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TSH w reflex to ft4 = 0.02 What does it mean?
I went to the doctor because I've been having headaches behind my eyes and in my sinus area. I'm tired much more than I used to be, my fingernails have become paper thin, and I feel like I'm having a harder time focusing. My eyes get so dry at night that I have to wake up and put drops in them.I don't have an appetite, but I gain weight easily. (I am female, late 40's, 5'5", 110 lbs) I exercise vigorously most mornings.
He did this blood test: TSH 2 reflex to ft4 - the result was 0.02.
He is on vacation, but the nurse called to ask if I have heart palpitations, or excessive sweating. I don't.
She said I have an overactive thyroid, and requested blood tests to confirm it. They also came back consistent with a hyperthyroid result, but I don't know what tests they did. It confused me because I don't lose weight easily and I don't have a big appetite - I thought those were the main symptoms.
She said they will monitor it and have me tested in another 2 weeks to see if they number stays the same.
I'm curious to know what might be going on, because the doc won't be back for another week. The headaches linger and often I have clear blurry spots in my vision when they begin. It's starting to worry me a little.
I appreciate any feedback about that TSH test result.
Thanks.
He did this blood test: TSH 2 reflex to ft4 - the result was 0.02.
He is on vacation, but the nurse called to ask if I have heart palpitations, or excessive sweating. I don't.
She said I have an overactive thyroid, and requested blood tests to confirm it. They also came back consistent with a hyperthyroid result, but I don't know what tests they did. It confused me because I don't lose weight easily and I don't have a big appetite - I thought those were the main symptoms.
She said they will monitor it and have me tested in another 2 weeks to see if they number stays the same.
I'm curious to know what might be going on, because the doc won't be back for another week. The headaches linger and often I have clear blurry spots in my vision when they begin. It's starting to worry me a little.
I appreciate any feedback about that TSH test result.
Thanks.
I know this is an old post but I hope you have stopped taking that Thyroid medication! There is nothing wrong with your thyroid! You have nutritional deficiencies that need to be addressed. Get a nutritional panel. If your doctor won't order one, get one yourself through Life Extension. All your nutritional deficiencies cause hypothyroid symptoms as do starvation and anemia because your thyroid has to work extra hard. If you deprive your body of essential nutrients, you can gain weight too. Address the deficiencies first and then if you are still having symptoms, run more labs. Biggest culprits off the top of my head are Vitamin D, Magnesium, B12, Iron...I may not have explained this properly because i am not a doctor but I cannot stress enough how important it is to get a nutritional panel. Nutritional deficiencies cause disease! That has been know for years. Get it checked out before you develop any disease. Treat the cause, not the symptoms.
Your Free T4 is way too low in the range. It should be at least mid-range. Even more importantly your Free T3 is terribly low. For most people it is better for Free T3 to be in the upper half of its range, and then adjusted as needed to relieve symptoms. Having a TSH that is relatively low in the range, along with low FT4 and FT3 points to you having central hypothyroidism. With central hypothyroidism there is a dysfunction in the hypothalamus/pituitary system that results in TSH output that does not adequately stimulate the thyroid gland to produce hormone.
Many doctors overlook central hypothyroidism due to their over-reliance on TSH as the diagnostic for thyroid status. 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. Symptom relief should be all important, not just test results.
There is no need to be worried, you just need to get your doctor to recognize that you have central hypothyroidism, and treat clinically as described, or you will need to find another doctor that will do so. You can confirm what I have said by reading at least the first two pages of the following link. I also suggest reading further if you want to get into the discussion and scientific evidence for what is suggested on page 2.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
Note on page 2 also that there are some other tests that should be done for you. In addition to FT4 and FT3 that should be tested every time you go for tests, you need to test for Vitamin D, B12 and ferritin and then supplement as needed to optimize. D should be at least 50, B12 should be in the upper end of the range, and ferritin should be at least 70. In view of your type of hypothyroidism, it would also be a good idea to test for cortisol level.
Many doctors overlook central hypothyroidism due to their over-reliance on TSH as the diagnostic for thyroid status. 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. Symptom relief should be all important, not just test results.
There is no need to be worried, you just need to get your doctor to recognize that you have central hypothyroidism, and treat clinically as described, or you will need to find another doctor that will do so. You can confirm what I have said by reading at least the first two pages of the following link. I also suggest reading further if you want to get into the discussion and scientific evidence for what is suggested on page 2.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
Note on page 2 also that there are some other tests that should be done for you. In addition to FT4 and FT3 that should be tested every time you go for tests, you need to test for Vitamin D, B12 and ferritin and then supplement as needed to optimize. D should be at least 50, B12 should be in the upper end of the range, and ferritin should be at least 70. In view of your type of hypothyroidism, it would also be a good idea to test for cortisol level.
Hi. Kindly check my TSH check and tell me what can you say about this. I do suffer hypo and hyperthyroidism symptoms; and im really worried. Thank you.
Sensitive TSH : 0.913 ref range: .27-4.2
FT4: 12.86 ref range: 12-22
FT3: 2.18 ref range: 3.1-6.8
Sensitive TSH : 0.913 ref range: .27-4.2
FT4: 12.86 ref range: 12-22
FT3: 2.18 ref range: 3.1-6.8
I am a hypothyroid patient. this time my reading has come
TSH - 0.03
FT3 - 6.3
FT4 - 2.18
can you suggest how much mcg i should take. i am taking 100 mcg from years now.
nickie
TSH - 0.03
FT3 - 6.3
FT4 - 2.18
can you suggest how much mcg i should take. i am taking 100 mcg from years now.
nickie
Reference ("normal") ranges vary lab to lab, so they have to come from your own lab report. Your results are posted above, but I need the range to see where in it you fall. The range should be somewhere near the result on the report. It's often in parentheses and should be something close to (0.8-1.8).
No FT3?
No FT3?
Years of hypo I was seeing a endo for years but I couldn't get him to help my symptoms. I am now seeing a internalist. I am confused with my TSH results. They are low but my Free T4 are ok now?
Thanks for your opinion, LorryK
See test results below:
Currently I take 88mcg levothyroxine
As of 10/27/15 I began 25mcg liothyronine
Bupropion Hal ear (do) 150mg TB24 (1 daily) depression
Date. TSH Free T4
12/11/15 .010 0.8
10/27/51 .010 0.9 88mcg levothyroxine and liothyronine
09/04/15 .032 1.3 150mcg
11/15/14 .037 1.4 here I was taking 150mcg
10/06/14 9.106 I was for years taking 125mcg
Thanks for your opinion, LorryK
See test results below:
Currently I take 88mcg levothyroxine
As of 10/27/15 I began 25mcg liothyronine
Bupropion Hal ear (do) 150mg TB24 (1 daily) depression
Date. TSH Free T4
12/11/15 .010 0.8
10/27/51 .010 0.9 88mcg levothyroxine and liothyronine
09/04/15 .032 1.3 150mcg
11/15/14 .037 1.4 here I was taking 150mcg
10/06/14 9.106 I was for years taking 125mcg
What's the reference range on your FT4? Ranges vary lab to lab, so you have to post them with results so we can see where in the range you are.
Please also post FT3 results and ranges.
How are you feeling now?
Please also post FT3 results and ranges.
How are you feeling now?
Years of hypo I was seeing a endo for years but I couldn't get him to help my symptoms. I am now seeing a internalist. I am confused with my TSH results. They are low but my Free T4 are ok now?
Thanks for your opinion, LorryK
See test results below:
Currently I take 88mcg levothyroxine
As of 10/27/15 I began 25mcg liothyronine
Bupropion Hal ear (do) 150mg TB24 (1 daily) depression
Date. TSH Free T4
12/11/15 .010 0.8
10/27/51 .010 0.9 88mcg levothyroxine and liothyronine
09/04/15 .032 1.3 150mcg
11/15/14 .037 1.4 here I was taking 150mcg
10/06/14 9.106 I was for years taking 125mcg
Thanks for your opinion, LorryK
See test results below:
Currently I take 88mcg levothyroxine
As of 10/27/15 I began 25mcg liothyronine
Bupropion Hal ear (do) 150mg TB24 (1 daily) depression
Date. TSH Free T4
12/11/15 .010 0.8
10/27/51 .010 0.9 88mcg levothyroxine and liothyronine
09/04/15 .032 1.3 150mcg
11/15/14 .037 1.4 here I was taking 150mcg
10/06/14 9.106 I was for years taking 125mcg
Yes, hypothyroid. Your TSH is high, and as you can see your FT4, which is much more important, is on the bottom of the range. Many of us find that FT4 has to be about the middle (1.3 on your range) of the range for us to feel well.
Do you have hypo symptoms?
Next time you have labs, insist of FT3 being included and start keeping copies of your lab reports so you have your own history.
Do you have hypo symptoms?
Next time you have labs, insist of FT3 being included and start keeping copies of your lab reports so you have your own history.
I just received test results and I'm confused as well.
TSH w/reflex to FT4 was 7.31 - reference range 0.40-4.50 and T4 Free is 0.8 with range of 0.8-1.8
No T3 test ran that I can see
Was retested today to double check because my doc was concerned. What does the result mean? Hypothyroid?
TSH w/reflex to FT4 was 7.31 - reference range 0.40-4.50 and T4 Free is 0.8 with range of 0.8-1.8
No T3 test ran that I can see
Was retested today to double check because my doc was concerned. What does the result mean? Hypothyroid?
That's a "normal" TSH. However, are you having symptoms? If you are, then further testing would be in order. TSH is often very unreliable.
Be sure he tests FREE T3. There's a total T3 test as well, and you don't want that one.
In terms of FT4, 50 mcg looks really good for you.
Before I was diagnosed with Hashi's, my "theory" was that I had DeQuervain's thyroidititis, which, like sub-acute, is "temporary". My endo said that, although usually temporary (they can become permanent), they can last a couple of years. I tested positive for both TPOab and TGab, however, so Hashi's it is!
Anyway, do get your FT3 level checked just to make sure it's adequate. Keep in mind that many people find FT3 has to be in the top half to top third of the range.
In terms of FT4, 50 mcg looks really good for you.
Before I was diagnosed with Hashi's, my "theory" was that I had DeQuervain's thyroidititis, which, like sub-acute, is "temporary". My endo said that, although usually temporary (they can become permanent), they can last a couple of years. I tested positive for both TPOab and TGab, however, so Hashi's it is!
Anyway, do get your FT3 level checked just to make sure it's adequate. Keep in mind that many people find FT3 has to be in the top half to top third of the range.
Thank you. I don't know the vitamin levels. I'm switching back to my reg doc. The endo said the 44 was too low for me. The top labs were from 4/23/13 - earlier this week. I feel much better, just getting tired and lost my apetite again. Could be allergies. Endo thinks I blame anything on thyroid, even things that aren't related. I am going to ask my fam doc for help. He will test T3 if I ask. I'll also ask him to do those vitamin levels. I'm glad you are weighing in on my latest test levels. I think that means that the 50mcg might be a good does.
The endo diagnosed me with sub-acute thyroiditis. Don't know if he's right, but it's been going on for almost a year now. I think I'll be stuck taking Synthroid forever now.
The endo diagnosed me with sub-acute thyroiditis. Don't know if he's right, but it's been going on for almost a year now. I think I'll be stuck taking Synthroid forever now.
Well, your FT4 is right on the money...it's exactly midrange.
Were those top labs from 2/20/13? You were on 44 at the time and increased to 50 afterwards?
If you're feeling tired, you really have to take a look at FT3. With FT4 so picture perfect, the answer almost has to be in your FT3 (if it's thyroid related).
I'm sure I must have asked before, but do you know your vitamin D, B-12 and iron/ferritin levels?
Were those top labs from 2/20/13? You were on 44 at the time and increased to 50 afterwards?
If you're feeling tired, you really have to take a look at FT3. With FT4 so picture perfect, the answer almost has to be in your FT3 (if it's thyroid related).
I'm sure I must have asked before, but do you know your vitamin D, B-12 and iron/ferritin levels?
Hi Goolarra,
Thank you for your help. Latest is TSH 1.34 (range 0.4 - 4.5)
T4, Free 1.3 (range 08 - 1.8)
I've been taking 50mcg Synthroid. Starting to get very tired again.
History:
TSH range: 0.4-4.5
T4, free (0.8 - 1.8)
T3, free
7/18/12 7/31/12 8/29/12 9/25/12 11/8/12 1/16/13 (note below)
TSH 0.02 0.01 0.03 1.8 1.37* 1.42
T4,Fr 1.7 1.5 1.1 0.8 1.0* 1.2**
*Synthroid 75 for 3.5 wks
**The 1/16 T4 note: the current lot of free T4 reagent available produces results that are approx 9% higher than previous reagent lots.
1/6/13 NOTE: I quit taking Synthroid on 12/23 - thought I was feeling too hypo.
2/20/13: Note - taking 44 per day for 3 weeks.
Thank you for your help. Latest is TSH 1.34 (range 0.4 - 4.5)
T4, Free 1.3 (range 08 - 1.8)
I've been taking 50mcg Synthroid. Starting to get very tired again.
History:
TSH range: 0.4-4.5
T4, free (0.8 - 1.8)
T3, free
7/18/12 7/31/12 8/29/12 9/25/12 11/8/12 1/16/13 (note below)
TSH 0.02 0.01 0.03 1.8 1.37* 1.42
T4,Fr 1.7 1.5 1.1 0.8 1.0* 1.2**
*Synthroid 75 for 3.5 wks
**The 1/16 T4 note: the current lot of free T4 reagent available produces results that are approx 9% higher than previous reagent lots.
1/6/13 NOTE: I quit taking Synthroid on 12/23 - thought I was feeling too hypo.
2/20/13: Note - taking 44 per day for 3 weeks.
TSH w/ reflex to FT4 is an instruction to the lab. It means "test TSH, and if it's not in reference range, test FT4 as well". Since your TSH was in range, they didn't test FT4. The TSH test is the same, whether with reflex or not.
Splitting pills is an acceptable practice. T4 is so slow acting, that a little more one day and a little less the next doesn't change anything drastically. I've split lots of pills when I am increasing. What I do is just make sure to take both halves of the same pill on consecutive days. Any variation in dosage in each half will be flattened out that way.
Splitting pills is an acceptable practice. T4 is so slow acting, that a little more one day and a little less the next doesn't change anything drastically. I've split lots of pills when I am increasing. What I do is just make sure to take both halves of the same pill on consecutive days. Any variation in dosage in each half will be flattened out that way.
Hi
The test results came in the mail today. I noticed it was a TSH w reflex to FT4. Is that different than TSH? The value was still 1.7. Yes. I will ask for follow up testing. Taking the 44 by breaking 88 in half is not very precise. I really need to take the right pill in order to sort out the correct dose. I'm going to follow up as you suggest.
Thank you
The test results came in the mail today. I noticed it was a TSH w reflex to FT4. Is that different than TSH? The value was still 1.7. Yes. I will ask for follow up testing. Taking the 44 by breaking 88 in half is not very precise. I really need to take the right pill in order to sort out the correct dose. I'm going to follow up as you suggest.
Thank you
Ah, sorry, I saw the TSH of 1.7, but I thought at least FT4 would have been tested. Unfortunately, that doesn't give us a lot to go on.
Perhaps your thyroid is recovering, but you're not yet at the point where it's totally recovered. It's so hard to say with just TSH available.
Do you think you could request a retest with FT4 added in? Looking at your labs, FT4 just doesn't track TSH. On 8/29, with FT4 of 1.1, your TSH is 0.03. Yet on both 1/16, with FT4 hardly different (when factoring in the reagent change), your TSH is 1.42. So, TSH is pretty useless.
Perhaps you'd feel better with a very slight increase. You could ask your doctor about going to 50 mcg. I think you really have to medicate on symptoms. Try 50, retest, then perhaps go to 62.5 if 50 isn't enough???
Perhaps your thyroid is recovering, but you're not yet at the point where it's totally recovered. It's so hard to say with just TSH available.
Do you think you could request a retest with FT4 added in? Looking at your labs, FT4 just doesn't track TSH. On 8/29, with FT4 of 1.1, your TSH is 0.03. Yet on both 1/16, with FT4 hardly different (when factoring in the reagent change), your TSH is 1.42. So, TSH is pretty useless.
Perhaps you'd feel better with a very slight increase. You could ask your doctor about going to 50 mcg. I think you really have to medicate on symptoms. Try 50, retest, then perhaps go to 62.5 if 50 isn't enough???
Sorry.
TSH on 2/20 was 1.7
T4 was not tested. Family doc ordered CBC. I had lost my appetite, and was really weak. I think it was stress. It seems to be returning now.
Still taking half of the 88 Synthroid. Still fatigued, but feeling better than when I quit taking it. This is very confusing.
TSH on 2/20 was 1.7
T4 was not tested. Family doc ordered CBC. I had lost my appetite, and was really weak. I think it was stress. It seems to be returning now.
Still taking half of the 88 Synthroid. Still fatigued, but feeling better than when I quit taking it. This is very confusing.
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