In my opinion you are over-thinking the issue about Free T4 level being so consistent. Your Free T4 level is too low. Your Free T3 level is most likely too low. Result is that you are hypothyroid and need thyroid med.
The doctor is wrong about a trial of thyroid med. It will reduce your TSH and your output of thyroid hormone, but will not kill the thyroid gland. There are numerous sources that found that if the thyroid med is stopped, the gland will start to function again. Also, why would thyroid med cause you to become hyperthyroid? That would happen only if your dosage was so high that you developed hyper symptoms. If the doctor thinks that a suppressed TSH makes you hyper, that is wrong. You are hyper only if having hyper symptoms due to excessive levels of Free T4 and Free T3. If you want info on this read Recommendation 10 on page 13 of the link I gave you above.
You are not crazy. The way you have been treated is crazy. You need to get your doctor on board with prescribing thyroid med, or find a good thyroid doctor elsewhere, and move on.
One last thing is ferritin. Did I overlook any test results for ferritin? If not tested you should make sure to do so and then supplement as needed to optimize. Ferritin should be at least 70.
Thank you for the feedback and info about trial dosing.
So my GP still has reservations and doesn't want to start a trial over concern that it will "kill" my thyroid and once I start, I can never go off because my thyroid will never function without it. GP agrees that raising my FT4 would give me more energy, make my hair come back, reduce my weight but feels these are not as important as the possibility of becoming dependent and hyperthyroid.
I have gone through all of the old labs that I have kept for over 10 years to see if there was any trend.
TSH (0.5-4.5) FT4 (0.8-1.8) FT3 (2.3-4.2) RT3 (8-25)
1999 1.4 2.0 (1.4-3.8)
1.88 1.0 (0.8-1.8)
1.92 1.1
0.94 (rflx)
1.58 1.1
1.41 (rflx)
1.43
1.75 1.1
1.99 (rflx)
1.6 1.06
1.6
1.45 1.1
1.62 1.1 2.7 17
1.28 (rflx)
2016 1.6 1.0 3.2 18
Anti TPO Antibodies <1
The last FT3 and RT3 are better (although I can't say I felt better) but I was taking several amino acids including tyrosine, which I've since read helps with conversion, so maybe it was helping but I wasn't feeling the effects yet. I was NOT taking for thyroid but following another means to health (happy to detail if you're interested).
As you can see, my TSH has bounced around the normal range for years but my FT4 has not moved (the top result was another lab and is still in lowest 25% of range).
The FT4 just confuses me. I could see if I had only checked once or twice, but this is almost 10 times and it's always at the bottom of the range. My GP said its the set point.
Maybe my thyroid is normal. Would anyone tell me the trend of their FT4? The 2 FT3 aren't too bad but I only have 2 so feel harder to distinguish a trend.
I can't find anything specific on a FT4 that doesn't move but have read about FT4 being in different parts of the range. Is it normal for it to not move in response to TSH moving?
I've had BBT averaging 97.6, but lows in mid 96s. Also, what is with BP? Mine seems to be going up -- isn't that a hyper symptom? Or is it just weight gain?
Thank you again. I'm just tired and tired of trying to understand why and find a way to fix or at least improve how I feel. I'm now fat and lazy and unmotivated and I'm fairly sure labeled a hypochondriac.
What else could explain the symptoms? I'm crazy. I'm starting to believe it.
You got some good advice from flyingfool. I just wanted to provide you the following link. I suggest reading at least the first two pages, and further if you want to go through the discussion and scientific evidence provided to support the 6 suggestions on page 2. You can also give a copy of the entire paper to the doctor, to persuade that you need to start on thyroid med. There is nothing in the paper that the doctor can effectively argue against, since it is all supported by lots of scientific evidence.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
As can be seen in the list of suggested tests, you have had all of them at one time or another except cortisol. So it would be good to know that level, since cortisol affects metabolism of thyroid hormone.
As for med and dosage, there is nothing wrong with using a T4 med as long as your body adequately converts the T4 to T3. That can be assessed by testing for Free T4 and Free T3 and comparing their relative positions within their ranges. If it were me, I would try and get the doctor to start with 75-100 mcg of T4 med. That starting dose would get you closer to your likely optimal dose requirement much faster than starting on the usual 25 mcg and then waiting for 6-8 weeks to re-test and adjust. Also realize that as you take thyroid med, the output of TSH will be diminished and the output of natural thyroid hormone will also be diminished. Since serum levels are the sum of both natural thyroid hormone and thyroid med, the net result of dose increases is little to no change in serum levels until the TSH is essentially suppressed and no longer a factor. After that further increases in med dosage will raise your serum levels.
Gimel and Flying Fool,
Thank you again for all of your feedback, it really is appreciated. As I mentioned, I am hoping my GP will be open to a trial of thyroid med.
I will use the info and suggestions you gave and hopefully get the chance to see if I can feel better.
Quick questions -- what med should I request, in what dose and for how long should I request the trial?
Are there any other tests I should request? Cortisol or anything?
Thank you again. It is amazing of you to take the time to help others the way you do.
Shar
Hi Gimel, thank you for your reply.
Symptoms: fatigue (immense, unrelenting), weight gain and can't lose, hard to get motivated (exercise, errands, etc.), constipation, dry skin, dry hair, hair loss (first legs and underarms and now head hair), always been cold (somewhat better with menopause hot flashes, but now have this weird cold hands/feet, hot torso -- prior to meno, just cold), crabby no doubt due to fatigue, low libido, puffy face (weight gain?), achy everywhere, memory issues, effort to focus. There may be others, but these are the most troubling.
Had/have tingling fingers and toes, which was attributed to low B12, but didn't resolve even when B12 was up. I also have sinus issues and this weird numb tingling in my nose. B12? Something else? I don't know. Doc didn't seem concerned so I ignore/get used to it.
I have been tested for SLE, RA, Sjorgerns, Celiac, Lyme and probably others but all negative. In fact my rheumatologist has now told me that she does not believe that I have an autoimmune issue and taken me off plaquenil. I have been seeing rhuemy for nearly 3 years and have not had one test that was positive other than a slightly elevated ana. She said she believes my issues are endocrine related and said I should be given a trial of thyroid meds despite normal thyroid tests.
Testing I have had:
ANTI TPO AB 1IU/mL <9
EBV -- old exposure
Ferritin 75 ng/mL 10-232
Iron, Total 91mcg/dL 40-190
(this was after 8+ mths no period and requested as last ditch effort to find cause of fatigue)
June 2016:
FT3 3.1 pg/mL 2.3-4.2
FT4 1.0 ng/dL 0.8-1.8
TSH 1.6 mIU/L 0.4-4.5
Vit B12 522 pg/mL 200-1100
LH 30.8 mIU/L 0.5-54.7 (depending where in cycle -- indicative of meno)
FSH 104.3 mIU/L 1.5-17.7 (normal -- anything over 17.7 is postmeno)
Estradiol <2
November 2015 (diff doc):
TSH 1.16 mIU/L 0.4-4.5
FT4 1.0 ng/dL 0.8-1.8
October 2015:
TSH w/reflex to FT4 1.28 mIU/L 0.4-4.5
December 2014:
FT3 2.7 pg/mL 2.3-4.2
RT3 17 ng/dL 8-25
FT4 1.0 ng/dL 0.8-1.8
TSH 1.62 mIU/L 0.4-4.5
Feb 2012:
TSH 1.6 mIU/L 0.45-4.5
FT4 1.06 ng/dL 0.82-1.77
Sept 2011 (5 mths postpartum):
TSH w/ reflex to T4 1.99 mIU/L 0.27-4.20
OLD TESTS:
Oct 2005:
TSH w/ reflex to T4 0.94 mIU/L 0.4-5.5
And then this weird one -- Nov 2002:
TSH 1.99 mIU/L 0.35-5.5
FT4 1.1 ng/dL 0.8-1.8
T3, TOTAL 203 ng/dL 60-161 (flagged HIGH)
T3 Uptake 23 % 25-37 (flagged LOW)
This is a diff doc at same practice (there have been several doc changes there), so it should be in my file. I only remember at the time he said the result didn't make sense so he disregarded. I know these tests aren't used anymore but I'm wondering if this indicates that what little T4 I was making was being converted more to RT3. ?
This is about when I first started complaining of fatigue and weight issues -- like gaining weight despite walking 2+ miles everyday and eating well. All attributed to having small kids. I was naive and just accepted it all. Over this time I've had multiple miscarriages (2 FT births as well) and gained 60 pounds, which I can't lose.
Vit B12 at initial reading was 202, range is 200-1100. It bounced up to 600 and then settled around 450-500.
Vit D3 was 8.9, over 30 is base. Got it up to 50, but bounces a lot.
I have a lot more tests -- comp meta, etc., if any of that is useful.
I apologize if this is difficult to read through. If there is a better format, let me know.
And thank you for taking the time to look it over. As I mentioned, the one thing that seems strange to me is that while my TSH has bounced all over the normal range, my FT4 has stayed in the 1-1.1 range. When does it ever get to that optimal range of 1.3-1.5? Would that even make a difference?
First thing to mention is that TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T4 and Free T3. TSH even varies by up to 70% over the day. So the main value for TSH is to distinguish between primary hypothyroidism (Hashimoto's Thyroiditis) and central hypothyroidism.
So please tell us about your specific symptoms and also post your Free T4 and Free T3 test results, along with reference ranges.