Need help with labs

[TCL12]

Hello, can someone help me with these lab results?

TSH .46 (.45 - 4.5)
Free T4 1.00 (.82 - 1.77)
Total T3 128 (80 - 200)

I don't know why they didn't test Free T3.I have a multinodular goiter with some complex nodules. I have had a negative FNA. I keep getting diagnosed as subclinical hyperthyroid but that just doesn't seem to jive with the numbers. Negative for TPO and TgAB.

[TCL12]

I've been to an integrative practitioner who wouldn't look at my numbers, but he did manage to integrate his hand and my wallet. I have seen every endo in my town that is covered under my insurance. I know of another IP about 2.5 hours away. I will call his office Tuesday and see what he thinks of those numbers.

I've had two local endo's tell me I'm subclinical hyper and the Mayo doc pronounced those recent numbers as normal. I wonder what part of my fat, freezing self they found hyper? I've had two bone density scans that were normal and I only get heart palps when I'm having an anxiety attack. I'm hot only when I have a hot flash. I also have a skin condition called granuloma annulare which is loosely associated with hypothyroidism.

Mostly I just want to find a quiet corner to cry in. Thank you for your help, and I'm glad you were able to find someone to help you!

[Barb135]

I'm sorry the integrative practitioner wouldn't help you.  It's true that some naturopaths and integrative doctors don't take insurance and are very expensive.  

When you call the new integrative practitioner, don't wait for her/him to mention secondary hypothyroidism... you should tell them you think that's what you have and ask for trial treatment to see if it helps.  Tell them that with your thyroid hormone levels as low as they are and the symptoms you have you're quite sure you can't be hyper or normal, just because you have low TSH.  If you let them know that you've done a little research and know what you're talking about, they might be more willing to work with you...

Aside from that, if you want to tell me where you're located, I might be able to help you find a suitable doctor, nurse practitioner or someone suitable to help you, as we do get recommendations from other members, from time to time.  If you don't want to post your location on the open forum, feel free to send me a private message.

[Barb135]

It's been found that most people feel best with Free T4 about mid range and Free T3 (not Total T3) in the upper half to upper third of its range.  

There aren't really any other tests to run for secondary hypothyroidism... The criteria is low TSH and low thyroid hormones, both of which you have.  The treatment is a trial of replacement thyroid hormones to see if it helps alleviate your symptoms.  

One is *never* hyper, simply based on a TSH level.  The only way one is ever hyper is if you have high levels of actual thyroid hormones AND hyper symptoms - you have neither and I'm appalled that a doctor at Mayo clinic would stick with a diagnosis of subclinical hyperthyroidism OR no diagnosis on the basis of those results being normal...

My recommendation is to try to find a doctor that's willing to treat, based on symptoms, rather than labs, specifically, TSH.  You might try a Naturopath or more holistic type doctor, since mainstream/conventional doctors tends to place too much strength on the TSH.  I actually found a nurse practitioner to manage my thyroid and she's ordering tests that my endo refused to order, plus she gave me back a thyroid medication that my endo had taken away, based on my TSH.

[TCL12]

I have gained about 35 pounds over the last 3 years, and my body temp is always several degrees below normal, it's gone as low as 94.7. I am having horrible panic attacks but those could be menopause related. The lymph nodes on the left side of my neck are swollen but not hard.

I am on HRT right now--minivelle dot and prometrium--if that could affect those test result numbers. I've looked back at my records and TSH is always low but T4 and T3 were mid to low end of the range. Hence the previous subclinical hyperthyroid diagnosis.

I just saw an endo at Mayo yesterday, he's the one who ran the labs for those test results. He said they are normal. I have left a message asking to be tested for secondary hypo but he hasn't gotten back to me yet.

[Barb135]

Can you tell us what, if any, symptoms you might have?  

If I had to guess, I'd say the diagnosis you've been given is based solely on the TSH level, which is quite low.  However, looking at your Free T4 level, which is only at 19% of its range and T3 level, at 40% of range, I'd say you might have Central or Secondary Hypothyroidism.  This would be especially true with the absence of thyroid antibodies.  

Central hypothyroidism occurs when there's a problem with the hypothalamus/pituitary axis, so there isn't enough TSH produced to adequately stimulate your thyroid to produce the thyroid hormones your body needs.