Low Thyroid Numbers but Normal Antibodies

[kris10_2]

I am a 35 year old female and when I FINALLY went to the doctor after months of hip pain and then recent back pain my doctor ordered a full blood work up just because it had been a while.  They called me the next day and said that my thyroid numbers were low and so they were going to request they do an antibodies test.  I don't know the first thing about all of this medical stuff and have a severe, probably unreasonable fear of "results" so I tend NOT to go to the doctor.  They called me after my antibodies came back normal and scheduled me for a thyroid ultrasound.  A little history of my symptoms might help so I'll tell you that I quit smoking seven months ago.  I gained 8-10 pounds gradually over about a 3 or 4 month period which I expected.  However...over the last 3-3 1/2 months, I have gained 18-20 pounds.  I have also felt extremely tired, have had lots of joint pain (that made me wonder if I could have arthritis), and have had an overall "yucky" feeling....like my body feels similar to what it has felt like when I've had the flu or some similar illness.  I'm absolutely terrified of the result of this test that I have to go get Wednesday and would love to know if anyone has experienced this same thing and if you might be willing to share their results.  I know I probably shouldn't worry YET but my biggest fear is going to the doctor and getting some terrible news.  I didn't think that at the age of 35, I would have to be worrying about something like this.  I do hope and pray that once the test is over, they find it's something that is completely treatable and will fix all that has been making me feel so uncomfortable, exhausted and irritable.  Thank you in advance for your assistance.

[gimel]

Please post whatever thyroid test results you have, along with their reference ranges, so that members can provide the best response.  You should make it a habit to always get a copy of your test results and keep for future reference.  Doctors are required to give you a copy upon your request.

[kris10_2]

I apologize.  I was not aware that I should have done that.  I'll get that information and post back.  Thanks for your response anyway.

[kris10_2]

After getting an ultrasound I have been referred to an endocrinologist for further evaluation.  I'm terrified but I did go pick up my paperwork to post here and see if there is anything that can be offered to me.  First off, I have read that nodules do not necessarily cause pain.  My throat hurts and my neck hurts.  My body aches as do my joints and I always feel physically drained...like I could take a nap at any time of the day and still go to bed early at night for a full night of sleep.  I am also forgetful and my attention span is about 2.  Cancer runs in my family but not thyroid disorders.

My original doctors visit was for blood work when led to a blood work up which resulted in the following:

Thyroid Panel with TSH                Result                        Limits          
TSH                                            0.265L uIU/ml             0.450 - 4.500
Thyroxine (T4)                              7.6 ug/dL                   4.5 - 12.0
T3 Uptake                                    30%                          24 - 39
Free Thyroxine Index                    2.3                             1.2 - 4.9

Then they requested Thyroid Antibodies with the following results:

Thyroid Antibodies                        Result                        Limits
Thyroid Peroxidase (TPO) Ab        8 IU/mL                       0 - 34
Antithyroglobulin Ab                     24 IU/mL                      0 - 40

Then they requested a Thyroid Ultrasound with the results following:

Technique: Real time ultrasound evaluation of the thyroid with multiple sagittal and transverse images.

Findings: Right lobe of thyroid measures 4.1 x 1.4 x 1.4 cm, left lobe 4.1 cm x 1.1 x 1.4 cm.  The isthmus is unremarkable.  There is a small 3-4 mm nodule in the mid right lobe that is hypoechoic of no clinical significance at this time.

Impression: Thyroid ultrasound essentially normal with a very small hypoechoic area in the right lobe of no clinical significance at this time.

To me...it doesn't sound too bad so why do I still feel like this?  Does TSH ever related to anything other than your thyroid?  

Thank you in advance for your advice.
~kris

[goolarra]

Your TSH is low, which might indicate hyperthyroidism.  However, it is not alarmingly low.  Your FT4 looks good...it's in the middle of the range.

Antibodies are not elevated, which is good, it indicates no autoimmune thyroid disease.

Your US report is clean, except for an insignificant nodule.

TSH is a pirtuitary hormone.  It's the "messenger" your pituitary puts out to tell your thyroid to produce more thyroid hormones.  TSH abnormalities can surface from anywhere in the thyroid/hypothalmus/pituitary circle.  The other test they should have run is free T3 (FT3), especially since your TSH is low.  However, your symptoms sound hypo, not hyper, but your labs do not support hypo.  I think I'd start looking for another cause of your symptoms.

[kris10_2]

Does that mean it could be something other than my thyroid that is causing the symptoms?  I've felt achy and feverish today with a sore throat.  I've always had problems with my tonsils and though I don't have a fever, I wonder if it could be something as simple as a strep infection that could be cured by antibiotics...though that could just be wishful thinking too because I'm terrified of what could be causing this.  How come you say my symptoms don't sound "hypo"?  Everything I've read points to hypo.  Dry brittle nairs and hair, extreme fatigue, muscle and joint pain and unexplained weight gain....I gained 5 pounds in the time that I had the blood work and this past Friday and I'm not eating more than normal or anything......

....sooo frustrated and scared!

[goolarra]

No, I said your symptoms DO sound hypo, but your TSH is below range, which indicates HYPER.  However, your FT4 looks good, so neither your TSH nor your FT4 support hypo.  

I think your thyroid checks out pretty "normal".  In my opiinion (not a doctor, just a fellow patient), I think you should look for other causes.  Considering your US report, I don't think your thyroid is causing a sore throat or neck pain.

[kris10_2]

What else could be causing symptoms of hyPOthyroidism?  I have an endo appointment at the end of the month so hopefully he'll be able to shed some light but in the meantime, I'd love to hear some other ideas or possiblities...

[dolphin27]

Hyperthyroid can be caused by the pitiutary gland. That is your master gland.
Ask them to check your hormone levels. Make sure those are ok.

[kris10_2]

I don't have symptoms of hyPERthyroid.  I have symptoms of hyPOthyroidism.

[goolarra]

It's good that you are following up with an endo.  I think that's an excellent idea, but just keep an open mind to other possibilities.  Best of luck with the endo, and let us know how it all works out.

[dolphin27]

your TSH is low which points to HyPERthyroid.

[goolarra]

This is why we hate to see doctors relying on TSH alone as a diagnostic.  kris's TSH is low, but there is no way she is hyperthyroid, with an FT4 just in middle range.  Low TSH can indicate hyper, but it must be supported by FT3 and FT4 and hyper symptoms.  Hers is not.  So many things can affect TSH, from the thyroid to the hypothalmus to the pituitary, that it is not relaible in diagnosing thyroid disorders or adjusting medications.  It's been the "gold standard" in thyroid tests for way too long.  Many of us are dedicated to toppling it from its pedestal!

[kris10_2]

Thanks guys for all of your comments.  I read an article today where someone had normal TSH levels but was still presenting with Hypothyroid symptoms.  The doctor did a TRH (Thyrotropin Releasing Hormone) test and it came back above ten which indicated that her thyroid was underactive.  It's mostly frustrating and a little scary right now for me.  My biggest...probably even unreasonable fear...is cancer.  I'm 35 years old and I just don't think I should have issue's like this at this time...though I've read that thyroid issue's can begin to present in the 20's.  Crazy.  I'm scared and will be until I get an all clear from my doctor.  It doesn't make sense why I feel so bad but yet there still is not an obvious reason for it.

[goolarra]

Thyroid issues can present in childhood.  Most of us are old farts, but not all!  As far as thyroid cancer is concerned, I'd relax...your US just doesn't support it.  Also, your antibodies are negative, which also does not support thyroid cancer.  Hope your endo can unravel all this for you.

[kris10_2]

I went to the Endo I was referred to last Wednesday.  He seems to be very knowledgeable also.  He says "the thyroid is my passion".  LOL!  They did an US and found a nodule on the left lobe too which of course put me right back in my fear zone.  He did say however that they were too small to biopsy right now and wanted to watch them for 3 or 4 months.  My thinking on that is that if they COULD be cancerous, even though only a 10% chance, I don't want to wait dang it.  I don't want to let something like that grow in my body.  I said jokingly to him, can't you just take out my thyroid and give me a pill?  He laughed and said no.  I asked him if there WAS anything he could do that day and he said that because my blood work didn't really give him any answers, he pretty much had to start over.  He was not happy with LabCorp's range for antibodies and after much research and studying, they finally called them and asked them where they got the range of 0-40 as a healthy range.  They said from an internet website.  So....I'm not sure if I totally understood his reasoning but I believe he said that if your antibodies were up too much over 0, that they were doing something or fighting something thus requiring more research.  So...they took six vials of blood and said he was going to go do another "full blood work up".  He sent the thyroid testing to a lab in California that he is more comforatable with and the other to LabCorp...who I'd just rather not use after his comment about the healthy range being found online.  I'm terrified of these nodules but pray that the blood work points obviously to something that's fixed/treated easily.  I'm soooooooooo tired of feeling so horrible.

One question...is it still possible to be HYPO with a low TSH? I know other tests are really going to be the deciding factor but as a base line....TSH being raised usually indicates hypo.....not it being low....right?  Doc is doing Free T3 and Free T4!  Thank goodness!

[ChitChatNine]

You can have hypO symptoms and be Hyper.  We use LabCorp, too, and my endo did repeat Vit D tests which he wanted to make sure were accurate.   My antithyroglobulin was 8 I think but since I had some small papillary tumors and did not receive RAI they are ok with the #.  And it's been stable for 2+ yrs.

How large are your nodules?  That is my main thougtht .. PM me to be sure I come back to your post and I'll watch list it, too!

C~

[ChitChatNine]

O I C the nodule is small.  Nothing you can do with them that small from what I'm told .. mine is a 4.0mm stable and my other ones removed via surgery that were atypical FNA were almost 2.0cm's and hypoechoic and turned out 100% benign.  I have to have my other side ultrasounded ev. year now for serial comparison with my one yr coming up next month.  Used to be ev. 6mos for which I liked better.

They usually can only biopsy > 1.0 cm

Vitamin D ... see if they can add that test to the bloodwork .. so many of us here on thyroid are low on Vit D and that, alone, can cause hypo-like symptoms.  Mine was a horrific 9 with normal being 32-100 ... and my hypo symptoms all went away with treatment.

C~
partial 1/07
synthroid 75mcgs

[kris10_2]

How much Vit D should one have in their body's?  I am in the sun 3-4 afternoons a week and now coming up, will also be on Saturdays as football season has started back.  Isn't the sun where you get Vit D?  I watched a show one time that said the majority of the general population don't typically get enough Vit D.  Should I just go buy some and start taking it to see if it helps or is there risk of having too much?  I've read about Calcium too and though I take fish oil vitamin w/ three kinds of oils and a Complex B12 w/ folic acid and Vit C in it, I haven't noticed any difference.  Well...I take that back...a day or two after I started taking it, I did notice a difference in my need for sleep over the weekend and I didn't feel as exhausted during the day but that didn't last.  I'm still taking those but still feel extrememly fatiued daily and my joints...especially my back, hips, knees and ankles hurt like crazy.  My endo said my symptoms could be rheumatoid related too so hopefully he requested that test also.  I think I'll call them today and see if they can add the Vit D and Calcium just so I'll know.  

Thanks for the note.  I'm going to go get the tracker you mentioned too.

Guess I should fix up my profile.  I'll likely be spending a fair amount of time here. :-)

[kris10_2]

I FINALLY heard back from my awesome Endo.  I'm SOOOO glad I decided to switch from the original Endo I was referred to and go to this one who was highly recommended by a co-worker.

I got some info on my blood work though they are still waiting on antibodies.

I forgot to ask the level and range for my Vitamin D but they said it was extremely low and are starting me on 50,000iu's of it now.  I will take it twice a week for 8 weeks to get it back up to normal range.  I think they will test it again then.  The nurse said that it's probably why I've been feeling so terrible too so hopefully it'll kick in pretty fast.  She said my calcium was right in the middle of the healthy range.  I wonder if I should still take some Calcium anyway?

TSH = 1.9 (.45 - 4.5)
Free T3 = 2.7 (2.3 - 4.2)
Free T4 = 1.23 (0.6 - 1.7)

They said that I would benefit from the Vitamin D AND after two weeks of being on that, they want to start Synthroid too.  They just want to make sure I don't have any kind of reaction to the Vitamin D first.  

I asked her what the numbers above mean and she said she really couldn't say yet because the antibodies won't be back until Tuesday next week but on a preliminary result she said there was evidence of them being active?  Not really sure if that means too much yet because I thought everyone had antibodies...that were active.  Maybe she thought they looked too active but are waiting on the antibodies to come back to confirm.

So....I feel a little better just knowing they are going to try these two things out and not make me go on living feeling so horrible.  I really like this doctor so far.  I hope that within the next 2-4 weeks, I'll start to resemble what I THINK I should really feel like.

[Barb135]

Everyone DOES have antibodies - the problem is that sometimes the antibodies, which are supposed to attack foreign things (like flu, colds, etc) sometimes start attacking parts of our bodies because for some reason they think that part shouldn't be there - these are called autoimmune diseases.  There are several of them, including Hashimoto's Thyroiditis, Graves Disease, which are both thyroid related.  

Your body does make vitamin D from sunlight, but there are some of us who apparently "malfunction" there too.  My job keeps me in the sun for anywhere from 3-8 hrs/day but a recent test showed that I'm deficient.  One thing is whether or not you use sun screen -- if you do, the rays can't get through, so your time in the sun doesn't do anything for you - vitamin D wise, that is.  Another thing is the color of your skin - the darker your skin, the less rays you absorb to make vit D from.  Aging is another factor - the older we get, the less efficient our bodies are at making vit D.  Personally, I have sort of medium olive skin, which burns once in the spring, then tans famously but apparently that tan is what contributes to my low vit D levels.  Another contributing factor is my age -- I recently turned 60, so you have that advantage.  I do not use sunscreen so my face/upper neck and arms are exposed to the sun most of the time I'm outside.........oh, woe is me --- I'm waiting for an appt with my pcp on the 23rd to see what kind of journey this is going to take me on...

Judging from the labs you posted above, your TSH is mid range (the lab is using an outdated reference range - the new one is 0.3 - 3.0); your FT3 is very low in the range; under most circumstances I would say your FT4 is good.  Sometimes, those of us with Hashimoto's benefit from having our TSH suppressed more, so I can see where you might benefit from synthroid.  One thing I'd ask you to make sure of is that you start at a very low dose, then work up slowly and retest in a few weeks.. You don't seem to be that far out of line and I'd hate to see a large dose all at once to send you completely hyper.  

[kris10_2]

I live at the beach but I don't go very often anymore.  I used to get way more sun time than I have the past two years or so.  I might have gone and stayed a couple hours at the beach a total of 5 times in the last two summers.  Part of it this year is the weight I've gained.  I don't usually wear sunscreen because after the first time or two in the sun, I tan well.  There are risks associated with sunning too in the form of cancer and after my mom worshipped the sun for so many years and having to get 3" of her leg dug out from a stage three melanoma, I'm not willing to risk it anymore.  I don't know that me not being in the sun though is the cause of my Vitamin D deficiency.

Regarding the Sinthroid...I'm a little leary to try it because I don't really like the idea of some of the reactions and side effects to it.  I feel confident that my Endo isn't going to prescribe me high levels of it though to start.  I may benefit from just a low dose of it.  Whatever he does, I do NOT want to go Hypo either.  Ive read about anxiety/panic attacks and I've had those before so I do NOT want to have those either.  They scare me so bad.

There seem to still be many debates about that range and what should be the correct one.  How do we know that just because one side says this 0.3-3.0 is the correct range to use that it IS really the correct one?  After all the reading I've done, I take the TSH ranges with a grain of salt. I believe that the TSH test is only a jumping off point for digging deeper.  It seems that some people function normally at one range while another group of folks function normally at a completely different range.  I'm just not convinced by that test.  I'm also not sure that these ranges really indicate anything.  Who decides what's normal for one person or another?  I don't think that every person is created equal thus can't always be treated equal but deciding with numbers. Who knows.  It's all crazy and I know that I want to feel better so I'm willing to try anything.  :-)  I feel a little relieved just knowing that there is SOME answer about why I feel so uncomfortable all the time.

I also hope that whatever they do...it clears up my brain because it feels like there is a huge fuzz ball soaking up it's power.  I'm such a major ditz lately.  If my posts ever sound dingy...well...there's my excuse.  LOL!

[Barb135]

The most recent TSH range was set several years ago by the, I think it was, AACE - that range is 0.3-3.0.  Some labs are still using old ranges and they vary greatly.  For instance my lab uses 0.4 - 4.5........

You are absolutely correct, without any doubt whatsoever that TSH is NOT the way diagnose a thyroid issue.  AND you are absolutely correct that not everyone is alike and should be treated the same.  That's why you will find such varying treatments on this forum - because we have all figured out that we can't be treated the same.  There are some guidelines for initial treatment, but once we start coming back to health, we all have to figure out what's right for us.......Some of are on synthroid, some on generic levo, some on cytomel, Armour, or varying combinations of meds- we all have to get to a point where we do what's right for US, not what everyone thinks we should do.  BUT having said that, I must also point out that *I* would never have learned enough without the great people on this forum helping me, to have gotten to where I am now because the doctor who diagnosed me refused to do anything except prescribe synthroid and THAT isn't what I needed........without the people on this forum, I would not have known what to look for in a doctor, what tests to ask for or anything........So yes, you have to do what's right for you, but don't discount the help of other people either.  You take each opinion and weigh it to see if there is information there you can use.......usually there is, if only a few words of encouragement, which goes such a long way toward helping us get well.  

As far as your vitamin D - experts say that 10-15 min/day in the sun without sun screen should be sufficient - for some of us it isn't --- as I said in my earlier post, I am in the sun for 3-8 hrs daily without sunscreen and I'm deficient.  I also drink milk, which is fortified with vit D, plus I eat fish, etc that are loaded with it.......So again, you are right - YOUR deficiency may not be because of lack of sunshine.  It could have to with your skin - remember, I said the darker the skin the less rays you absorb - or it could be because you don't eat the right things OR it could be because there is something going on in your body that either can't produce it or USE it.......

I'm not sure what reactions/side effects you are referring to from synthroid, but there shouldn't be too many, except that it will help you feel better.  If for some reason you don't do well on synthroid - there are other meds to try, including generic, natural, etc.  Synthroid will help you keep from being hypo or did you mean you don't want to go hypER?  You will have to monitor your symptoms, along with regular testing to prevent it.  

[kris10_2]

I apologize if I appeared to discount what you said because that was not my intention at all.  I am only speaking from my point of view and expressing my opinions based on what I've read and learned over the last two months. I thought that's what this site was for.

I meant I didn't want to go hyPER.  Isn't that where you are basically bouncing off the walls and people that have those symptoms can have heart palpitations, anxiety and panic attacks too?  I have read more on hyPO because that's what my symptoms point to than I have on hyPER.  Neither one can be fun and I know I hate the way I've felt for the last few months but for some reason, hyPER scares me more because of the things like heart problems and anxiety.  I've had enough issues with anxiety and panic attacks so I surely don't want to go the opposite of what I am now.  On the same token, I want to come out of this fuzz and discomfort I've been in for what seems like forever.

When it comes to Vitamin D deficiencies, are there typical things that can occur in one's body that causes that deficiency?  I am out in the sun for football practice in the evenings 2-3 times a week but it's getting dark earlier so I probably don't get as much at that time of night.  I am outside on Saturdays for 3-4 hours in the sun at the games but I guess my body is stubborn and doesn't want to produce it.  I have a friend that was diagnosed with a D deficiency and the put her on the prescription D but she doesn't have a thyroid problem or anything else that they could find.  I'm just curious what could cause someone to just not produce it correctly.  I also was curious as to calcium.  My doctor said my calcium level came back right in the middle of the normal range and didn't suggest taking calcium.  Doesn't calcium help absorb Vitamin D?  

I don't go on the Synthroid until two weeks from now so they can see if I do ok on the D.  I hope they start off low and go from there.  

[Barb135]

Yes, you can speak your opinions on this forum - I thought I was agreeing with almost everything you said and explaining WHY I agreed.................lol.  

I'm not UP as much on the vit D as I'd like to be as I've not had a lot of time to research it.  Just basically what I've told you so far - that sometimes we just can't make it for whatever reason, such as skin type, age, etc and I'm sure there must be something within the body that could prevent us from producing it also.  If I'm low, as much time as I spend in the sun, there has to be something in my body that isn't working right, but I've no idea yet what that might be.  

I figured you might have meant that you didn't want to go hypER - yes, you are correct - that's when people "are bouncing off the walls", having heart palps, anxiety/panic attacks etc and often much worse.  I agree that you do not want that to happen.  I know there are some on this forum who have been hyper and went through he// with it.  Personally, I'd prefer to stay a bit hypO in order not to have to go through that.  

No, calcium doesn't help absorb vit D - it's the other way around - vit D helps absorb calcium, as does magnesium.  That's why a lot of calcium supplements also have vit D and magnesium in them.