My TSH is 8.5 and my T4 is 0.5

Question

I've had hypothyroidism symptoms for almost 10yrs but Drs don't treat them because they say everything is normal. My sister and my  mother both suffered for yrs before being treated.  I am so tired, hair falling out, eyebrows nearly gone, depressed for no reason, periods are all over the place.
can anyone advise me on this please.

gimel · Answer

A Free T4 that low in the range is consistent with having hypo symptoms.  Due to the erroneous assumptions used to establish ranges for Free T4 and Free T3, they ranges are far too broad.  We usually say that FT4 or FT3 results in the lower half should be considered as suspect for hypothyroidism, if there are also symptoms that can are typical of hypothyroidism.  Also, in the words of a good thyroid doctor, "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."  

Did they not check for Free T3 or anything else?

gimel · Answer

The NHS may be good in numerous areas, but as I described, not when it comes to testing and diagnosing and treating hypothyroidism.  

Was that ferritin level of 43 done when you were taking your current amount of ferrous fumarate?  If so, then you need more.  If not, then you need to get it tested again and supplement as needed to get to at least 70, and some places recommend 100.  

You also need to know your Vitamin D and then supplement as needed to optimize to 50 min.

Another thing is that even if you were diagnosed with hypothyroidism the NHS dictates that the patient should only be medicated enough to bring the TSH within range.  They also try to prevent any thyroid med being prescribed other than T4.  Often the patient does not adequately convert the T4 to T3, and ends up with a Free T4 high in the range, and a Free T3 in the bottom of the range, and with lingering hypo symptoms.  

So if you can get to a private doctor and get the suggested testing done and then push for medication adequate to relieve symptoms, it will be well worth the cost.

gimel · Answer

Is that 210 mg of ferrous fumarate?  Please double check.  

Glad it is Free T3.  Is there any way to get tested for Vitamin D and B12 also?

Sorry I have no knowledge of any good thyroid doctors in that area.  So you are going to have to work on your doctor and get him to change, or possibly find another doctor that will treat clinically, as described.  The third option is to go private.

gimel · Answer

Try to make sure it is a Free T3, not a Total T3.  Also, along with the B12 test I highly recommend getting tested for Vitamin D and ferritin (iron).   If you can get to a private doctor you will be much more likely to get the needed testing, diagnosis and treatment.  I have names of a few doctors, mostly in the London area, that have been recommended by hypothyroid patients.  If you will tell us your location, perhaps we can suggest someone.  

You should give a copy of the paper on diagnosing and treating hypothyroidism and tell him that his approach seems to be different than tthat recommended in the paper, which is supported by extensive scientific evidence.   Everyone is entitled to their own opinion but not their own facts.

gimel · Answer

I wondered if perhaps you were located in the UK.  Being there increases the problem of getting adequately tested and treated.  Per the NHS the patient is tested for TSH and if over 10, then it is diagnosed as overt hypothyroidism and treated.  If over 5, then a Free T4 test is done.  If that is within the range, then the patient is told there is no thyroid problem and that symptoms must be due to something else.  Unfortunately for the patient that approach does not work for many people, who are left to suffer with hypo symptoms, like yourself.  Since I expect that your Free T4 was actually below range, I totally don't understand why your doctor did nothing further.

Following is a link to some info that you may find useful.  Also there is a further link to a paper written on diagnosing and treating hypothyroidism, currently posted on the ThyroidUK site.  Just within the first two pages you will find out what should have been done for you.  Then there is a lot of discussion of current practices and why they are inadequate, recommendations for what should be done instead, and extensive supporting scientific evidence.  If your doctor is open at all to considering the need for additional testing and diagnosis, then perhaps a copy of the paper might push him in the right direction.  If not, then you should consider the following advice from a fellow UK member who had similar trouble and was finally successful in getting what she needed from a doctor.  Another option would be to try and find a doctor that understands and cares.  

"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge.  You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid.  If you fight for what you want, you will eventually find someone that is happy to go along with your wishes.  But we all have to take charge of our own health, right?" 

http://www.medhelp.org/user_journals/show/2019570/Diagnosing-Treating-Hypothyroidism-A-Patients-Perspective?personal_page_id=12021

gimel · Answer

There is a lot to discuss but first, is that a Total T4 or a Free T4 test result?  If you will post the reference range shown on the lab report I can tell which.  Also, where are you located?  I ask about that because getting adequately tested, diagnosed and treated is more difficult in some countries than others.

My TSH is 8.5 and my T4 is 0.5

Do i question my doctors treatment plan

muscle weakness in legs from too much thyroxine

With in range

Should I lower my thyroid med?

Do i question my doctors treatment plan

muscle weakness in legs from too much thyroxine

With in range

Should I lower my thyroid med?

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