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Avatar universal

TSH Normal, Free T4 Normal but still not feeling good

Hi:

I am a 32-year-old, with 3 children. After the birth of my last child in 2015 - it took me 7 months to have a period and I was not breastfeeding. I thought it was a little odd, considering with my other children it came within 6-8 weeks. Prior to him being born, my period was every 27 days, like clockwork since I was 12 years old. When the period started it was ranging from 30 to 35 days, now it ranges from 24-28 days, sometimes I have a 3 day period and sometimes its 8 days.  However, I did not seek medical advice because I am stubborn.
Since the birth of him, I have went through various symptoms, such as fluctuating BP, Heat intolerance, cold sensitivity, night sweats, dry dry skin, low body temp (97.5), low grade fever(99) with no symptoms of being ill, carpal tunnel, dry/red eyes, muscle aches, GI issues, intense migraines, 6 miscarriages, and now I am losing the outer part of both my eyebrows. The problem is, I don’t ALWAYS feel like this, it’s almost like I have flare ups. Last year, I went to my GP who tested my tsh – which was normal at 1.46 m(.40-3.8 range) and Free T4 1.2 ( .7-1.4 RANGE). Everyone keeps pushing me off, stating various reasons as to why I am feeling like this instead of diagnosing me. Also, my family history includes – all on my dad’s side – 1st generation relatives – Lupus, Hashi and Graves.

I am just looking for some guidance because as this keeps going, I am becoming more discouraged and just am needing some advice  as to what I should do with something that is very real going on with my body.

Thanks!
4 Responses
Avatar universal
If you will click on my name and then scroll down and read the one page overview of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective, I think it will clarify a few very important things for you.  First is that  the most important indicator of a person's thyroid status is an evaluation for symptoms that occur more frequently with hypothyroidism.  You have quite a number of those.   Following that evaluation should be extended biochemical  tests to affirm symptoms.  Those tests should include not only TSH and Free T4, but also Free T3, cortisol, Reverse T3 (RT3), Vitamin D B12 and ferritin.   You have been tested only for TSH and FT4 apparently.  That is inadequate.  Hypothyroidism is best defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone."  

So inadequate Tissue T3 Effect is what causes hypothyroidism.    Assuring  adequate Tissue T3 Effect involves much more than just testing for TSH and FT4.  You also must have sufficient Free T3.  Also there are variables that affect transport of thyroid hormone into cells.    So serum thyroid levels may not accurately reflect tissue thyroid levels.  RT3 is a useful indicator of tissue thyroid levels and the ratio of Free T3 to RT3 is also useful, since RT3 can bind to membrane receptors and create hypo-metabolic effects.  In addition there are a number of variables that affect conversion of T4 into the very important T3, instead of converting to excess RT3.  And at the cellular level thyroid metabolism is affected by cortisol and Vitamin D.

This is probably too much information but I am trying to explain why you could be hypothyroid even when your TSH and FT4 are in the so-called "normal" ranges.   A good thyroid doctor understands that hypothyroidism is inadequate Tissue T3 Effect, and is willing to do the evaluation for symptoms, plus extended testing, and if hypothyroidism is tentatively diagnosed, then thyroid med is prescribed as needed to relieve symptoms.   For the first time, a recent, excellent scientific study quantified the effect of Free T3 on hypo symptoms.  The researchers concluded that,  "Hypothyroid
symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range".  

With your TSh and FT4 levels, just getting a prescription for a T4 med is not the way to go.  You need to get the additional tests done for Free T3, RT3, cortisol, Vitamin D, B12 and ferritin.  That will help determine what needs to be done to treat you.   I suggest  to facilitate even getting the testing done, that you give a copy of the one page overview I mentioned above to your doctor and ask him to read it and consider doing the testing and then review results and decide what is causing all your symptoms.   If you are able to get that done, then post test results and reference ranges here and we will be glad to help interpret and advise further.  
1 Comments
Thank you for such detailed information. I will request those tests, the one thing I do know is the highest I ever have tested for Vitamin D was 14 and my lowest was 7. I will make sure to bring that up, as well.

I really am just wanting to feel better, by any means necessary. It baffles me that Dr's will be so quick to prescribe anti depressants for symptoms they believe are made up...versus taking blood tests. I had an ENDO last year, down right refuse to test and basically tried to educate me on what PMS is. It was ridiculous. It took 4 years for my cousin to be diagnosed and by time she did, she was balding, gained 60 lbs and her thyroid was inflamed. It is the most frustrating thing.
Avatar universal
Vitamin D is very important.  It should be at least 50.  B12 should be in the upper end of its range, and ferritin should be at least 100.

You are absolutely right about the frustration.   Good thyroid doctors are very scarce and hard to find.  We try to keep lists of good thyroid doctors so that we can give them to members like yourself who need one so badly.  If you will give us your location, perhaps we can suggest a doctor. in your area, for your consideration.

Most doctors have the "Immaculate TSH Belief" and only pay attention to that for both diagnosis and treatment.   That doesn't work at all.  If they go beyond TSH and test FT4 then they use "Reference Range Endocrinology" and will tell you that a test that falls anywhere within the so-called "normal" range is adequate.  That is also very wrong for a number of reasons.  

If you will look at page 7 of this link, which is the full paper, you can see a graphic of all the main parts of the thyroid system and all the variables that affect the all important Tissue T3 Effect.   This makes clear just how ludicrous it is to think that TSH is an adequate diagnostic for thyroid status.  Everything in the paper is supported by extensive scientific evidence, so if doctors will read the paper with an open mind it is hard for them to dispute the recommendations.  


http://www.thyroiduk.org/tuk/thyroid_articles/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
Avatar universal
Sorry that link doesn't get shown properly.   I had to convert the link to this:

https://tinyurl.com/y8k2zswb
2 Comments
Apparently that link is not working, so try this one.

https://tinyurl.com/y7sfp5r8
I did a full thyroid panel and the results were:

Thyroglobulin antibodies 1  range < or = 1
Thyroid Peroxidase Antibodies 15 range <9
TSH 1.46 Range .4-4.50
t3 Uptake 38 Range 22-35%
Total T4 7.9 Range  4.5-12
Free T4 Index 3.0 Range 1.4-3.8
Reverse T3 22 Range 8-25
Total T3 92 Range 76-181
Free T4 1.4 range .8-1.8
free t3 3.5 range 2.3-4.2

If its not my thyroid - I am not sure what it could be



Avatar universal
For future testing, T3 Uptake, Total T4, Total T3  and Free T4 Index tests are outdated and not really required now that we have accurate Free T4 and Free T3 tests available.    The TPO ab test result is somewhat over the range but your TSH is not high, so I would just make sure to get tested for TPO ab occasionally to make sure you know if it starts increasing, as would be expected if the TPO ab is indicative of Hashimoto's thyroiditis.  

Your Free T4  of 1.4 is at 60% of the range, so no problem with that .  Your Free T3 of 3.5 is  about 60% of its range, which also should be okay; however, the problem I see is that your Reverse T3 of 22 is high in the range.  That means that your ratio of Free T3 to Reverse T3 is only 1.6.  Various sources recommend that it should be at least 1.8 or even 2.0.    Reverse T3 is a normal result of conversion of T4 to T3 and Reverse T3.  Under some conditions excess RT3 is produced.  RT3 can bind to membrane receptors so that in excess, can produce hypo-metabolic effects.    Reported possible causes for excess RT3 are leptin resistance, inflammation, dieting, low iron/selenium/ zinc/ chromium/B6/ B12/ vitamin D/iodine/low testosterone, low HGH.    

So at this point I would get some further testing done, starting with Vitamin D, B6, B12, zine, chromium, iodine and testosterone.    I would also add ferritin to the list.   If you can get that done it should point the way to what is needed for you to get relief from those hypo symptoms.    By the way you can find all this info in the paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.  
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