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Need answers...

I have been having ongoing issues with my thyroid for some time. I have nodules on my thyroid and had the following recent blood test...

FREE T3 (RANGE) 2.8-5.3 pg/mL   (My Result) 2.4

T4 THYROXINE, FREE (Range) 0.7-1.9 ng/dL  (My result) 0.8

TSH (Range) 0.40-4.70 uIU/mL (My result) 1.28

I also have a high WBC (13.4) , and low ferritin (12).

As a background note, my TSH was .08 in March.

When I spoke to my endocrinologist office today they said they (meaning my PCP)  doesn't need to be check my T3 and T4, TSH is what matters. She feels my levels are fine now, and there is no need for any other tests or medication. I guess I don't want to sound like she doesn't know what she's talking about but I messaged my  PCP doctor asking for a TPO test. Would you have? I am so lost, and tired from dealing with all of this.....
7 Responses
Avatar universal
We would like to know what symptoms you are having.  Beyond that I think that you have Free T3 and Free T4 levels that are clearly hypothyroid.   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."   Clearly your test results are far below even those levels.

Your Endo seems to have the "Immaculate TSH Belief, by which he only wants to diagnose and medicate based on TSH.  That does not work.  There is no scientific evidence that TSH correlates well with either of the biologically active thyroid hormones, Free T3 or Free T4, much less correlate well with symptoms, which should be the main consideration.  The main value of TSH in early diagnosis is to determine between primary (Hashimoto's Thyroiditis) and central )hypothalamus/pituitary related hypothyroidism.  I'd say that the likelihood for you, with a TSH of 1.28 is central hypothyroidism.

In addition your ferritin is way too low.  I expect that testing will show that two other important contributors, Vitamin D, and B12 are also too low in their range.  

You are wasting your time with that doctor.  You need a good thyroid doctor.  If you will tell us your location, perhaps a member can recommend one for you.

649848 tn?1534637300
Find another endo asap.  Free T3 is the hormone that's actually used by the individual cells and yours is below range.  To say that it doesn't even need to be checked, tells us right there that your endo is not a good thyroid doctor.  Your FT4 is also very low in the range.

Are you on a thyroid replacement medication? If so, which one, what dosage and how long have you been on it?

The high WBC indicated inflammation "somewhere" in your body and the low ferritin indicate low iron levels.  You should ask for an complete iron panel.

Instead of a TPO test, you want a TPOab test, which is Thyroid Peroxidase Antibodies.  In addition, you want a Thyroglobulin Antibodies (TgAb) test.  Both of these tests are indicators for Hashimoto's and you need them both, because some of us have one or the other, some have them both.  You should also as for a thyroid ultra sound and a vitamin B12 test.
Avatar universal
I am in Northeast WI.

When my TSH was very low, they believed it was post partum thyroiditis. My daughter turned 1 on August 12th, so I am on the way out of the time period for post partum thyroiditis. Even so, if that is what I have I would like to get it resolved. A whole year of varying symptoms I am going crazy!
Avatar universal
I had a thyroid ultrasound done about 2 months ago and the  nodules have not changed since my last ultrasound 2 years ago.

I am not on any thyroid medication. I was taking iron supplements for the last month, but after my ferritin result started taking ferrous sulfate.

I do take metformin for PCOS, so that does effect B12 as well.
649848 tn?1534637300
Have you had vitamin B12 tested?  If not, you should do so.

What symptoms do you have?
Avatar universal
I have not had my b12 checked.

fatigue, depression, no weight gain recently but the inability to lose weight, muscle tenderness.
649848 tn?1534637300
I agree with gimel that you could have central hypothyroidism.  Your fatigue is most likely a result of the combination of low thyroid hormones, low iron and low B12.  Depression is a common symptom of hypothyroidism.  Metformin often helps with weight loss, but since your thyroid hormones are so low, it may not.

Post partum thyroiditis often turns into permanent hypothyroidism.

You should ask your pcp for a referral to an endo who is willing to get to the bottom of your issues and not just write it off because your TSH is "in range".
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Queensland, Australia
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