Reading my TSH levels and T4 Free levels

[NubionQueen]

I do not understand my blood test for TSH levels and T4 Free, Direct levels.  What does this reading mean...TSH 0.351 and T4, Free (Direct) 1.01?

[gimel]

Sounds to me like you do have a thyroid problem, but it is being overlooked by doctors because of your TSH.  Most doctors seem to have the "Immaculate TSH Belief" because of what they were taught in med school that TSH is the most sensitive test for thyroid status, and that TSH is all they need to know to diagnose and treat a patient.  Unfortunately this is very wrong because TSH is a pituitary hormone and it cannot be shown to correlate well with either of the biologically active thyroid hormones, Free T4 or Free T3, much less correlate well with symptoms, which should be the main concern, not just lab results.

In your case, you have a multitude of hypo symptoms, your Free T4 is in the low end of its range, which is less than optimal, you haven't even been tested for the most important thyroid test, which is Free T3, and along with all this, you have a low TSH which most likely indicates central hypothyroidism as the cause.  Central hypothyroidism is due to malfunction of the hypothalamus/pituitary area causing inadequate TSH to be secreted, with resultant low thyroid function and hypo symptoms.

In addition, hypo patients are frequently too low in the range for Vitamin d, B12 and ferritin (iron).  All of these affect how thyroid is metabolized, plus they will cause symptoms of their own, some of which mimic hypo symptoms.  

So what you need most is a good thyroid doctor.  That does not necessarily mean an Endocrinologist.  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."

http://hormonerestoration.com/files/ThyroidPMD.pdf

If you present all this to your doctor, is he/she the type that might listen and reconsider and do the right tests and treat you clinically, as described in the link?  If not, then you will need to find a good thyroid doctor that will do so.  If needed, we might even be able to help find such a doctor.  

[NubionQueen]

No, I have never been diagnosed with a thyroid disorder and have never been treated for one.  My TSH 0.351 Low Reference Interval 0.450-4.500 and T4, Free (Direct) 1.01 Reference Interval 0.82-1.77.  In addition, My RDW 15.8 High Reference Interval 12.3 - 15.4 and Vitamin D, 25-Hydroxy 23.6 Low Reference Interval 30.0 - 100.0. My doctor says that he will retest in 6 weeks and has started treating me for vitamin D insufficency with Vitamin D Supplements.  In addition, I have coronary artery disease, has had a heart by-pass, I have fatique, hair loss and thinning, muscle aches and pain, weakness, memory loss, weight gain, lack of energy, insomnia and restlessness.  I had contributed my muscle weakness, hand , leg and back cramps to the cholesterol meds that I have been taking for approximately 5 years.  Any information that you may be able to provide to assist me in knowing what is going on per my blood test would be highly appreciated.

[gimel]

We need more info in order to give you our best response.  Have you been previously diagnosed with a thyroid problem?  If so, are you taking thyroid med?  What symptoms, if any, do you have?  Please post the reference range for the Free T4 result, as shown on the lab report.