Thyroid Disorders Community
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Avatar universal

Low T4 and normal T3???

I have been having many symptoms of hypothyroid, among other things. About a month ago I had a blood test done, TSH was 2.58, they didn't test free t3 or free t4. My estradiol and testosterone levels were also on the the low normal, and low side. So I asked for and just had another blood test done. This time my TSH was 1.740, free T3 3.1 and T4 was 0.8.

All the literature I can find deals with the t3 being low with a normal t4, not the other way around. I am a 30 year old female, my OBGYN office said I am fine. Should I leave it at that or do I have a problem since I have such a low t4 and a previous higher midrange TSH. This is all very confusing to me.
15 Responses
Avatar universal
Test results will vary a bit from one lab to another, so their ranges also vary.   Please post the reference ranges for the Free T3 and Free T4, as shown on the lab report.
Avatar universal
Thank you for the reply, the lab results were given to me over the phone this morning. I am going to try to make it into the doctors office today to pick up the hard copy of it and I will post the lab values.
Avatar universal
Free T4 range 0.7-1.6
Free T3 range 2.3-4.2
TSH 3RD GEN 0.400-5.100
Avatar universal
Does anybody know?
Avatar universal
So if I have this right your lab tests were as follows:

TSH= 2.25 (0.4 - 5.1)
Free T4=0.8 (0.7-1.6)
Free T3= 3.1 (2.3-4.2)

listing the lab results this way makes it easier to analyze.

You state that you have many hypo symptoms. Could you please list some of them.

But in general many people who fall within the normal ranges (which you do) will find it VERY difficult to get a Dr to prescribe a medication.  Some Dr's with you having symptoms may prescibe medicine since many Dr's believe that TSH should be between 1 and 2.  With your's being slightly over that @ 2.58 along with symptoms you MAY be able to find a Dr who will give you a starter does at least as a trial.

Many other people here have found that if they are symptomatic, they actually need in order to feel well their blood labs to be BOTH of the following.

1) FT4 levels at or slightly above the MIDDLE of the range (50% of range plus)


2) FT3 levels in the UPPER 1/3 of the range (67% of the range)

Your tests show the FT4 to be towards the very bottom.  You are only at 11% of the range certainly a far cry away from 50%.  Your FT3 is at 42% again a fair amount shy of 66%.

FT4 is a storage hormone and is converted into T3.  The common first thing to prescribe is a pure synthetic T4 medication.  This should raise both your FT4 and FT3 levels if your body is converting properly.

You can spend a lot of time here and there are some very good websites that can help educate you on all of this.

Bottom line is that I think you will start to feel better if you can get some thyroid medication.  But as I said don't think that this is any slam dunk easy process since all your labs are within the "normal" range.

Also the American Academy of Clinical Endocrinologists (AACE) like 8 years ago recommended the TSH range be changed to (0.3 - 3.0) but labs and Dr's have been unwilling to use this new range.  With this range your TSH of 2.58 would be towards the higher part of the range, which would indicate LOWER thyroid amounts.  TSH works backwards (high results mean low thyroid).
Avatar universal
Sorry for the confusion.  :(

4wks ago
TSH 3RD GEN = 2.580 (0.400 - 5.100)

A couple of days ago
TSH 3RD GEN = 1.740 (0.400 - 5.100)
FREE T4 = 0.8 (0.7 - 1.6)
FREE T3 = 3.1 (2.3 - 4.2)

Both tests were done in the mid afternoon, is it weird that my TSH changed so much in 1 month?

After having children I started having problems.
I went through a huge stage of horrible stress in my life.
Bad fatigue even after a full nights rest, I am always tired and have to force myself to do everything it seems like.
This greatly affects my patience.
My very thick hair has been thinning out, dry scalp.
I have problems with dry skin patches on my upper arms and on my hands, evening primrose oil and flaxseed oil have given me some great relief with this though.
Menstrual irregularities and pain.
Great difficulty with weight loss even with strict calorie counting.
I get more energy at night and I have to force myself to go to bed.
Avatar universal
Thank you for your reply. Should my next step be finding a knowledgeable endocronologist that uses the latest lab values?
649848 tn?1534637300
You don't necessarily need an endo, but you do need a doctor who will look at all the lab values, not just the TSH.  FT3 and FT4 must be tested every time you have blood work.

TSH varies greatly, even intraday, so the fact that it's lower, after a month, isn't really impressive.

You said that your estradiol and testosterone levels were both low normal, as well; that could have a bearing on how you feel.  

You should ask to get vitamin B12 tested, as deficiency can cause absolutely debilitating fatigue.  You also need to get vitamin D tested, since deficiency can cause a lot of thyroid like symptoms. While you're at it, you might as well ask for calcium, magnesium and iron/ferritin.

I'd also suggest that you try to get tested for thyroid antibodies to determine whether or not you might have Hashimoto's Thyroiditis, which is an autoimmune disease in which the body sees the thyroid as foreign and produces antibodies to destroy it.  The destruction can take decades, or it can go pretty fast. If you test positive for Hashi's, you will know that your thyroid function will decline over time.
Avatar universal
Don't count on an  endocrinologist to be any better than your primary care Dr.  Most Endo's these days spend 99.9% of their time with diabetes and little to no time with anything else.

All the Dr's were trained the same way with immaculate TSH belief. So the trick is to find a Dr who will actually treat you clinically by symptoms.

You defiantly sound from symptoms like you are Hypo. Like I said the FT4 is very low in the range and many people here myself included feel poorly with FT4 that low in the range.  I have still been unable to get a Dr to provide any medication.  Your symptoms seem a bit more pronounced than me.

TSH is HIGHLY variable even within the DAY.  For this reason it is best to try to have blood labs taken approximately the same time each time.  Because of TSH high variability.  And the FACT that symptoms do NOT correlate to TSH we here on this forum and other places have determined that TSH is at best a screening tool and should be used for nothing more than that.

To really adjust medication and to truly determine thyroid health both the Free T3 and Free T4 need to be tested.

Bottom line you need to simply find a Dr who is willing to prescribe you at least a starter dosage of thyroid medication.  At that point you should monitor your symptoms and blood labs to keep adjusting the medication until you feel well.  Understand that sometimes symptoms lag the blood labs by a fair amount of time like a couple of weeks.  So as you get closer to optimizing, the longer the time between adjustments.

You may spend a LOT of time shopping for a Dr who will treat you.  With your last TSH between the mystical 1 and 2 range, AND your other FT4 and FT3 being "within the normal range".  Makes it terribly difficult to find a Dr to prescribe medicine.  So be ready for this most common reaction.

In the mean time, people who are Hypo also typically are also deficcient in one or more vitamins.  So you may want to get blood labs for these as well.

Vit D3
Vit B-12

The ranges on many of these are extremely wide. Many people find they need to be well up towards the upper ends of the ranges escpecially in B-12 and certainly above half way.

Also you may want to be tested for Hashimoto's. This is a blood test and you need to test for two antibodies. They are:  TPOab and TGab.  If either one of these are elevated it would be indcative of Hashi's.  

Hashi's is an autoimmune disease and the most common cause of hypo in the industrial world.  For whatever reason your immune system believes your thyroid gland is a foreign invader. And like a good immune system it goes to work to kill it.  As a result the thyroid produces less and less thyroid hormone over time.

IF you test positive for Hashi's, that MAY give the Dr a little more reason to start you out with Thyroid medicine as Hashi's is progressive. So since sooner or later you will be needing thyroid medication, and you are currently already symptomatic, the DR MAY be willing to prescribe the thyroid medication.
Avatar universal
I forgot I also have problems with being cold now, my husband likes the thermostat at 72 degrees at night and most nights I just can't get warm. My hands and feet will feel like they are freezing and to fall asleep I have to put on my floor length fleece robe and wool socks and get under the covers.

I have struggled along with weight loss over the past year and a half. I'm happy to say I have gone from 220 to 173. I know how to eat properly and religiously watch my calories, it shouldn't be this hard. Plus now my body is disproportionate, all my weight is around my middle in size
Avatar universal
I have other symptoms I forgot to mention, like the fact that sometimes at night with the thermostat at 72 degrees my hands and feet are freezing and I have to put on A fleece robe and wool socks and get under the covers to fall asleep. All the weight I have left to lose is concentrated around my stomach and thighs, it is very weird.  :(
Avatar universal
I don't know why I keep getting double posts on this forum, I apologize for that.

Thank you flyingfool for that information, I have a lot of reading up to do on this subject. It was my OBGYN that did the tests for me. I had an early miscarriage last fall, 5wks 3d. I believe that I have a progesterone deficiency and she wanted me to have exploratory surgery to look for endometriosis. It is like what you say, she isn't concerned about my labs because they are in the normal range. Her solution for everything is birth control pills. I have been taking Prenatal vitamins, B complex, magnesiuma and 1000mg vit C, magnesium and either 3000mg flaxseed oil or evening primerose oil depending on the time of the month, daily.

It looks like I have a long road ahead, I think I will make an appointment with my primary care physician to see if he would like to look at my labs. I just know I can't live like this anymore, I am definitely not depressed and I have a lot of things to be happy about, nobody should have to walk around everyday like a zombie.
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