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Thyroid Disorders Community
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Avatar universal

Is normal really normal?

I am new to all of this...but for years I have been having thyroid symptoms. I have begged my doctor to run the gamut of thyroid tests. She claimed she did and everything was always "normal". My symptoms seem to get progressively worse over the past 3 years or so.

Today I signed up for my insurance companys' app to track my appointments and test results and such. Turns out she never ran all the tests she claimed. Only a TSH in 2015 and a TSH and Free T4 last year. These were the numbers:

2015: TSH/Thy.Stim.Horm 1.25 µIU/mL

2016: TSH/Thy.Stim.Horm 0.84 mIU/L
FREE T4 0.9 NG/DL

Just looking at the 'normal' ranges from my lab, it seems like I am on the very low end of normal. Considering I have multiple symptoms would medication be warranted? I have since found a new doctor and happen to have an appointment tomorrow. I don't know much about thyroid other than reading online, but everything I have read says that a normal range may not mean normal?!

Thanks!
Lauren
14 Responses
649848 tn?1534633700
COMMUNITY LEADER
Hi there...I hope I've seen your post in time...

In one word: No... normal on a lab report isn't always normal for you... We're all different and need different levels of hormones to feel well.

We really need the reference ranges for the Free T4, since ranges vary from lab to lab, but comparing your Free T4 to ranges we, typically, see, we can figure that it's pretty low in the range.  Your TSH is also low in the range.

TSH is meant to stimulate the thyroid to produce thyroid hormones and with your low Free T4 as low as it looks to be, we'd expect your TSH to be much higher than it is.  

Since, both, TSH and Free T4 are low, it would appear that your problem is Central or Secondary hypothyroidism, rather than Primary hypothyroidism, which is what your doctor would have been looking for.  She probably looked at the TSH, saw that it was low and didn't go any further, which is  what happens all too often.  

With primary hypothyroidism, the problem is that the thyroid stops working, which is why TSH keeps rising in an effort to stimulate the thyroid.  With secondary hypothyroidism, the thyroid actually works just fine, but there's a problem with the pituitary/hypothalamus, so there isn't enough TSH to stimulate the thyroid, which is why, both TSH and FT4 are low.  Either way, it's hypothyroidism and needs to be treated.

When you see your new doctor, be sure to point this out and ask her/him to add Free T3 to the Free T4 and TSH tests that s/he will undoubtedly order.  Just to be on the safe side, s/he should also order thyroid antibody tests to rule out/confirm Hashimoto's, which is an auto-immune thyroid condition.  The tests you need for that are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  You need them both, as some of us have one or the other and some have them both.  If both are not done, you risk misdiagnosis.
1 Comments
Thank You so much for your response! This is what my lab results say...

2015: TSH/Thy.Stim.Horm  range:0.35 - 5.50 µIU/mL  result: 1.25 µIU/mL




2016:     TSH/Thy.Stim.Hor        range: 0.40 - 4.50 mIU/L    result: 0.84 mIU/L
FREE T4     range: 0.8 - 1.8 NG/DL     result: 0.9 NG/DL
Avatar universal
Well that was a huge waste of time. My doctor refused to test my T3 because its "too controversial" and not many people believe in it to determine an issue. He did claim my T4 is low but that my TSH looks good cause low is high and high is low. My head is spinning!!
1 Comments
Hi... I just popped on to see what's new and saw your post... I only have one comment and that is - you need a new doctor!!  

Your TSH is "in range" - that doesn't mean it's "great".  TSH is counter-intuitive, which is, basically, what your doctor is saying.  

Typically, when thyroid levels are high, TSH is low and when thyroid levels are low, as they are with hypothyroidism, TSH is high... this is what your doctor was looking at. With secondary or central hypothyroidism, this pattern does not hold true, because there's nothing wrong with the thyroid; it simply needs TSH to stimulate it.  The problem is in, either the pituitary or hypothalamus gland, so the thyroid is not getting the stimulation it needs to produce the thyroid hormones.  

Your doctor would not be the first one to neglect this possibility... nor would he be the first one to refuse to test Free T3, because of its "controversy".  I once had a doctor who claimed that Free T3 was used only for "research" purposes - yeah, research on MY body!!  lol   Things like these are clear signs that the doctors are not good thyroid doctors and will keep their patients ill, because they're focusing on TSH, rather than the best interest of their patient, which symptom alleviation.

If you like, we can tell you where you can get the proper labs done without a doctor's order and you'll be that far ahead, but you'll still need a good thyroid doctor to prescribe the medication.  
Avatar universal
He is very old. Lol Makes me think maybe he is a little closed minded to things like this. He said if I wanted to further test, to see an endo, cause my t4 is low. He said that can be indicative of an issue. No kidding! That's what I'm saying! I'm making an appointment for tomorrow with a female endo. Fingers crossed.
3 Comments
It's good that he acknowledged that and that you have an appointment with an endo.  I hope you get the treatment you need, but remember - not all endos are good thyroid doctors, so you may have to move on, again, if this endo won't treat you either.

Do be sure to mention secondary hypothyroidism as a possibility, because many doctors don't even consider it.
Thank You so much for all your helpful and kind words!
:-)  Let me know how it goes...
Avatar universal
The only test which is very reliable to test thyroid problems is Free T4 so even if your TSH is normal or low and if your Free T4 is close to low reference range (provided you not took levothyroxine or other thyroid medication for at least 24 hrs before blood draw) then you need thyroid hormone pill.

The treatment approach is to make Free T4 come close to middle of reference range by taking levothyrxine or NDT or a combination. For this also need to make sure not take levothyrxoine or other thyroid horomone pills for at least 24 hrs before blood draw otherwise it might show false high.

T3 also have major role in subsiding symptoms as its the active hormone but T4 is the basic which need to be addressed and in no point Free T4 should go close to low reference range as T3 half life is very small but T4 very high (acts a s a buffer or storage hormone) and thus very crucial to maintain optimal levels.
6 Comments
Free T4 is not the "only" hormone that matters... Since Free T3 is the active hormone that's used by every cell in the body is just as important, if not more so... When being diagnosed, it's very possible that Free T3 levels will be higher in the range, because what T4 is being produced will be converted to T3.
Yes but maintaining Free T4 in optimal range is basics in treating hypothyroidism. Also keeping Free T3 in optimal range also not solve all as Free T3 need to be entered inside cell and that require many other factors like good adrenal, liver function and many others.
Neither does maintaining Free T4 in optimal range solve all the problems, because not everyone converts Free T4 to Free T3 adequately... We always have to look at the whole picture, without zeroing in on a single parameter to test.  It's necessary to test, both Free T4 and Free T3 and maintain a balance between the 2, with Free T3 higher in its range than Free T4 is in its range.
But even if Free T4 and Free T3 brought under optimal ranges will it solve all problems? What about cortisol levels?
My endo ordered cortisol and creatinine tests to rule out/in Cushings
Cortisol can always be a consideration, but we don't know that until we get Free T4 and Free T3 into their optimal ranges.  If Free T4 and Free T3 are optimized and symptoms are alleviated, it's a pretty sure thing there's not a problem with cortisol.

This endo has chosen not to even think about prescribing thyroid hormones in an effort to alleviate symptoms.
Avatar universal
2 pm today I'm going to a female endo. I really hope she listens. There are a dozen doctors in the group so hopefully someone can help me. You ever feel like you KNOW what's wrong but no one will help you?! I could just cry....
Avatar universal
I want to say thank you for all of your responses. I went today and had an appt with an endo. She was nice and asked a lot of questions about my symptoms. She mentioned that I definitely needed to retest my TSH as well as all the antibody testing because autoimmune disorders run in my family. She also mentioned that since my weight gain was sudden (30 lbs in 3 months) she wants to test me for Cushings Disease, a cortisol disorder. My lifestyle is super high stress, so that kinda makes sense...
1 Comments
Isn't she going to retest Free T4 and Free T3?  It's a waste of time to just test TSH, without the Free's... Hypothyroidism can cause a sudden weight gain like that, as well.  I gained almost 30 lbs in just over 2 months before I was diagnosed, too...

It's good that she's going to test the antibodies and test for Cushings, but I'll put my money on Hashimoto's and hypothyroidism... :-)
Avatar universal
It doesn't look like she ordered the Free tests. She did order 2 cortisol and creatinine tests.
3 Comments
Did you ask about the Free's?  Can you call and request that they be added to the lab order?
I will call! I didn't ask :(
:-)
Avatar universal
:-) Good luck!

Anyway if doing the Free T4 and Free T3 test along with TSH and if on that result too see a low Free T4 level as before,

FREE T4     range: 0.8 - 1.8 NG/DL     result: 0.9 NG/DL

then no matter what your TSH or Free T3 value is you need to take either levothyroxine or NDT or a combination of both as hypothyroidism is there and no need to do any further test to confirm it as maintaining an optimal Free T4 is very crucial.

Generally if Free T4 level is low like .9 then TSH value will be raised much high but if have central hypothyrodism then TSH will not increase. Your case is similar like this so don't let your doctor dtermine whether you need replacement pill based on TSH value, tell to he or she, about central hypothyrodism.

More about central hypo here

http://www.pituitarydisorder.net/central_hypothyroidism.html
Avatar universal
Just got my antibodies test back and the Peroxidase was at a value of 40 with a standard range of <9
5 Comments
TSH/Thy.Stim.Horm
0.40 - 4.50 mIU/L
0.75 mIU/L (result)
She's probably, either, going to say that's fine or that you're bordering on hyper, since there's no Free T4 or Free T3 to show that your actual thyroid hormones are low.

Your antibody count indicates Hashimoto's.  She only ordered TPOab for antibodies?  You should ask for TgAb, also... both are indicative of Hashimoto's and it's very possible that your TgAb would be higher in its range than your TPOab is.

You won't hear anything over the weekend, but be sure to let us know what she says. In the meantime, you might want to start looking around for a different doctor to call, as well, as you may need one.
She ordered the other TgAb too. It was 1 with a standard range of =1
She was very honest with me, so I'm trying to stay hopeful. She wanted to test the antibodies first since I have auto immune disorders in my family. She did mention Hasimotos. I have to do the 24 hour urine test for my cortisol levels on Monday.
Thyroglobulin Antibodies<OR=1 IU/ML  <1 IU/ML(result)
Thyroid Peroxidase Antibodies<9 IU/ML  40 IU/ML (result)
Avatar universal
So the doctor emailed me and said that I need to be periodically monitored because of my elevated antibody levels, but don't need treatment :( I'm so devastated
Avatar universal
Obviously it is time for you to see a good thyroid doctor.  I have sent you a PM with a few candidates in your general area.  To access the PM, just click on your name and then from your personal page click on messages.
Avatar universal
Thank you very much! Sadly, that was a thyroid doctor. I appreciate your help!
Avatar universal
An Endocrinologist is not necessarily a good thyroid doctor.  A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resulting TSH levels.  Symptom relief should be all important, not just test results.  Clearly that was not the case with your recent doctor experience.
Avatar universal
Ohhh. I see. I emailed her back asking to retest the Free t4 and t3. We'll see what she says
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