Low T4, Low T3 and high cortisol!

[Hannah1982123]

I am just wondering if anyone might shed any light or had any experience with both low T4 and low T3? I was feeling very tired back in July and so had some blood work done which showed my T4 count was a little low: 9.1 instead of within the normal range of 12 - 22. At that stage T3 was normal at 1.79 and TSH was also low end of normal 1.69. As I was so exhausted the Dr put me on a low dose of eltroxin to see what that would do. A month later (2 weeks ago) the bloods were repeated and despite being on the eltroxin my T4 dropped again to 8.2 and this time my T3 had also dropped under the normal range to 1.23. My TSH had INCREASED from 1.69 to 3.73.

They then ordered a morning cortisol test last week and that came back yesterday......normal range 171 - 536 and mine came back raised at 888.

I have been referred to an endocrinologist but my mind is going around in circles and I'm trying to make sense of it - is it normal for T4 AND T3 to go down? Everything I can find seems to suggest one will rise when the other drops......

From what I can find it seems to be maybe pituitary related? Obviously I do know there are some not-so-good reasons for these figures but I suppose I'm just seeing if anyone else has had figures similar to these or different possible explanations!

I've never had thyroid issues before so all of this is new to me! Thanks :-)

Hannah x

[goolarra]

It is a bit of an art.  Doctors tend to want your numbers "in range", but they often don't go any further than that.  Most of us are not comfortable lower in the ranges.  So, we have to convince them to raise our meds until our symptoms are gone.  It takes time and patience; it's a process.  We just have to find that spot where we each feel best.

[Hannah1982123]

Thanks so much for the reply, seems like other people have similar issues and mine aren't perhaps as bad as it seems when you see it on the paper (especially when you don't know what you are looking at!!) Seems like there is an art to getting it right so hopefully it will settle!

Thanks again!

[goolarra]

I think your doctor will suggest an increase.  Just take it slowly.  When cortisol is high, it can be hard to tolerate thyroid hormones.  So, you want to start out low, like you did, and increase slowly.  

Many of us found our FT4 had to be around the middle of the range and FT3 the upper half of the range before symptoms were relieved.  That's because the ranges for both FT3 and FT4 are very flawed.  So, while your FT4 doesn't look too low, it really should be somewhere around 17.0, and FT3 should be higher than 2.2.  

Most hypothyroidism in the developed world is autoimmune, Hashimoto's thyroiditis.  Next time you have labs, you might ask for TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) to be tested.  Those are the two markers for Hashi's.  

Whether hypo is caused by Hashi's or pituitary (secondary hypothyroidism), it's treated the same.

[Hannah1982123]

Ft3 was 1.23 with the normal as 1.3-3.1 so only just dipping under the range.

Eltroxin I was on the minimum dose 25mg and had no issues with it at all...

[goolarra]

Generally speaking, FT3 and FT4 move together.  When FT4 goes down, so does FT3, BUT TSH goes up.  TSH is counterintuitive, the higher it is the more hypo you are, the lower the more hyper.  There are, however, some conditions in which FT3 does not follow FT4.

How much Eltroxin were you on?  It's not unusual to experience a worsening of labs and symptoms on a very low dose.

Cortisol is high.  That often happens, too, when our thyroid hormones are low.  The adrenals are stepping in and trying to make up for the lack of thyroid function.

Did you tolerate the Eltroxin well?  

You could have a pituitary issue.  I'd expect your TSH to be higher with FT4 and FT3 below range.  What was your FT3 and its range?