Aa
What should my tsh be?
What should my tsh be around if my free t4 is .8 (.8-1.8)? Anyone have a free t 4 like mine? Could you post your tsh? Also anyone think that a free t4 like mine is normal or ok?
i have alot of your symptoms and my levels are almost exactly as yours. general doctors and even 2 endo's tell me there is no thyroid problem because my tsh is in normal range. i dont believe thats true though from what ive read that many other people say it can be hypo and or pituitary. im so afraid i have a pituitary problem because i have low esrogen also with normal fsh. i feel like im going to die all the time from this. i am going to see an endo soon i hope you get to feeling better and get answers.
I am very concerned for you! You mentioned sucidal thoughts as one of your symptoms and that has me very worried. I too live in constant pain and have most of your symptoms. I have Hashi's and have had a pituitary tumor removed in 2005 (my second one). I am addressing this bc i want you to be acutely aware that there are so many other reasons that can cause your exact symptoms, Now i am not suggesting that you have any of these nor that you do not have a thyroid problem, just to let you know that all of us care and want you to receive the care that you deserve. Some things that mimics those symptoms are Sjogerens Syndrome, (have it)Chronic Fatigue, Fibromyalgia,(have it) Lupus and even MS.
Because the endocrine system is so complex with each gland feeding off the other and dependent that they all cooperate, minor glitches in one can cause another to look like it is in a frenzy.
I do believe that knowledge is power and sometimes when I am frustrated I too research, but keeping in mind that 1st- I have never been to medical school and 2nd I have to take a lot of what we find on the internet with the knowledge that not everything is accurate and although I am intelligent , I still do not have the ability to comprehend some of the medical jargon. Ha, sometimes I say that I know enough to be dangerous (only with my imagination running away with me). I want you to do your research and print out what really means the most to you or makes sense and take it to your doctor. I think your doc also needs to know the level of your frustration and has a grasp of your symptoms.
I know you have to be miserable with your fatigue and pain. You sound like you are trying very hard to do all that you can do to help yourself.
I am on .88 mcg of levothyroxin at this time, pretty much everytime i am tested they increase my meds.
at this time my TSH is 6.66
Free T-4 is 1.2
Free T-3 is 2.3
my TPO is >1000
FSH is 49.9
LH is 26.2
Cortisol, A.M. is 8.0
I have an active growth on my thyroid gland and am awaiting an ultrasound, my endocrinolgist has already suggested a biopsy too.
Again, even though these are my readings at this time ..they will change!!
Are you seeing a regular General Practioner? You can request to be seen by a specialist. And I think you should.
I really do understand what you are going thru and hear your questions as well as your frustrations. Just keep in mind that there are possibilties that it may not be your thyroid causing all of these symptoms. And then again it could....sadly, we just don't have the answers.
I wish that I could help you more.
Blessings To You,
Sass
Because the endocrine system is so complex with each gland feeding off the other and dependent that they all cooperate, minor glitches in one can cause another to look like it is in a frenzy.
I do believe that knowledge is power and sometimes when I am frustrated I too research, but keeping in mind that 1st- I have never been to medical school and 2nd I have to take a lot of what we find on the internet with the knowledge that not everything is accurate and although I am intelligent , I still do not have the ability to comprehend some of the medical jargon. Ha, sometimes I say that I know enough to be dangerous (only with my imagination running away with me). I want you to do your research and print out what really means the most to you or makes sense and take it to your doctor. I think your doc also needs to know the level of your frustration and has a grasp of your symptoms.
I know you have to be miserable with your fatigue and pain. You sound like you are trying very hard to do all that you can do to help yourself.
I am on .88 mcg of levothyroxin at this time, pretty much everytime i am tested they increase my meds.
at this time my TSH is 6.66
Free T-4 is 1.2
Free T-3 is 2.3
my TPO is >1000
FSH is 49.9
LH is 26.2
Cortisol, A.M. is 8.0
I have an active growth on my thyroid gland and am awaiting an ultrasound, my endocrinolgist has already suggested a biopsy too.
Again, even though these are my readings at this time ..they will change!!
Are you seeing a regular General Practioner? You can request to be seen by a specialist. And I think you should.
I really do understand what you are going thru and hear your questions as well as your frustrations. Just keep in mind that there are possibilties that it may not be your thyroid causing all of these symptoms. And then again it could....sadly, we just don't have the answers.
I wish that I could help you more.
Blessings To You,
Sass
Regardless of the cause of your TSH being low along with low FT4 and somewhat low FT3, with that extensive list of hypo symptoms, I have no doubts that you need to be treated clinically by testing and adjusting your FT3 and FT4 levels as necessary to relieve symptoms, without being constrained by resultant TSH levels. A good thyroid doctor will treat you in this manner. Many of our members report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range. To give you a little more confidence in this being the right approach, this is a copy of a letter that was written by a good thyroid doctor. He frequently consults with patients who live some distance away. He then sends the letter to their PCP to help guide them in treatment of the patient's hypothyroidism.
For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.
For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.
So here is my detailed history in case anybody wanted to know:
I have had a long haul here. I had a grandmal seizure almost a year ago this march. It resulted in a major concussion where I didn’t remember anything for 15 min not even my name. My memory returned to normal ( well more normal) I cannot remember a lot, like why I am going to another room) and nobody could ever find the cause. I found out I have factor 5 lieden and protein s def. which means my blood clots easier but that is about it everything else seemingly normal. So about 2 months after, I began getting so tired I could not drive TO work even after 12 hours of sleep. Tried everything to see if it would help for 2 months. Nothing so I saw a dr. did thyroid tests and a barrage of other tests with everything seemingly normal. My lipase was high, albumim was low, mean platelet high, but dr.s were not concerned about those levels. I have every hypo thyroid symptom out there and my pain is especially bad. I have to take percocets to function. It seems as though the only test I haven't done is hormonal tests I asked my obgyn and she said there is no need if I am not missing my period completely. My complete list of symptoms is( I took most of this from a list of symptoms and deleted the ones I didn’t have of stop the thyroid madness.com):
-I have been for 10 months now been experiencing extreme fatigue, I can't even drive myself home from work unless I take an energy drink first to keep me awake. I can't lose weight even though I'm exercising 5 times a week at an hour and a half (800-900 cals burned) & eating right foods ( 1800 cals or less per day, 6 small meals per day),
- Less stamina than others
- Less energy than others
- Long recovery period after any activity
- Inability to hold children for very long
■Arms feeling like dead weights after activity
■Chronic Low Grade Depression
■Suicidal Thoughts
■Often feeling cold
■Cold hands and feet
■High or rising cholesterol
■Plaque buildup
■Hard stools
■Constipation
■Dry Hair
■Hair Loss
■White hairs growing in
■Dry cracking skin
■Nodding off easily
■Requires naps in the afternoon
■Air Hunger (feeling like you can’t get enough air)
■Inability to concentrate or read long periods of time
■Forgetfulness
■Foggy thinking
■Inability to lose weight
■Always gaining weight
■Inability to function in a relationship with anyone
■NO sex drive
■Moody periods
■PMS
■Excruciating pain during period
■Nausea
■Swelling/edema/puffiness
■Aching bones/muscles
■Bumps on legs
■Hives
■Exhaustion in every dimension–physical, mental, spiritual, emotional
■Inability to work full-time
■Inability to stand on feet for long periods
■Complete lack of motivation
■Slowing to a snail’s pace when walking up slight grade
■Extremely crabby, irritable, intolerant of others
■Internal itching of ears – wow this happens all the time, but I didn’t think anything of it.
■Broken/peeling fingernails
■Dry skin or snake skin
■Major anxiety/worry
■Ringing in ears – rarely but it happens
■Joint pain
■Carpal tunnel symptoms
■Blood Pressure problems – Low almost always, when I am in lots of pain, high.
■Varicose Veins
■Dizziness from fluid on the inner ear
■Low body temperature
■Tightness in throat; sore throat
patients)
■Headaches and Migraines
■Sore feet (plantar fascitis); painful soles of feet
■irritable bowel syndrome
■painful bladder
■Extreme hunger, especially at nighttime
■Dysphagia, which is nerve damage and causes the inability to swallow fluid, food or your own saliva and leads to “aspiration pneumonia”. –This happened to me only once for about 2 days.
I have taken 3 thyroid tests now to date. One in September , One in October and then one in December. I will post them. If my TSH is going down, then shouldn’t my free t4 be rising? That is not happening with me. They are both droppping My TSH is dropping slightly faster than my free t4 , but both still dropping. And should they be changing this much in a matter of 3 months? Here are my test results, please help me decipher these tell me what you think.
09/07/10
TSH - 1.83 (.4-4.5)All Tests Had these reference ranges.
Free T4- 1.1 (.8-1.8
NO FREE T3 Done
10/13/11
TSH - 1.48(see above)
Free T4- 1.0
11/2
Tested for Cortisol levels. it was 16.2 at 4 pm (No reference Range, but found something online saying 23 is high end at 9am and 13 is high end at midnight? so I am not sure what a 4pm readout should be for cortisol but I am assuming this is normal or a little high?
12/03
TSH 1.0 (.4-4.5)
Free T4 - .8 (.8-1.8)
Free T3 - 3.5 (2.3-6.9)Dr. Said this is very good.
Everything I have read says that TSH should go up if your frees are low... and why would my freet3 be more normal /higher than my free t4?
Any help would be greatly appreciated. I am hurting so bad, I seriously think there is no possible way that a thyroid disorder could cause this much joint pain and muscle pain. My soles of my feet hurt in the morning and I am so stiff I can hardly walk. I am dizzy and recently started experiencing blurred vision. I could starve my self for 3 days and not lose a pound (I have only done this once, just to see) my whole body feels like the flu as far as achiness and nausea every day. Could I have like Hashi's and its just beginning? or does that not correlate with my TSH dropping?
I also have recently developed a sore throat and scratchy voice like I lose my voice if I talk too much. I never had this symptom before a couple of days ago.
And are there any further tests I should be asking for? and how should I ask him?
I have had a long haul here. I had a grandmal seizure almost a year ago this march. It resulted in a major concussion where I didn’t remember anything for 15 min not even my name. My memory returned to normal ( well more normal) I cannot remember a lot, like why I am going to another room) and nobody could ever find the cause. I found out I have factor 5 lieden and protein s def. which means my blood clots easier but that is about it everything else seemingly normal. So about 2 months after, I began getting so tired I could not drive TO work even after 12 hours of sleep. Tried everything to see if it would help for 2 months. Nothing so I saw a dr. did thyroid tests and a barrage of other tests with everything seemingly normal. My lipase was high, albumim was low, mean platelet high, but dr.s were not concerned about those levels. I have every hypo thyroid symptom out there and my pain is especially bad. I have to take percocets to function. It seems as though the only test I haven't done is hormonal tests I asked my obgyn and she said there is no need if I am not missing my period completely. My complete list of symptoms is( I took most of this from a list of symptoms and deleted the ones I didn’t have of stop the thyroid madness.com):
-I have been for 10 months now been experiencing extreme fatigue, I can't even drive myself home from work unless I take an energy drink first to keep me awake. I can't lose weight even though I'm exercising 5 times a week at an hour and a half (800-900 cals burned) & eating right foods ( 1800 cals or less per day, 6 small meals per day),
- Less stamina than others
- Less energy than others
- Long recovery period after any activity
- Inability to hold children for very long
■Arms feeling like dead weights after activity
■Chronic Low Grade Depression
■Suicidal Thoughts
■Often feeling cold
■Cold hands and feet
■High or rising cholesterol
■Plaque buildup
■Hard stools
■Constipation
■Dry Hair
■Hair Loss
■White hairs growing in
■Dry cracking skin
■Nodding off easily
■Requires naps in the afternoon
■Air Hunger (feeling like you can’t get enough air)
■Inability to concentrate or read long periods of time
■Forgetfulness
■Foggy thinking
■Inability to lose weight
■Always gaining weight
■Inability to function in a relationship with anyone
■NO sex drive
■Moody periods
■PMS
■Excruciating pain during period
■Nausea
■Swelling/edema/puffiness
■Aching bones/muscles
■Bumps on legs
■Hives
■Exhaustion in every dimension–physical, mental, spiritual, emotional
■Inability to work full-time
■Inability to stand on feet for long periods
■Complete lack of motivation
■Slowing to a snail’s pace when walking up slight grade
■Extremely crabby, irritable, intolerant of others
■Internal itching of ears – wow this happens all the time, but I didn’t think anything of it.
■Broken/peeling fingernails
■Dry skin or snake skin
■Major anxiety/worry
■Ringing in ears – rarely but it happens
■Joint pain
■Carpal tunnel symptoms
■Blood Pressure problems – Low almost always, when I am in lots of pain, high.
■Varicose Veins
■Dizziness from fluid on the inner ear
■Low body temperature
■Tightness in throat; sore throat
patients)
■Headaches and Migraines
■Sore feet (plantar fascitis); painful soles of feet
■irritable bowel syndrome
■painful bladder
■Extreme hunger, especially at nighttime
■Dysphagia, which is nerve damage and causes the inability to swallow fluid, food or your own saliva and leads to “aspiration pneumonia”. –This happened to me only once for about 2 days.
I have taken 3 thyroid tests now to date. One in September , One in October and then one in December. I will post them. If my TSH is going down, then shouldn’t my free t4 be rising? That is not happening with me. They are both droppping My TSH is dropping slightly faster than my free t4 , but both still dropping. And should they be changing this much in a matter of 3 months? Here are my test results, please help me decipher these tell me what you think.
09/07/10
TSH - 1.83 (.4-4.5)All Tests Had these reference ranges.
Free T4- 1.1 (.8-1.8
NO FREE T3 Done
10/13/11
TSH - 1.48(see above)
Free T4- 1.0
11/2
Tested for Cortisol levels. it was 16.2 at 4 pm (No reference Range, but found something online saying 23 is high end at 9am and 13 is high end at midnight? so I am not sure what a 4pm readout should be for cortisol but I am assuming this is normal or a little high?
12/03
TSH 1.0 (.4-4.5)
Free T4 - .8 (.8-1.8)
Free T3 - 3.5 (2.3-6.9)Dr. Said this is very good.
Everything I have read says that TSH should go up if your frees are low... and why would my freet3 be more normal /higher than my free t4?
Any help would be greatly appreciated. I am hurting so bad, I seriously think there is no possible way that a thyroid disorder could cause this much joint pain and muscle pain. My soles of my feet hurt in the morning and I am so stiff I can hardly walk. I am dizzy and recently started experiencing blurred vision. I could starve my self for 3 days and not lose a pound (I have only done this once, just to see) my whole body feels like the flu as far as achiness and nausea every day. Could I have like Hashi's and its just beginning? or does that not correlate with my TSH dropping?
I also have recently developed a sore throat and scratchy voice like I lose my voice if I talk too much. I never had this symptom before a couple of days ago.
And are there any further tests I should be asking for? and how should I ask him?
I don't mind you being a mother hen type at all :) at least someone is, haha., I don't have a mom, so I miss that.
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