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Where to go next, normal TSH...
I’m new to this forum and not sure what do next?
I have been noticing since the last year that my weight has been increasing and energy levels going down. I chalked it up to getting older (I’m currently a 45 year old female with 3 kids and work full time.) Within in the last 12 - 6 months I decided I better start a good exercise routine to tone up, keep a healthy diet and hopefully would increase my energy levels. Since then, nothing has changed and I’m actually increasing in weight, (even ran a half marathon, last spring, no weight loss the whole time), my fatigue has increased (falling asleep in meetings), I’m cold all the time, I have memory and brain fog, I can’t find my words when talking, constipation, irritability, ridges on my finger and toe nails, eyebrows thinning on outside, etc. I went into my Dr. in March, explained my concerns and symptoms and he ran a complete CBC, TSH, Free T4 & Free T3.
TSH - 2.23 ulU/ml (didn’t list range)
Free T4 - 1.19 ng/dl (didn’t list range)
Free T3 - 2.5 pf/ml (2.2- 4.0)
Vit D,25 - 35 ng/ml (30-100)
My doctor, called to go over my results and said that I’m within normal range and told me to get a personal trainer or start yoga or I can do hormone therapy, but I would be taking it for more than 5 years and chance of breast cancer can increase. I asked about why I’m having all these other symptoms, if I’m in normal range and he said that those will all go away once I start a new fitness program. I’m not happy with this explanation and just want to feel myself again, so I called back a couple days later and asked for a referral to see an endocrinologist for a 2nd opinion. They sent the referral, but because of how the referral was written, the endocrinologist will not see me because the referral doesn’t warrant that I should be seen, because I’m in “normal range”. I’m not sure what to do at this point, I feel helpless, I just want to understand what is going on with my body, because before all this, I was a an energetic, loved life and generally a happy, go lucky person. I’m now very withdrawn, no energy and feel awful all the time. I live in the Green Bay, WI area and need to know if there are any good physician’s that they can recommend or what should be my next steps?
I have been noticing since the last year that my weight has been increasing and energy levels going down. I chalked it up to getting older (I’m currently a 45 year old female with 3 kids and work full time.) Within in the last 12 - 6 months I decided I better start a good exercise routine to tone up, keep a healthy diet and hopefully would increase my energy levels. Since then, nothing has changed and I’m actually increasing in weight, (even ran a half marathon, last spring, no weight loss the whole time), my fatigue has increased (falling asleep in meetings), I’m cold all the time, I have memory and brain fog, I can’t find my words when talking, constipation, irritability, ridges on my finger and toe nails, eyebrows thinning on outside, etc. I went into my Dr. in March, explained my concerns and symptoms and he ran a complete CBC, TSH, Free T4 & Free T3.
TSH - 2.23 ulU/ml (didn’t list range)
Free T4 - 1.19 ng/dl (didn’t list range)
Free T3 - 2.5 pf/ml (2.2- 4.0)
Vit D,25 - 35 ng/ml (30-100)
My doctor, called to go over my results and said that I’m within normal range and told me to get a personal trainer or start yoga or I can do hormone therapy, but I would be taking it for more than 5 years and chance of breast cancer can increase. I asked about why I’m having all these other symptoms, if I’m in normal range and he said that those will all go away once I start a new fitness program. I’m not happy with this explanation and just want to feel myself again, so I called back a couple days later and asked for a referral to see an endocrinologist for a 2nd opinion. They sent the referral, but because of how the referral was written, the endocrinologist will not see me because the referral doesn’t warrant that I should be seen, because I’m in “normal range”. I’m not sure what to do at this point, I feel helpless, I just want to understand what is going on with my body, because before all this, I was a an energetic, loved life and generally a happy, go lucky person. I’m now very withdrawn, no energy and feel awful all the time. I live in the Green Bay, WI area and need to know if there are any good physician’s that they can recommend or what should be my next steps?
You do have a lot of symptoms that are frequently caused by hypothyroidism. Your Free T4 and free T3 are also too low in the ranges for many people. Due to the erroneous assumptions used to establish those ranges they are far too broad to be functional across their entire breadth, for many people.
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."
Your TSH being low in the range, along with the low Free T4 and Free T3 may indicate central hypothyroidism. Central is a dysfunction in the hypothalamus/pituitary system that results in a TSH output that is too low to adequately stimulate the thyroid gland.
Your doctor just followed normal practice for doctors who don't know about how to best test, diagnose and treat hypothyroidism. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. You can get some good insight from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
Hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin. Your D is too low. Should be about 55 min. You also need to test for Vitamin B12 and ferritin. and supplement as needed to optimize. B12 should be in the very upper end of its range and ferritin should be about 70 minimum.
At present I only have the name of only one doctor in your area that might meet your needs; however, they don't accept insurance. You get a bill that you have to pay and then submit to your insurance company. If interested I'll provide info.
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."
Your TSH being low in the range, along with the low Free T4 and Free T3 may indicate central hypothyroidism. Central is a dysfunction in the hypothalamus/pituitary system that results in a TSH output that is too low to adequately stimulate the thyroid gland.
Your doctor just followed normal practice for doctors who don't know about how to best test, diagnose and treat hypothyroidism. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. You can get some good insight from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
Hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin. Your D is too low. Should be about 55 min. You also need to test for Vitamin B12 and ferritin. and supplement as needed to optimize. B12 should be in the very upper end of its range and ferritin should be about 70 minimum.
At present I only have the name of only one doctor in your area that might meet your needs; however, they don't accept insurance. You get a bill that you have to pay and then submit to your insurance company. If interested I'll provide info.
I sent you a PM with info. To access, just click on your name and then from your personal page, click on messages.
Could someone please tell me of a good thyroid doctor in the St. Louis area I feel just terribe, tired, eyes hurt, can't concentrate. My TSH is 0.94, T4 free is 1.3 and T3 free is 2.7. I had my thyroid removed 15 years ago and take Synthroid 75 mg. Thank u so much!
No, my hormones were not tested. I'm sure if I wanted to go the hormone route, he would have tested me before putting me on something. I just think he was reaching for other answer's because he didn't really have an answer for me. I'm going to go a family doctor and see if I can get a the other tests, that have been recommended run and hopefully get some answers. Thank you both for your help and talking me through with this.
1 Comments
Best of luck and do let us know what you find out and how it all works out for you.
COMMUNITY LEADER
Were your reproductive hormones tested to make sure you need to have hormone therapy? You need to be tested before anything is prescribed in order to make sure you need it and to make sure you get the right hormones, at the proper dosages.
Central hypothyroidism is treated with replacement thyroid hormones, just like any other hypothyroidism.
You have the thyroid panel, already. You'll want to have the antibody tests to confirm/rule out Hashimoto's and a thyroid ultrasound would be good, to determine if you have nodules. Nodules are very common with Hashimoto's and are usually nothing to worry about; most of us have them.
It's understandable that you'd want to use your insurance if possible. If you have a primary doctor, it might be a good idea to make an appointment and see if you can get further testing done there.
Central hypothyroidism is treated with replacement thyroid hormones, just like any other hypothyroidism.
You have the thyroid panel, already. You'll want to have the antibody tests to confirm/rule out Hashimoto's and a thyroid ultrasound would be good, to determine if you have nodules. Nodules are very common with Hashimoto's and are usually nothing to worry about; most of us have them.
It's understandable that you'd want to use your insurance if possible. If you have a primary doctor, it might be a good idea to make an appointment and see if you can get further testing done there.
I sure would not consider hormone therapy without being tested for Free testosterone, progesterone and estradiol.
Yes, I would go to the Family doctor and get tested for Free T4, Free T3, B12, ferritin, and I'd even add selenium since your body doesn't seem to be converting T4 to T3 very well. I would also throw in a test for Reverse T3 to see if your T4 is being over-converted to Reverse T3, which is a mirror image molecule of T3, but biologically inactive. The body continually produces some RT3, but under the wrong conditions produces too much, which can result in inadequate Free T3 effects.
The treatment with central hypothyroisim is essentially the same as with primary (Hashimoto's Thyroiditis). You just need to get your Free T4 and Free T3 levels high enough to relieve symptoms. Also you need to get your Vitamin D level optimized and find out about ferritin, seleniuum, B12 and RT3.
Yes, I would go to the Family doctor and get tested for Free T4, Free T3, B12, ferritin, and I'd even add selenium since your body doesn't seem to be converting T4 to T3 very well. I would also throw in a test for Reverse T3 to see if your T4 is being over-converted to Reverse T3, which is a mirror image molecule of T3, but biologically inactive. The body continually produces some RT3, but under the wrong conditions produces too much, which can result in inadequate Free T3 effects.
The treatment with central hypothyroisim is essentially the same as with primary (Hashimoto's Thyroiditis). You just need to get your Free T4 and Free T3 levels high enough to relieve symptoms. Also you need to get your Vitamin D level optimized and find out about ferritin, seleniuum, B12 and RT3.
Thank you for your responses. The type of hormone therapy was estrogen. Thinking that I'm peri-menopausal and that my estrogen levels are decreasing and my testosterone is increasing. My OB/Gyn is who tested my blood work i mentioned above. Should I try and go to a Family Doctor and have them run a full thyroid panel, B12 and ferritin? I would like it go through my insurance first if I can. Also, if it is central hypothyroidism, what is the treatment for that and what kind of testing would you recommend?
I have forgotten to mention this above, but I have been taking Vitamin D Drops ( 2000iu/drop) for a little over a month before he tested me. Not knowing that it helped with Thyroid, but because of the dark circles and puffys eyes I have. Which has also just showed up within the last year.
I have forgotten to mention this above, but I have been taking Vitamin D Drops ( 2000iu/drop) for a little over a month before he tested me. Not knowing that it helped with Thyroid, but because of the dark circles and puffys eyes I have. Which has also just showed up within the last year.
COMMUNITY LEADER
What type of "hormone therapy" did your doctor offer you?
Your FT4 looks like it might be quite low, but without the reference range, it's hard to tell, since ranges vary lab to lab and have to come from your own report. Rule of thumb for FT4 (where most of us tend to feel the best) is mid range; without the reference range, we can't calculate yours, but I'd guess it's less than that.
Rule of thumb for FT3 is upper half to upper third of its range. Yours is downright dismal at only 17% of the range. Since FT3 is the hormone that correlates best with symptoms, it's no wonder you don't feel well.
I'd recommend that you go back to your doctor and ask to get thyroid antibodies tested to determine whether or not you have Hashimoto's Thyroiditis. Hashimoto's is an autoimmune condition, in which the body determines that the thyroid is foreign and produces antibodies to destroy it. The destruction often takes years, and symptoms can be present long before labs, such as FT levels and TSH indicate an issue.
The problem is that with Hashimoto's and that low FT3 and FT4, we'd expect your TSH to be mush higher than it is. This makes me think there's a possibility you could have Central Hypothyroidism, which isn't really a problem with the thyroid. Central hypothyroidism is an issue with the hypothalamus/pituitary axis, in which the pituitary isn't producing enough TSH to stimulate the thyroid to produce thyroid hormones.
I also notice that your vitamin D is way too low in its range. Vitamin D should be around 55-60 to be optimal. Low vitamin D levels can cause many hypothyroid-like symptoms.
Will check for doctors in your area...
Your FT4 looks like it might be quite low, but without the reference range, it's hard to tell, since ranges vary lab to lab and have to come from your own report. Rule of thumb for FT4 (where most of us tend to feel the best) is mid range; without the reference range, we can't calculate yours, but I'd guess it's less than that.
Rule of thumb for FT3 is upper half to upper third of its range. Yours is downright dismal at only 17% of the range. Since FT3 is the hormone that correlates best with symptoms, it's no wonder you don't feel well.
I'd recommend that you go back to your doctor and ask to get thyroid antibodies tested to determine whether or not you have Hashimoto's Thyroiditis. Hashimoto's is an autoimmune condition, in which the body determines that the thyroid is foreign and produces antibodies to destroy it. The destruction often takes years, and symptoms can be present long before labs, such as FT levels and TSH indicate an issue.
The problem is that with Hashimoto's and that low FT3 and FT4, we'd expect your TSH to be mush higher than it is. This makes me think there's a possibility you could have Central Hypothyroidism, which isn't really a problem with the thyroid. Central hypothyroidism is an issue with the hypothalamus/pituitary axis, in which the pituitary isn't producing enough TSH to stimulate the thyroid to produce thyroid hormones.
I also notice that your vitamin D is way too low in its range. Vitamin D should be around 55-60 to be optimal. Low vitamin D levels can cause many hypothyroid-like symptoms.
Will check for doctors in your area...
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