Low TSH and Low Free T4?

[Runsg9]

I am a 26 year old woman and I feel like I am 126. I have been an athlete my entire life, and recently struggle just to get out of bed. I’ve gained 40 pounds in less than a year, despite working out and eating well (whole grains, lean protein, lots of veg and fruit). More recently, I began to have severe anxiety attacks, my hair began falling out, and my skin is dry and flaky. My mother and both maternal and paternal grandmothers have thyroid disorders (hashimotos and hypothyroidism) so, given my symptoms, I went to the doctor. The doc ordered a thyroid cascade and I just got my results. I have a follow up appointment in a few weeks, and am hoping this community can give some insight into what my results could mean and what questions I should ask at my follow up appointment. I appreciate and any all help!

TSH: .72 Range: .55-4.78 ulU/ml
FT4: .9 Range: .8-1.8 ng/dl

[flyingfool]

I agree 100% with Gimel

[gimel]

First you have numerous symptoms that are commonly related to hypothyroidism.  Next, your Free T4 is much lower than optimal for many people, and you were not tested for Free T3, which is the thyroid hormone metabolized by all the cells of the body.  Many doctors would only pay attention to the TSH result being within range, and that the Free T4 was also in range, and ignore symptoms.  That is totally wrong.  

Having all those symptoms with a Free T4 at only 10% of its range, and a TSH near the low end of its range, points to the probability of central hypothyroidism.  Central hypothyroidism is related to a dysfunction in the hypothalamus/pituitary system that results in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.  Doctors tend to overlook central hypothyroidism because of the low TSH and the general belief that central hypothyroidism is not very common.  In reality it is quite common but not commonly diagnosed correctly.  

A good thyroid doctor will treat a potential hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by TSH levels.  Symptom relief should be all important, not just test results.   So, you should make sure that you are always tested for both Free T4 and Free T3 every time you are tested.  In addition other tests are also needed.  You can read about all this in the first two pages of the following link.  If you want to read further you can see the related discussion and the scientific evidence for all the suggestions on p.2.  I highly recommend reading and preparing for your appointment.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

At your appointment I suggest that you request to be tested for Free T3, free T4, Reverse T3, cortisol, Vitamin D, B12 and ferritin.  I also suggest that you ask the doctor if he is willing to treat clinically as I described above and also according to the info in the paper linked above.  You might also consider giving the doctor a copy of the full paper and references.  I would also ask if the doctor is willing to prescribe T3 type meds like Armour Thyroid and Cytomel.  If either answer is no, then you are going to have to find a good thyroid doctor that will do so.