I think many of us can empathize with the unwillingness of Dr's to listen to their patients when they say something is wrong. Depression, in my estimation, is probably the number one response to thyroid patients initially. My dr. told me that, as well as a co-worker's dr. told her that. It's sad that thyroid is always the last resort to check, when often times, months or even years could have been spared for the individual fighting these symptoms. As far as your results, I am NOT the expert on here at all. I am just now starting to grasp these results myself, so someone else would probably be able to answer that better for you. Based on the limited experience I have, they, along with your symptoms, lead me to believe that you do need some kind of intervention. I know this doesn't give you any relief from what you've been dealing with for awhile now, but don't give up on it. Keep making your face show up at the dr office and let them know that you're not going to give up. Switch to a different dr. if you have to. Unfortunately, that's what most of have to do in the end. Wish you the best of luck. You will find lots of valuable information on this board, and lots of people willing to help. Hang in there!
We have so much to tell you. Where to start? Maybe the first thing is to emphasize that TSH is a pituitary hormone that is affected by so many variables that it is totally inadequate as the primary diagnostic for thyroid issues. Even though TSH is supposed to accurately reflect levels of the actual thyroid hormones, there is no valid scientific data to support that TSH correlates well with either of the biologically active thyroid hormones, Free T3 or Free T4 (not the same as Total T3 and T4), much less with symptoms, which of course are the most important consideration.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."
Of course there are multiple possible reasons for weight gain, including extra calories, inadequate exercise, low metabolism, insulin resistance, and PCOS. Far too many doctors automatically assume the first possibility as the cause, when it is not. That can be very frustrating, especially when it is very possible that you have low metabolism due to low thyroid levels.
One way to possibly get around the argument about whether you are truly hypothyroid or not, is to get a Basic Metabolism Rate test done somewhere. That will show what your actual result is versus what BMR would be expected, based on your weight, height, and age. Along that line, I think you will find interesting this post from a nurse that had gone through a similar situation. She was unable to convince her doctor that she had a metabolism and thyroid problem until getting a BMR test done.
"I was having some major problems with my metabolism. I am a nurse and I thoroughly researched all the scientific research on the internet and at the medical library. I, too was going to see doctors who would not help me. Fortunately, I found a doctor who gave me armour thyroid despite "normal" levels. I brought him a BMR test that showed my BMR in 750-900 range which is very low, I was cold all the time. I was fatigued. When you have to get in the tub 2-3 times a day to warm up your body, you got a problem I have fake nails and suddenly I wasn't needing to go as normally to have them filled they had really slowed in growth. I put together my own research on my body. I started taking the medication as prescribed and he adjusted accordingly until I was free of symptoms. I documented all the thyroid lab work before and after treatment. I went and had metabolic testing to test my BMR and it measured normal for my age and weight and I was symptom free. I then tapered myself off the thyroid and within 2 months all symptoms returned and metabolic testing once again was done, and BMR was extremely low. Back on meds. normal. You know your body best and I am not afraid to put the research in front of a doctor's face. The human body is not black and white."
Since your Free T4 is, I assume, on the very low end of the range, that is indicative of hypothyroidism. It is unfortunate that you were not also tested for Free T3 since Free T3 has been shown to correlate best with hypo symptoms, while Free T4 and TSH did not correlate at all. Free T3 largely regulates metabolism and many other body functions.
So, at this point, do you think there is any possibility of getting the BMR test, and also Free T3, along with the Free T4 and TSH? Also, do you think there is any possibility of being able to persuade the doctor to allow you a trial of thyroid meds if test results confirm hypothyroidism, and we give you enough scientific study data to refute their diagnosis and treatment so far? If not, then you are going to have to find a good thyroid doctor that will treat you clinically, as described above.
OK, I got my lab results today, for my "follow up" work I insisted on.
TSH Sensitive -- 3.04
FT4 -- .86
FT3 -- 2.66
In September my levels were:
TSH -- 2.9
FT4 -- .67
FT3 -- 2.8
So, clearly, my levels are getting worse. Just since September, even! With only half a Thyroid, I consider these latest labs to be proof I need to be started on SOME kind of replacement. Right??
My Iron is at 42 ug/dL and my Vitamin D is at 16 ng/mL.
I also have an ACTH of 32 and a TSH Receptor AB of <89.
Whatever THOSE all mean?! LOL
Before answering further, please post the reference ranges for those test results, as shown on the lab report.
TSH Sensitive -- 3.04 (Range -- .34 to 4.8)
FT4 -- .86 (Range -- .6 to 1.6)
FT3 -- 2.66 (Range -- 1.4 to 4.4)
Iron Range is 46 to 178
Vitamin D Range is 30 to 100
ACTH Range is 6 to 50
TSH Receptor AB says that above result is <140% of baseline, but doesn't give the actual baseline. Sorry!
Your test results are way too low in a number of areas. First, and most important is Free T3, which largely regulates metabolism and many other body functions. Scientific studies have shown that Free T3 correlated best with hypo symptoms while Free T4 and TSH did not correlate at all.
Both your Free T3 and Free T4 are too low in the range to be functional for you. The range for FT4 is one I see quite frequently. The range for FT3 is way lower than the one usually seen, 2.3 - 4.2. When you think about it, how could a patient with a Free T3 at the low end of the range, which is only about 30% of a patient's level at the top end of the range, both be considered as "normal"? Not possible.
The ranges are flawed because of the erroneous way they are established. Many members say that symptom relief required Free T3 in the upper third of the range and Free T4 around the middle of its range. Ranges and position in the range would not matter if the ranges were appropriately used as guidelines within which to adjust levels as necessary to relieve symptoms. Instead they are used as pass/fail decisions. This doesn't work. Following is a link to some work done by a good thyroid doctor. It is a long document, with lots of references to scientific studies supporting what is stated by the doctor. Take a close look at the abstract and consider giving your doctor a copy of the whole document. It might persuade the doctor to revise his approach to treatment.
Beyond the Free T3 and Free T4 issues, your Vitamin D is also way too low. It should be more like middle of the range. Also, your iron level is very low and you need to supplement that as well. You should also request test for B12.
Regarding the notion that you are depressed and that is causing your issues. Have a look at this article. In it you will notice that, "It has been estimated that more than one third of people suffering from depression are hypothyroid. Some are in hospital. They receive, over long periods, antidepressants of one sort or another when actually the problem is deficiency of thyroid hormones. It is simply that no one thought of thyroid deficiency as a cause when their illness began; or the simplistic tests failed to reveal it."
Any patient suffering from depression should be routinely assessed for hypothyroidism. There should be no exceptions; half to one third will be found to be hypothyroid, and as a result of treatment, their depression will begin to lift in weeks."
From what I see your doctor has a lot to answer for and you need to become your own best advocate and insist on the tests and treatment you need. If they don't respond then you will need to escalate somehow to get what you need.