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TSH Levels are Normal and Still Constipated And Sensitive to cold?

My last TSH  level was 3.70 reference range 0.5 to 4.0. However, I am extremely constipated  Before, I ate a banana to relieve constipation, and it helped tremendously. Now, I ate a banana, and it did not help. I eat a lot of vegetables and fruit.  I cannot feel my stomach muscles working. I also have a swollen belly,

In addition, I am sensitive to cold. I get very cold easily and have cold feet.  

I also have muscle weakness and tender muscles.

I had a  T4 level test in 2017 was 0.40. I am not sure if that is normal or not for hypothyroidism.  I never had a T3 test done.  

Same thing happened to me when I went to school at UC Davis. They kept on saying my TSH levels were too high that they put me on a lower dosage of thyroid medicine.  After a few months, I became extremely constipated and forgetful. I also had muscle weakness. Then, I had a fissure on rectum. I told them about my symptoms, and the tests came back normal.  Finally, I had enough, so I went to Kaiser. Kaiser said my TSH levels were too low, so they put me on a higher thyroid dosage for my medicine 150MCG.  From 2007 to 2013, everything went good.  

When I changed my health insurance, the lab said TSH levels were too high. The lab is called Quest Diagnostics. My doctor put me on a lower dosage for my thyroid medicine until it is now 100 MCG.

This 100 MCG for thyroid is too low for me because I am still constipated. I do not feel any bowel movements whatsoever. I take laxatives for constipation. Even if I take it, I still do not feel anything.  .  

What is wrong with me?

5 Responses
Avatar universal
In 2014, free t4 was 2.7
Avatar universal
A few things to clarify.  First is that TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, not a diagnostic.  Far better is to evaluate for symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  Thyroid med dosage should never be adjusted according to TSH.  A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and free t3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  I say that because, in the majority of cases, hypo patients taking thyroid med adequate to relieve symptoms find that their TSH is suppressed below range.  

The 100 mcg dose is clearly too low for you.  In addition, you need to test for both Free T4 and Free T3 (not Total T4 and Total T3), in order to make sure that your body is adequately converting the T4 med to T3.  Most doctors think that T4 is just automatically converted to T3, but that is not the case,   There are a number of variables that affect conversion.  T4 has to be converted to T3 in order to be metabolized by the cells of your body to produce the needed energy.   And If Free T3 is level is too low, or it is not being adequately metabolized, symptoms are the result.  

In addition, hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin, so you should make sure to get those tested and then supplement as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.

I am not too optimistic that, from what we have heard about Kaiser, that you will be able to get all this testing done and then get properly medicated.  If you run into resistance, you can possibly make use of the following link to persuade your doctor.  I recommend reading at least the first two pages and more if you want to get into the discussion and scientific evidence for all that is recommended.  


If your doctor still refuses to do the testing and proper treatment then you need to find out if it is his decision, or the restrictions of Kaiser.  If it is just the doctor's decision then you will need to find a good thyroid doctor, as described above.  
Should Free T3 be in the higher range .
I was tested for FreeT3 in 2014, and it was 2.83. I do not know what is reference range.  I am not sure if that is good.
I am on a different health insurance now. When I first started on this insurance,  the lab test said my TSH was 0.4 ref range .5 to 4.5. So the doctor prescribed lower  dosage of thyroid medication to 125mcg. She did not test Free T3 To confirm if I really had hyperthyroidism.

On this medication dosage, I experienced constipation, and I am experienced severe bleeding on my rectum. For odd reason, another doctor switched me to even lower dosage to 100mcg.

Now, I am experiencing constipation and sensitivity to cold. I also experienced cold feet and muscle cramps. The same thing happened to me in 2006. I complained to doctor in UCD. They did not listen to me. Eventually, I changed to Kaiser, and TSH  was 18.90 reference range 0.5 to 4.5.

Given previous experience with lower dosage of thyroid medication, I am afraid now that I might a severe case of hypothyroidism again.

Are there medication to raise Free T3?

I go  to Washington township medical foundation.

I read that American board of Endocrinology said that TSH levels range should now be 0.5 to 3.0. instead of national board biochemistry range of 0.5 to 4.5. Many labs and doctors use this old range.

Given this American Board of Endocrinology range, my hypothyroidism symptoms might become so severe.

What kind of medication do you take for you?

Do you think I should be referred to an endocrinologist?
Avatar universal
Yes, hypothyroid patients frequently find they need FT4 at least at the middle of its range, and FT3 in the upper part of its range, and adjusted from there as needed to relieve symptoms. So your FT3 test of 2.83 would be much too low in the reference ranges we usually see, like 2.3-4.2 Pg/mL.  So the doctor should not be adjusting your thyroid medication based on the TSH level.  When taking adequate thyroid med, the majority of patients find that their TSH becomes suppressed to the low end of the range, or below.  That does not mean hyperthyroidism, unless there are accompanying hyperthyroid symptoms due to excessive levels of FT4 and FT3.  So, as stated in Sugg. 6 on page 2 of the link I gave you, "TSH should not be relied on to determine the medication dosage."

If you cannot persuade your doctor to treat you clinically, as described previously, then you will have to find a good thyroid doctor.  That doesn't necessarily mean getting a referral to an Endo.  Many of them specialize in diabetes, not thyroid.  Also many of them have the "Immaculate TSH Belief", which you have already encountered with your current doctor.  That is very wrong.  Further, if the Endo tests beyond TSH, for FT4, then he will usually use "Reference Range Endocrinology" and tell you that a thyroid test that fall anywhere within its reference range is adequate.  That is also wrong.  

So, right now you need to be tested for Free T4, Free T3, Vitamin D, B12 and ferritin, as a start.  If you can get that done it will be good info.  I would also talk to the doctor about clinical treatment, and show him the paper in the link above, and ask if he will treat you clinically, as described, without being influenced by resultant TSH levels.  

If your FT4 level is below mid-range, then you need an increase in your T4 med.  If your body is not adequately converting the T4 to T3, and your Free T3 is lower in range than your FT4, then you may have to add some T3 med also.  

Where is Washington Township?

Washington township is in, Cal. I find that they have many Indian doctors. the Endocrinology doctor is Indian. I am not sure they are willing to help me.

In 2014, FreeT4 was 2.3 ref range 0.8 to 1.8. In 2014,  the doctor did TSH reflex to free T4 and that was 0.10 ref range 0.40 to 4.40. I am not sure what is that. Okay. I am going to find a doctor that specializes in thyroid disorders.
Avatar universal
The order will usually read TSH w/reflex to FT4.  That means if TSH is out of range, then a FT4 test is done.  Those two tests you listed would clearly be identified as being hyperthyroid.  Were you tested further to determine the cause?

Finding a good thyroid doctor, that will treat clinically, rather than just by test results is not easy.  When I search all the doctors on my lists of patient recommended thyroid doctors most of them are Naturopathic doctors and they don't accept insurance.  I do have one in San Francisco.  would that be of interest to you?
No. I was not tested for the cause. I usually  have hypothyroidism symptoms. I do not understand what is going on. San Francisco is too far for me. Do you have one in Fremont, California? I wish they do accept health insurance.
Avatar universal
I just sent you a PM with doctor info.  To access, just click on your name and then from your personal page click on messages.
Check your messages.
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