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Low T4 levels with Normal TSH


After the birth of my first child, my life was never the same.   I had all the symptoms of a thyroid problem, but every time I got tested, my results came back normal.  That was until I found a doctor who tested my Free T4 too.  It came back low.  I have been put on a low dosis of Synthroid and was wondering if my life will go back to normal and when?  I have picked up 20kg despite any effort of trying to eat healthy.  I live with headaches on a daily basis and have so much water retention that my hands and legs hurt.

My lab results:

TSH:  1.39 (ref range 0.27 - 4.2)
Free T4:  10.5 (ref range 12.0 - 22.0)  The doctor seems to think for my age it should be between 15 and 18.

Please can you advise me on this result and give me hope.  I am so depressed with the extreme weight gain and really want to feel myself again.  Any advise?
1 Responses
Avatar universal
It was very unfortunate that you had a doctor with the "Immaculate TSH Belief".  TSH is a ptiuitary hormone that is affected by so many variables that it is totally inadequate as the sole diagnostic for thyroid.

At best TSH is an indicator to be considered along with more important indicators such as symptoms, and also the levels of the biologically active thyroid hormones, free T3 and free T4.  Studies have also shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate very well at all.  For that reason, you should also get tested for free T3, along with the FT4 and TSH.  I expect that you will find that FT3 is low, or below, its range also.  You should be aware that even if the FT3 and FT4 results are in the lower end of the range, that does not mean that all is okay.  Many members report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range.  

In order to determine if the cause of your low thyroid is due to Hashimoto's Thyroiditis, you should also be tested for the thyroid antibodies, TPO ab and TG ab.  Since many hypo patients also have deficiencies in Vitamin A, D, B12, iron/ferritin, and selenium, it would be good to be tested for those as well.  

A good thyroid doctor will test and adjust FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  So your first priority should be to talk with your doctor and get started on the testing.  Also, you need to find out if the doctor is going to be willing to treat you clinically, as I just described.  That's what it will take to get your life back to normal.

For a little more info on clinical treatment, here is a link to a letter written by a good thyroid doctor for patients that he is consulting with from a distance.  The letter is sent to the patient's PCP, to help guide treatment.  


When test results are available, please get a copy and post results and reference ranges and members will be glad to help interpret and advise further.

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