TSH levels high but T3 and T4 normal, am I hypo?

[NoNRG]

I went in to the Dr. because I was having GI problems and I was tired all the time. I mentioned that I also get cold very easily in comparison to others. He said it sounded like IBS.
Tests come back and my TSH is a 12 (twelve). A week later I take T3 and T4 tests. They start me on 50mcg levothyroxine after the test.
Four days after starting the pills I am told to stop taking them because my T3 and T4 levels are normal and that my first TSH test must have been a lab error.
I didn't even know what hypothyroidism was when this all started, but now I've found out that my mother (whom I don't speak with regularly) has had hypo since she was 40. I'm 22 now, am I hypo, are the tests wrong, should I see a specialist?
Thank you for any suggestions, I'm really confused.

[vi71]

Total T3
Adult           : 0.60-1.81ng/mL
0.92
T4
Adult           : 4.5 -10.9 µg/dL
6.30

TSH
Adult           : 0.35-5.5 µIU/mL
7.94

I am 44 Years Male, kindly go through the lab reports and guide me what to do and how to get TSH reduced to normal level.

[gimel]

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.  Your TSH results have fluctuated quite a bit, but typically on the high side which frequently is associated with Hashimoto's Thyroiditis.  The doctor's conclusion from your ultrasound test was also Hashi's.  Although you haven't always been tested for both Free T4 and Free T3, you should make sure they always do both in the future.   Free T3 has been shown to correlate best with hypo symptoms, while Free T4 and TSH did not correlate.

In the words of a good thyroid doctor, ""The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

So from your ultrasound results, your TSH tending high, and your symptoms and the results from your limited tests for Free T4 and Free T3, I would say that you are in the early stages of Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously determines that the thyroid gland is foreign to the body and produces antibodies to attack and eventually destroy the gland.  As this proceeds, the output of natural thyroid hormone is diminished and the TSH levels start to rise and symptoms start to appear.  To offset the loss of natural thyroid hormone, thyroid med is required in gradually increasing doses.  

Some doctors will not start a Hashi's patient on thyroid meds as long as test results are within the so-called "normal" ranges.  That is erroneous because the ranges are far too broad to be functional across their entire breadth for everyone.  Other doctors are willing to take a proactive approach and will start you on thyroid meds to keep your Free T4 and Free T3 levels high enough in the range to prevent hypo symptoms.  Needless to say, you know which doctor I would choose.  

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  

So hopefully you can use this info to get your doctor to start you on thyroid meds and gradually increase as needed to relieve symptoms.  Otherwise you will need to find a good thyroid doctor that will do so.  

Also, be aware that hypo patients often are too low in the ranges for Vitamin D, B12 and ferritin.  So you should test for those and supplement as needed to optimize.  D should be about 55-60, B12 in the very upper end of its range, and ferritin should be about 70 minimum.

[zlf]

I have been feeling unknown reason fatigue from time to time since 2010. It is not constant. It is like a flu or cold. After a couple weeks, I will get better. At that time, my blood test showed normal.
(2013 test result:
TSH W/REFLEX TO FT4 3.97 0.40-4.50 mIU/L NW)


Last November, annual physical exam showed elevated TSH.

TSH W/REFLEX TO FT4 5.67 H 0.40-4.50 mIU/L NW

T4, FREE 1.2 0.8-1.8 ng/dL NW

The doctor asked retest in a month, and the result showed normal:

Test Name In Range Out Of Range Reference Range Lab

TSH 3.02 0.40-4.50 mIU/L NW

T4, FREE 1.3 0.8-1.8 ng/dL NW

T3, FREE 3.1 2.3-4.2 pg/mL NW

Then the doctor thought I should be fine.

This year on 23/07, another physical test showed TSH 5.77 and the doctor ordered ultra sound neck area and blood test in two weeks.

The ultrasound shows:

FINDINGS:

RIGHT LOBE: 5.1 cm in cephalocaudad x 1.5 cm in AP x 1.4 cm in transverse dimension for a volume of 5.6 cc. No visible mass, cyst or calcification. Mildly increased parenchymal blood flow.

LEFT LOBE: 4.0 cm in cephalocaudad x 1.6 cm in AP x 1.5 cm in transverse dimension for a volume of 5.0 cc. No visible mass, cyst or calcification. Mildly increased parenchymal blood flow.

ISTHMUS: 3.0 mm in thickness. No visible mass, cyst or calcification.

OTHER: The thyroid parenchyma is moderately, diffusely heterogeneous in echogenicity. Mildly increased parenchymal blood flow is present.

There are normal appearing deep cervical chain lymph nodes bilaterally.

CONCLUSION:

Heterogeneous thyroid without focal nodules or masses, consistent with thyroiditis, likely Hashimoto's thyroiditis.

But the blood test two weeks back on 08/29 showed normal:
T4,Free 0.90 0.8-2.2
t3: 124 97-169
TSH:4.82

And since at that time I felt fatigue and back pain with puffy eyes. The doctored ordered urine test and blood test again. It turned out kidney function tests are fine but TSH was elevated again with

TSH: 7.07  (0.40-4.50)
T4, Free 1.0 (0.8-1.8)
Plus fasting glucose a little high
101 H (65-99).

The doctor said since my T4 free is normal so no medication needed. But anytime I felt sore or pain about neck, need to call him and he may let me take some steroid like medicine.

However, based on this thread, it seems that I need to start to take the medicine to adjust T4 now?

Thanks.

[gimel]

Symptoms are the most important indicator of possible hypothyroidism.  fatigue is a frequent symptom of hypothyroidism.  Weight loss can occur with hypothyroidism, but is unusual.  Your Free T4 result is is at a good level.  Your Free T3 is less than optimal for many people.  Before concluding hypothyroidism and considering thyroid med, I would first test for Vitamin D, B12 and ferritin.  Low levels of those can also cause symptoms, and D and ferritin are important for metabolism of thyroid hormone.  

So before anything further, I would get tested for Vitamin D, B12 and ferritin.  With those results we will be better able to advise you.

[Ravi910000]

I feel fatigue  & I m losing weight that's it.

[gimel]

What symptoms do you have, if any?