Need help please with conflicting TSH level blood results

[MrsB_2inlove]

Good morning!

I'm completely new (as in only the past 2 days) to all of this thyroid talk, but I'm fascinated by the thought that maybe I've FINALLY discovered what's going on with my body!  Here's my story: I'm 32, 5'2, 140 lbs., in good health (other than this possible thyroid issue), and I exercise by doing weight training and 30 minutes of jogging on the treadmill at LEAST 3 times a week.

I'm SO completely lethargic (to the point that I'm almost falling asleep at the wheel driving to/from work everyday), I go to my car everyday on my lunch break to take a nap for an hour (and that's still not enough), my menstrual cycle has been crazy (even though I'm on birth control and am usually very regular), I've gained 25 lbs. over the past year, I've started seeing a Psychiatrist for depression and irritability and lack of focus (ADD), and the list of symptoms that mirror hypothyroidism just goes ON and ON so I won't bore you with it.

I initially went to my Primary Care Physician (our Family Practitioner) in December 2008 to find out what my problem was and he had me do some bloodwork with which he ran every test known to man and all of my levels came back "normal" (in particular my TSH was 3.37, Free T4 was 1.1 and Free T3 was 323) so he's completely at a loss.  He then told me that maybe my body wasn't absorbing vitamins the way it should (hmm, to me this would only explain the lethargy and NOT the other symptoms, but what do I know!) so he suggested I take his very own in house test (he has started his own "wellness" program so I'm sure this is part of that) that can screen for this for the bargin price of $500 which isn't covered AT ALL by my insurance.  So, I just dropped it because I couldn't be out-of-pocket $500 at the time.

Fast forward one year later and I've called him for a referral to an endocrinologist who has drawn my blood twice now because the first time the lab didn't even run half (namely the TSH testing) of the tests that my doctor had requested so I had to have a "redo".  I called my doctors office yesterday to ask about my TSH levels and the nurse told me everything is "fine" (if she was living in this body she would know everything isn't "fine"!).  My TSH was 1.20 and Free T4 was 0.5.  I then asked about my Free T3 and she said they didn't test for that.  WHAT?  WHY NOT?  Why would they test for everything else and not the Free T3!?!  Therefore, I've completely lost faith in this lab and potentially this doctor if he doesn't order another blood test.

So, my main question is....do you think it's possible that this most recent lab result of TSH = 1.20 could be correct even though it's only been a year since my TSH was 3.37?  I'm getting really confused and I'm trying to plan my next steps in this process.

I'm PERSONALLY going by the AACE's new guidelines (adjusted in Nov 2002) for a narrower margin based on a target TSH level of 0.3 to 3.0.  My Family Practitioner bases his "normal" range within the old standard of 0.5 to 5.0 which is why he said my results were "normal".

Thanks in advance for any help you may be able to offer and for taking the time to read this (I know it's lengthy!).

[Barb135]

You need to have antibody testing done to see if you have Hashimoto's or Graves Disease.  The tests would be TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) for Hashi's and (I *think*) the main one for Graves is a TSI test, but I'm sorry I can't tell you what that stands for, as I don't have Graves and am not real familiar with it.  A thyroid ultra sound would also be helpful to determine if you have a goiter and/or nodules.

If the range of your FT4 is anything near the one my lab uses, your FT4 is too low at 0.5.  I would suspect that your FT3 might also be too low, but since that wasn't tested the last time, there's no way to tell.  

It's very possible to have a normal TSH, even if your actual thyroid levels are off.  I'm not a believer in even looking at TSH until the very last thing because it's a pituitary hormone and is not necessarily indicative of your actual thyroid levels.  For instance: *my* TSH runs at only 0.01, so anyone adjusting meds based on TSH would decrease my med (yes, my doctors have done that) and send me back to hypo he// (yes, THAT happens too - in fact, I'm just "coming back" from a hypo crash for that very reason).  

I suggest that you find a doctor who will look first at your symptoms, then at your actual hormone levels (BOTH FT3 and FT4), and lastly at your TSH -- the idea being to begin and adjust med to alleviate symptoms, not just get the lab results into the "normal range".  

You might also want to have your vitamin b12 levels tested -- b12 deficiency can cause a lot of the fatigue you mentioned, along with tingling/numbness in the hands, feet, legs.  I turned out to have a combination of b12 deficiency AND hypothyroidism, so was getting a "double whammy".......I'm now on both thyroid med and b12 shots and now that my thyroid med is pretty much adjusted, I'm feeling better than I have in years.

[LazyMoose]

Its good to know if you convert to T3, as you seem to understand the possibilities are not 'standard' with all of us. They dont test to save money, I would suspect, even though the odds are against some of us.

You should seek testing for autoimmune thyroid issues.

In your quest, do not rule out other things that mimic hypo thyroid, gluten issues, digestive (whole body) bacterial overgrowth including Candida.

Your tsh seems to vary, have other hormones tested ever? - they 'pull' on each other. Adrenal levels are tied into this as well (the 4 point, 24 saliva test is best).

[6hashi]

Can you post the reference range for the FT3,FT4 ?
If you are treated correctly then TSH and FT4 are adjusted properly then your FT3 supposed to be fine except some cases of conversion problems.
Some times the TSH is in normal range but you still have autoimmune disorder ,to know that you need to ask for anti TGab and anti TPOab .