Questions regarding TSH and Free T4 Levels

[fatgirl213]

Hi,

I am new to this forum. I have not been feeling well for now several years and was dx as Chronic fatigue Syndrome but I often wonder if these symptoms are all due to my thyroid or my pituitary gland. I listed my labs and symptoms below. If anyone has some advice I am surly open to it.

My Free T4 levels are borderline low at 0.9 normal is 0.7-1.8
TSH is also borderline low at 0.71 normal is 0.50-6.00
Total T3 is 124
Thyroid Peroxidase Antibodies are 15, normal is <35

Symptoms:
Severe Fatigue
Cognitive issues
Just don't feel well - general malaise
Shortness of breath with minimal exertion
Cold feet and hands sometimes purple in color
Can't loose weight
Weight Gain on 1400 calorie diet. Using Weight Watchers and I follow my plan 100%, easy to do with no appetite.
Dry Skin
No Appetite
Gastroparesis
GERD
NO Libido
Constipation
Insomnia - only sleeping 3-4 hours per night and I can not initiate sleep until 3am
Joint Pain
Abdominal pain
Flank pain
Bruise easily
Hair thinning
Thin Nails
Puffy Face
I have two small hypoechoic nodules in my thyroid gland both less than 1 cm in size
My skull has an appearance of salt and pepper however my parathyroid hormone is normal.

I really need some expert advice. Does anyone have a clue what could be going on. I wonder if my pituitary may not be working correct.
I hate to even go back to my primary because I dont think she knows what is going on.

Thanks to everyone for their support.
Fatgirl

[gimel]

Was that the only thing tested?  You should be tested for both Free T4 and Free T3 each time you go in for tests and those typically need to be in the upper half of their ranges for best effect.  I would also test for Vitamin D, B12 and ferritin since hypo patients are so often too low in the ranges for those as well.

[gimel]

From the symptoms you listed and the limited amount of test data, it is possible that you are hypothyroid.  You really need to test for the biologically active thyroid hormones, Free T4 and Free T3 (not the same as Total T3 and T4) along with the TSH test.   Also, I would do the TSI test for the possibility of Graves' Disease.  Also a good idea to do an ultrasound test of the thyroid gland to see if there are nodules that might be causing excess thyroid hormone.  When you have further information, if you want to post it here, we will be glad to try and interpret and advise further.  

[Vero1291]

Hi, I just received the results of my T4 free test. My value was also 0.9. I am concerned because I am pregnant, can this result in complications during labor? I am also feeling light-headed very often, and very very tired. I am 19 weeks right now.

[bimla_sharma]

my tsh level is 0.9. is it normal????
also m having symptoms like weight loss, falling and thining of hair, heart palpitatation, trembling in hands and fingers, malaise, shortness of breath...what can be the reason for this???

[fatgirl213]

Kevieb,

Thanks you so much for the support. We do have almost the exact same symptoms. My bones hurt so bad at night I would wake up crying in severe pain.
I was worked up for Multiple Myeloma because of the severe bone pain. The docs thought it may have been cancer but those labs came back negative. Thank God!

Did you have much luck with a endocrinologist or did you need to find a thyroid specialist? I am finding more and more people with thyroid disorders don't have much luck with endocrinologist.

Can I ask you what meds you are taking for your central hypothyroidism? Does it take a long time to get the meds regulated and did you feel any better? I have gained about 25 lbs in the last several years and have had a horrible time taking the weight off. I am working with Weight Watchers and using the point plus and still the scale doesn't move. But I know I am eating healthy.

My Vitamin D level is still around 59 and I cant seem to get it any higher.
I am taking 10,000 IU a day.

I was in and saw my OB-GYN doc and my estrogen level was 0. Nothing on board and testosterone was the same. So not so good for the libido. I am also 50 years old and this should be a fun time in my life as we are empty nester.

I think having a 9 year old would be really hard right now. I am very thankful my two daughter are raised and living on their own. I hope you have some support to help raise your children.

Its so good to talk with someone else who understands what we are going through and how we feel. Can you believe it I have been diagnosed with Chronic fatigue syndrome and fibromyalgia. Who knows maybe this is the root of this evil in my body.

Every thing seemed to go down hill after my hysterectomy and I blamed it on that for many years. But I think we are on to something that is tangible.        

Thanks again Kevieb and I would like to stay in touch with you. I will let you know how my labs turn out.

Hugs,
Fat Girl

[kevieb]

i was thinking the same thing gimel told you----My TSH was low along with my FT4---my FT3 was at the low end, also when I finally got to an endo and she tested it.   I have central hypothyroidism, which is basically hypopituitarism.  Your symptoms are so similar to mine--and I've been trying to get things balanced since last summer---but I was due for new blood work a couple of months ago---and my doctor got sick---so I'm without a doctor right now.

My VIT D was also low---my bones hurt, but one of my docs said, that's just you---because they were used to my chronic pain.  the endo ignored my D level because it was in the range--it was 33---the bottom of the range was 30.  I took 10,000 a day until I got it up to 79--now I take 1000 a day.

My ferritin is still in the 70s--so my doc increased my iron with my last blood work.

I also have low DHEA and low testosterone, and a number of low vitamins and minerals that are being supplemented.

i also have secondary adrenal insufficiency.  You may want to have your cortisol levels checked , also.   If you have a pituitary problem, chances are it could be affecting your cortisol production also.

I am so tired all the time--I just turned 50--and my youngest daughter is 9----i feel so bad that I just don't have the energy to do much of anything.

gimel---I'm going to have to look at the paper you linked to----since I need a new doctor, maybe it will help me with some more info.

[fatgirl213]

ok thank you, I read the paper and was very impressed.

[gimel]

That ferritin is still a bit below optimal, from what I've read.  80-90 would be better.  

Just because a doctor is an Endo does not mean a good thyroid doctor.  Frequently they have the "Immaculate TSH Belief" and use "Reference range Endocrinology", which prevents adequate testing and treatment.  You just need a good thyroid doctor, as I described above.

[fatgirl213]

Oh Gimel, you are an ANGEL!

I am an old RN and have been trying to figure this out on my own. I feel you are right on track. I am going to step up to the plate and pull up my big girl panties and request these lab tests.

I am very very Vitamin D deficient, I had a vitamin d test done and it was 2.  I have to take 10,000 IU of Vitamin D3 daily to just be in the mid range and be able to keep it there. Plus I live in Ohio where the sun never shines. LOL

I had Ferritin done and it was 67 normal is 30-160.
TIBC was 372 normal is 228-428. So those look good.
I think or I should say I am going to ask to be seen by a endocrinologist. I just don't trust this FP doctor. She just seems to blow things off. And then I am here suffering with these awful symptoms.

It feels so good just knowing someone else cares and who has been through this and understands. I will be in touch once I have labs drawn and thank you so much.

God Bless You!
FatGirl

[gimel]

Symptoms sure look like hypothyroidism to me.  Also, your Free T4 is too low in the range.  You were only tested for one of the two tests recommended for the possibility of Hashimoto's Thyroiditis; however, in view of your relatively low TSH, I don't think Hashi's would be the problem.  It is much more likely that you have secondary or tertiary hypothyroidism, due to your pituitary not producing TSH adequate to stimulate the thyroid gland to produce the thyroid hormone you need.  

It is unfortunate that you were tested for Total T3, rather than Free T3.  Free T3 is much more revealing and scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  

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

I suggest that you should go back to your doctor and request to be tested for Free T3, along with the Free T4 and TSH.  It would also be a good idea to test for Reverse T3, since reports say that the best measure of tissue thyroid levels is the ratio of Free T3 to Reverse T3.  If the doctor resists doing these tests, just insist on them and don't take no for an answer.  Since hypo patients are frequently too low in the range in other important areas, I also suggest tests for Vitamin D, B12, ferritin, and a full iron test panel.   While at the doctor it would be a good idea to ask if he is going to be willing to treat you clinically, as described.  If not, then you need to start looking for a good thyroid doctor that will do so.

When results are available, please get a copy and post results and their reference ranges shown on the lab report and members will be glad to help interpret and advise further.