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Tsh level high with "normal" t3 t4
I had a total thyroidectomy in Sept. due to Papillary Cancer. I have been struggling to feel normal since. I have episodes where my heart races, fatigue, weight gain. I just did bloodwork and my levels were... TSH 8.17, T4 1.5 and T3 2.1. The reference range for t3 was 2.0 - 4.4 so that is pretty low on the "normal" scale. I see my endo Tuesday. Any advice on what to ask for? Could i have a problem converting t4 to t3? Anyone else with similar experiences?
Because of the way ranges are established, test results that fall just anywhere within the ranges does not mean they are optimal. The ranges for Free T4 and Free T3 are far too broad and skewed to the low end. As for Vitamin D, B12 and ferritin, what were the actual levels?
The correct definition for hypothyroidism is not just insufficient thyroid levels, erroneously assumed to be correctly sensed by the pituitary, which then secretes TSH as needed to stimulate the thyroid gland. These erroneous assumptions are the reason that doctors use TSH tests for both diagnosis and treatment. This does not work. Hypothyroidism is correctly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone. " So having adequate Free T3 is very important. In addition hypothyroidism is not only inadequate supply of thyroid hormone but also the response to that hormone at the tissue level, which is affected by a number of variables, including cortisol and Vitamin D.
So diagnosis and treatment should be based primarily on symptom relief, and Free T4 and Free T3 are used to monitor progress as med dosage is increased. In trying to assess a person's thyroid status, the most important is an evaluation for symptoms that occur more frequently with hypothyroidism than otherwise. You mentioned some of those type symptoms. Next it is important to do extended testing including Free T4, Free T3, Reverse T3, cortisol, Vitamin D, B12 and ferritin. From your thyroid tests, I assume your FT4 was around the middle of its range, which is adequate; however, your Free T3 is way too low. This is typical for many people taking T4 med and not adequately converting the T4 to T3, and sometimes converting excessive Reverse T3, which is biologically inactive. Conversion can be affected by several variables including ferritin and B12 so it is important to optimize those.
So you need a good thyroid doctor that will evaluate for symptoms, do all the listed tests and treat clinically, by adjusting Free T4 and Free T3 levels as needed to relieve symptoms. Symptom relief should be all important, not just test results, and especially not TSH when already taking thyroid med. I expect that this will require a reduction of your T4 med and the addition of T3. Note the following conclusion from a recent, excellent scientific study that quantified for the first time the effect of Free T3 on hypo symptoms. " 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." So you can see just how far your Free T3 is from this.
If you think you can get your doctor to treat clinically, as described, then that would be good. If not, then you might consider clicking on my name and then scrolling down to my Journal and read at least the one page overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective. Then make a copy and give it to your doctor and ask him to review and consider clinical treatment. If even that doesn't work then you will need to find a good thyroid doctor that will do so.
The correct definition for hypothyroidism is not just insufficient thyroid levels, erroneously assumed to be correctly sensed by the pituitary, which then secretes TSH as needed to stimulate the thyroid gland. These erroneous assumptions are the reason that doctors use TSH tests for both diagnosis and treatment. This does not work. Hypothyroidism is correctly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone. " So having adequate Free T3 is very important. In addition hypothyroidism is not only inadequate supply of thyroid hormone but also the response to that hormone at the tissue level, which is affected by a number of variables, including cortisol and Vitamin D.
So diagnosis and treatment should be based primarily on symptom relief, and Free T4 and Free T3 are used to monitor progress as med dosage is increased. In trying to assess a person's thyroid status, the most important is an evaluation for symptoms that occur more frequently with hypothyroidism than otherwise. You mentioned some of those type symptoms. Next it is important to do extended testing including Free T4, Free T3, Reverse T3, cortisol, Vitamin D, B12 and ferritin. From your thyroid tests, I assume your FT4 was around the middle of its range, which is adequate; however, your Free T3 is way too low. This is typical for many people taking T4 med and not adequately converting the T4 to T3, and sometimes converting excessive Reverse T3, which is biologically inactive. Conversion can be affected by several variables including ferritin and B12 so it is important to optimize those.
So you need a good thyroid doctor that will evaluate for symptoms, do all the listed tests and treat clinically, by adjusting Free T4 and Free T3 levels as needed to relieve symptoms. Symptom relief should be all important, not just test results, and especially not TSH when already taking thyroid med. I expect that this will require a reduction of your T4 med and the addition of T3. Note the following conclusion from a recent, excellent scientific study that quantified for the first time the effect of Free T3 on hypo symptoms. " 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." So you can see just how far your Free T3 is from this.
If you think you can get your doctor to treat clinically, as described, then that would be good. If not, then you might consider clicking on my name and then scrolling down to my Journal and read at least the one page overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective. Then make a copy and give it to your doctor and ask him to review and consider clinical treatment. If even that doesn't work then you will need to find a good thyroid doctor that will do so.
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