very rapid and unexplainable.

Anyway, after they found the cysts I scheduled with the first endo I could find. He took the blood work results from my primary and said my tsh and t3 levels were normal. I demanded (nicely) that he run them again (3 months later) and include the t4free, t3 free and tsh. these were the results (including glucose and isulin to ck for insulin resistance with the weight gain and PCOS:

TSH - 1.25
T4 free  1.0
T3 free  3.1

fasting glucose 94
insulin < 2
c - peptide  0.94

Now I am waiting for my biopsy results to go in and discuss all of my symptoms and lab results with him. In the meantime I called and asked for a lab slip to check my cortisol levels and for the thyroid antibodies. I read that a normal tsh and low t4 could indicate a pituitary issue.

So my questions are, am I requesting the correct tests and is there any thing else I should request?

If he is willing to do so, do you think I could benefit from hypo meds?

I absolutely hate taking any medication at all. I fractured my femur a few years ago and couldn't stand to take the pain meds because of how they made me feel.

But my current symptoms are almost debilitating some days and I have developed such anxiety in trying to learn what it is. There is definitely something wrong and I am desperate to find answers.

I apologize for the length of this. Your suggestions and opinions are much appreciated. I just want to feel better... especially before I am 100 lbs over weight!

Thank you,
Danielle

[jbrownwsk]

     Thank you again for the response. It was very helpful. I am onto an endocrinologist now rather than a family doctor and he is open to discussions so maybe he will be more willing when I do my follow up visit.  I'm starting to get worse and I'm getting more symptoms and problems I wasn't having before.

[goolarra]

FT3 should be included in every thyroid panel.  The liver converts some of the FT4 to FT3, so liver dysfunction can impact conversion.  FT4 is the "storage" form of the thyroid hormones.  Before cells can use it, it has to be converted to FT3, the "active" form.

As I said, your TPOab is elevated, and that's a marker of Hashi's.

Your FT4 is right on the floor of the range.  This doesn't look too bad until you realize that thyroid reference ranges are very flawed.  The whole bottom half of the range should probably be considered hypo.  That's why the target for FT4 is midrange (based on where many of us had to be to be asymptomatic).  So, what seems "low normal" at first is really 50% below where it should be.

Unfortunately, your TSH looks good.  That's "unfortunate" because many doctors, even though they order FT3 and FT4, really never get beyond looking at TSH.  They were taught in med school that TSH was the gold standard in thyroid testing, and they aren't changing their minds.  So, what that means for you is that you will probably have to find an enlightened thyroid doctor.

They tested your sed rate to rule out deQuervain's thyroiditis, which is characterized by an elevated sed rate.

The first thing I'd do if at all possible is repeat TSH and FT4 and see what your FT3 is doing at the same time.  I think you'd feel a whole lot better on meds.  With elevated antibodies, it's a matter of when, not if, you have to start meds.  

[jbrownwsk]

Hi. Thank you for getting back to me. My lab's are this:
T4 free .61 (.60-1.4)
Tpo antibody 149.70 (0-9)
bilirubin .22 (.30-1.00)
Tsh 1.82 (.44-4.21)
Sedimentation rate 22 (0-26)

Let me know if another lab would be helpful. I included bilirubin because use someone told some liver and thyroid things could go together.

[goolarra]

Please post your lab results with reference ranges.  Ranges vary lab to lab and have to come from your own lab report.  

We've seen higher antibody counts, but I'd still consider yours a strong positive. If your FT4 is on the floor of the range, you probably should be on meds now...I'll explain more when you post your labs.

[jbrownwsk]

I'm having the same problems you guys have been taking about. However a few extras. I'm also going through and almost all the way through menopause at 40. That doesn't help either. I did see an endocrinologist and had the t4 free done, tsh, and the antibodies along with others like the b12, vit d, and glucose. My main thing that came up was the antibodies. The labs said they should be 0-9 and mine were 149. T4 was at bottom limit normal. I did read this was signs of hasimotos. I've seen other people saying their levels were higher. I thought 149 was high. How high is too high? Just based on them and my symptoms is it likely to end up on meds? Thanks for any help. Enjoyed reading these posts.

[goolarra]

In October, your FT4 was only 20% of range, which is low of the 50% target.  50% is where many of us have to be to relieve symptoms.  Your TSH is also on the high side.  Many years ago, AACE recommended that TSH range be changed to 0.3-3.0.  On this more reasonable range, you are high.  Both of those indicate hypothyroidism.  

Adequate ferritin levels are also necessary to metabolize thyroid hormones at the cellular level.  22 is still too low.

You should be retested for FREE T3, FREE T4 and TSH.  In addition, you should ask for the antibody tests to see if you have Hashimoto's thyroiditis, thyroid peroxidase antibodies and thyroglobulin antibodies..