Thyroid Disorders Community
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Avatar universal

Normal tsh low free t4 free horrible

I continue to get sicker and sicker and i don't know where to turn.   My labs on 15mgs of np thyroid were tsh 2.93 (.35-4) and free t4 .82 (.89-1.76).  My doctor added 12 mcg of t4 and 6 weeks later my tsh was 2.93 and free t4 was .98 free t3 was 3.21 (2.3-4.2).  I had to stop the t4 because i
my eyes became so dry i couldn't wear my contacts. It was almost like my eyes had dried up. I was also very constipated  (sorry) and was completely exhausted. Shouldn't i have been getting better and not worse?  
I had a partial thyroidectomy 14 years ago and have never felt well.  Im always sick...have major brain fog...depression..anxiety...lack of concentration...total exhaustion...im a mess.  I can barely function.  Im seeing an endo in a few weeks but i know how they are (some) so needless to say im nervous.  If anyone has any advice or suggestions i would appreciate it very much.  Thank you
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Avatar universal
Don't quite understand why your doctor started you on such a low dose as 15 mg of NP Thyroid.  The addition of 12 mcg of T4 was also a very small increase.  What was the diagnosed cause for you being hypothyroid and needing thyroid med?

Your Free T4 was below range, yet your doctor only increased your meds by 12 mcg, which is not nearly enough to raise your FT4 to a good level, which is middle of the range, at minimum.  The only test for Free T3 was below the middle of its range, when it is usually best if it is in the upper third of its range, or as needed to relieve hypo symptoms.  You do have hypo symptoms.  Even dry eyes can be a hypo symptom, so you need a substantial increase in med.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  You can get some good info from this link written by a good thyroid doctor.


Also, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  Low levels can cause symptoms that mimic hypothyroidism.  D should be about 55-60, B12 in the upper end of its range, and ferritin should be about 70 minimum.  You should get those tested and supplement as needed to optimize.  Also you should always make sure they test for both Free T4 and Free T3 each time you are tested.  

Even though you plan to see an Endo in a few weeks, be aware that  doesn't guarantee a good thyroid doctor.  Many specialize in diabetes.  Many have the Immaculate TSH Belief and only pay attention to TSH, which doesn't work.  If they test beyond TSH it is usually only Free T4 and then they use "Reference Range Endocrinology", by which they will tell you that a test that falls anywhere within the so-called "normal" range is adequate.  That is also wrong.  You need a good thyroid doctor as described above.  

Avatar universal
I have always been sensitive to thyroid meds.  That's why im only on 15 mgs of np thyroid.  My b12 is always normal.  Not sure about ferritin.  I'll request a test at my physical next week.   My vit d is 39 up from 30. I take 5000 a day. That will also be tested again.  Im thinking of switching to a t4 med and adding a small amount of t3 because every time I raise my dose i have anxiety and major palpitations.  
I have a pituitary tumor also but im not sure if that affects anything.  My major symptom is brain fog. Its so intense i feel like im losing my mind.  Could the low free t4 be making me this sick??
Thank you for your time and advice.  I appreciate it so much.  Im desperate.
Avatar universal
Sometimes patients who are "sensitive" to thyroid meds find that the cause is low cortisol or low ferritin.  In reality your Free T4 and Free T3 levels are much too low for many people.  Many members say that relief from hypo symptoms required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, or as needed to relieve symptoms.  So yes, your inadequate Free T4 and Free T3 levels could be making you that sick.  Along with that you need for your cortisol level to be adequate, your D about 55-60, B12 in the very upper end of its range, and ferritin about 70 minimum.  

As you prepare for your appointment with the Endo, keep in mind what I said about a good thyroid doctor.  I would ask the Endo if he is willing to treat clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, rather than just by lab results, and especially not by TSH results.  Also find out if the Endo is willing to prescribe T3 type meds.  If either answer is no, then I don't have much confidence that the Endo will be adequate for you.  

Your results and symptoms indicate central hypothyroidism, which is characterized by relatively low TSH along with low Free T4 and Free T3.  So the pituitary tumor could be the cause for the central hypothyroidism.  

If you will tell us your location perhaps we could suggest a doctor that has been recommended by other thyroid patients.  Then you could see about an appointment, in anticipation of no success with the Endo, which is the usual result for patients with test results like yours.  .  
Avatar universal
Even the small uptick in the T4 resulted in a small increase while still very low in the FT4 range.  It also showed an increase in the FT3 levels, which indicates that you are converting some of the T4 into T3.  So that is good.

I do NOT believe the dry eyes was a result of the T4 addition.  In fact from your description and the results of the lab work as noted above, I would suggest the exact opposite and increase the measly dose of T4 medication.

Often times when starting on thyroid medication it is pretty common actually to feel WORSE for a time as your body's systems adjust to actually having some thyroid hormone.  Particularly the adrenals which have been trying to "carry the load" to make up for the lack of thyroid.

It is up to you if you want to go the straight T4 only route. But I would expect in that case to see a DROP in your FT3 levels and thus for you to become MORE hypo and symptomatic until the dose of T4 ramps up enough to get the blood labs back up to at FT3 level to where it is now.

Remember that your body at the cellyular level ONLY uses the Free T3 hormone.  So your symptoms are most impacted and more directly correlated to the FT3 levels than FT4 and certainly not TSH which is almost a completely useless test other than for mass screening.

As gimel states, if the endo snubs his nose and pooh-pooh's the nature thyroid or cytomel (t3) and insists only on use of TSH, my advice is to simply stop the appointment at that point and walk out and go find another Dr.  As that one will only keep you feeling like crap.

Avatar universal
Thank you so much.  I live in lancaster pa.  My primary doctor  is wonderful.  But not an expert on thyroid disorders.   I will stay on np thyroid and try adding t4 again.  Or see what the endo says.  I know they are lovers of synthroid and hate the natural meds.   Im prepared for that lecture.  
I did have a cortisol test.  Saliva.  My dhea was 3.9 (2-23)
Am cortisol 8.4 (3.7-9.5)
Noon 3.5 (1.2-3)
Evening 1.7 (.6-1.9)
Night .5 (.4-1)
Thank you again.  I appreciate it so much.
Avatar universal
Thank you so much.  I won't quit np thyroid.  And thank you for reminding me that you feel worse before you get better. .i forgot about that.  If my appt with the endo ends in disaster I'll talk to my primary doctor.  He's very open minded and is willing to let me try different things.  Oh and when i tried cortef years ago it was awful.  I was puffy and anxious and felt worse.  So i don't really want to do that again.
Thank you so much!
Avatar universal
So your cortisol levels are okay.  Just for info when taking cortisol to avoid side effects it is necessary to also make sure DHEA levels are good.  Yours was too low.

As mentioned your Free T4 level is too low.  Needs to be up around 1.32, which is middle of the range.  Your Free T3 is also lower than needed, plus I wonder if you have low ferritin which can affect transport of T3 into cells.  Ferritin needs to be bout 70 minimum.  I highly recommend testing for that.  

In prior post I defined what a good thyroid doctor is.  Odds are that the Endo will not be a good thyroid doctor, just based on our experience.  So you might want to check out getting an appointment with another doctor in case the Endo turns out to be a waste of time.  I just sent you a PM with some names.  To access, just click on your name and then from your personal page, click on messages.  

Avatar universal
Thank you so much.  I will ask him to check my ferritin. Every time I would try to take iron it would upset my stomach.  Is there a brand you recommend?  
Thank you for sending me some doctors names.  I really appreciate it!
Avatar universal
The best forms of iron for supplementation include ferrous fumarate, ferrous sulfate, and ferrous bisglycinate.  To avoid stomach problems probably the last one is best.
Avatar universal
Thank you!
Avatar universal
Oh my b12 level was 462 and the paper says anything over 211 is normal.  Is that a decent level?  I hope so.
Avatar universal
Interestingly we understand that in Japan and Europe the lower range limit is about 500.  We recommend the upper end of the range, so your level is a bit lower than optimal.  
Avatar universal
Thank you.  I appreciate your help :)
Avatar universal
I would say that anything lower on B12 than about 700 to supplement and many people need it above 900 to feel well.
Avatar universal
Oh wow.  I have a lot of work to do.  Thank you for all your help.
Avatar universal
You seem to have a lot of knowledge.  Do you know if a person can feel crazy when their levels are off?  I feel like im going to have a nervous breakdown.  My free t4 has been low forever but no one ever said anything (i just looked at my old labs). Could this be why i continue to get sicker and sicker?  
Sorry.  I know i have a lot of questions.
Thank you so much
Avatar universal
There is a site on which the author has compiled a list of every symptom she could find that has been related to hypothyroidism.  Following is one section from the list.


    Wanting to be solitary
    Mood swings
    Personality changes
    Feelings of resentment
    Easily startled
    Lack of confidence

Your Free T4 needs to be at the middle of the range, at minimum, and your Free T3 high enough in the upper half of its range to relieve symptoms.  Of course don't forget Vitamin D, B12 and ferritin, as previously mentioned.
Avatar universal
Thank you!
Avatar universal
I was curious so i got out my file and looked at my labs dating all the way back to the late 90's. My free t4 has never been above a 1.  Ever.  And not one doctor ever said a word because my tsh was apparently normal.  Let's hope this is one of the pieces of my huge complicated puzzle.  Ive been sick for years.  
Avatar universal
I just got my results back. My ferritin is 11 (10-232). I am wondering if this is why I cannot raise my thyroid medication.
I am very sensitive to vitamins and supplements. Would blackstrap molasses work just as well as iron pills?  Or is there a brand that people prefer?  
Thank you so much.
Avatar universal

I'm recently diagnosed hypo and I am having to raise my B12, Iron, D3.

I looked into Blackstrap but it is about 3.5mg iron/Tbsp. I decided against it as I would have to eat 14 Tbsp each day (to reach my goal of 50mg iron/day).

I am using Solgar Gentle Iron Bisglycinate, 50mg each night on empty stomach with Vit C for better absorption. I was terribly constipated/bloated but it was my hypo, it went away with NDT treatment and this iron supplement hasn't caused me any problems at all.

Best, Kel

Avatar universal
So your ferritin was way too low and you do need to supplement.  1Kel12 gave you some good info on that.  What does your doctor plan to do to adequately raise your thyroid levels?
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