Labs can get messed up with Hashitoxicosis (both Hashimoto's thyroiditis and Graves antibodies). My labs were showing subclinical hypothyroid when I very hyperthyroid! Some people mention completely normal labs while swinging between hyper and hypo symptoms.
The most important consideration should always be symptoms. You have many of those that are frequently related to hypothyroidism, plus a few others that need further evaluation. After symptoms, biochemical tests are useful to help confirm what the symptoms show. Since lab results and calculated reference ranges can vary from lab to lab, we need to know the reference ranges shown on the lab report for the thyroid related tests.
As mentioned you have lots of symptoms that are frequently related to being hypothyroid. In addition, in the words of an excellent 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 FT4 is only at 25% of its range, and your FT3 is higher in its range, at 50%, so I'd say that even though your FT4 and FT3 levels fall within range, they fit this description for causing hypothyroid symptoms.
Many doctors would argue with this because they consider any test results that fall within range cannot be considered as hypothyroid. They fail to understand what the ranges represent. Unfortunately, the ranges for FT4 (and FT3) are not well standardized among different test machine manufacturers, generally validated, or based on large databases of healthy adults with no thyroid pathology. Instead those ranges are locally established from test data available at any given laboratory, excluding only data from patients assumed to have thyroid issues based on the flawed TSH range. Clinically hypothyroid patients with TSH within the reference range, people with hidden pathologies such as undiagnosed central hypothyroidism or autoimmune disease, and patients taking thyroid medication can all be included in the database. This results in ranges that are too broad to be functional for everyone, and that are skewed to the low end.
Further, each person has different setpoints for thyroid levels, at which they feel best. So trying to identify abnormality by comparing individual FT4/FT3 test results to reference ranges based on a group of patients can also be misleading.
A good thyroid doctor will diagnose a potential hypothyroid patient clinically, by evaluating for symptoms that occur more frequently with hypothyroidism. These are then followed by biochemical testing for FT4, FT3, Reverse T3, TSH, cortisol, Vitamin D, B12 and ferritin. Every tentative diagnosis of hypothyroidism is a probability theory that must be evaluated with a therapeutic trial of thyroid med adequate to raise the FT4 and FT3 levels into the upper half of their ranges. If symptoms ease, then the theory is accepted and FT4/FT3 levels should be increased as needed to relieve hypo symptoms, without increasing to the point of creating hyper symptoms. . Except at extreme values, TSH has little value as a diagnostic for thyroid status, and should never be used to determine thyroid med dosage adequacy.
Looking at the rest of your test results, I see that the TG ab test indicated an autoimmune condition, which can be either Graves' or Hashimoto's. Your TSI for Graves' was negative, so that leaves Hashi's, yet your TSH was not consistent with that, so it could be an indication of early Hashi's. What is the TBI test for ? Your Reverse T3 was good. Vitamin D should be at lest 50. B12 should be in the upper end of its range. You should also be tested for cortisol and ferritin. Both are very important for a hypothyroid patient. If you want to confirm what I have said, please click on my name and then scroll down to my Journal and read the one page overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.
So you need to start on thyroid med and get both your FT4 and FT3 into the upper half of their ranges, and adjusted from there as needed to relieve hypo symptoms. You need to supplement as needed to get Vitamin D and B12 optimal. You also need to test for cortisol. Your also need to test for ferritin and supplement as needed to optimize to at least 100. Do you have a doctor that will test, diagnose, and treat clinically, as described? If not then you will need to find one that will do so. That does not necessitate an Endo, just a good thyroid doctor. If you are interested, please give us your location and perhaps we can suggest doctors that have been recommended by other thyroid patients.
My recommendation is to forget TSH, and don't allow the doctor to make decisions about diagnosis and treatment based on TSH. As mentioned TSH is affected by so many things that the only time it is useful for diagnosis is for an untreated hypothyroid patient, when TSH is at extreme values such as being suppressed below range, along with hyper symptoms indicating the possibility of Graves' , or when it is extremely high, with attendant hypo symptoms, indicating the possibility of Hashi's. Either condition is then confirmed with further tests. TSH results within the range, have almost no value for diagnosis and treatment for a thyroid patient. All this is confirmed with extensive scientific evidence included in the full paper linked in the overview I mentioned that is in my Journal.
If your Endo will do the recommended tests and diagnose and treat clinically, then he will be somewhat unique within the Endo group. Most seem to have the "Immaculate TSH Belief" and erroneously only pay attention to TSH for diagnosis and treatment. If they go beyond TSH they revert to "Reference Range Endocrinology", by which they will tell you that a thyroid test that falls anywhere within the range is adequate. That is also very wrong. Just logically, how can a FT4 test at the lower limit of the range be considered as good as a FT4 test result at the high limit of the range, which is about 90% higher than the lower limit. And that doesn't even take into account the inter-individual differences in FT4 and FT3 requirements needed for a person to feel well. Clinical diagnosis and treatment, as described above, is what every hypothyroid patient needs.
Assuming that you will be discussing all this with your doctor, please let us know how it goes and if we can be of further help.
Your TG is high. As far as I know this means you have Hashimoto's but I'm not a doctor. You also have detectable TSI levels (most healthy people don't!). Your thyroid could be swinging between hyper and hypo.
Like you, I have Hashimoto's antibodies and measurable TSI levels. My symptoms were similar to yours when my thyroid problems started and my thyroid levels were constantly fluctuating.
Based on your tests your T4 was high in 2017. Did your doctor not treat you for that?
i got an update from my doc. he said even though mild positive but still positive thyriod autoantibodies which means i have autoimmune thyriod disease although it wasnt very "active" at the time of testing.he want to do a trail of armour and see how it goes. i asked if it was hashimotos and he hasnt gotten back yet but now im assuming it is and treating as such. i just got a book "how to heal hashimotos" buy a doctor mark ryan and its very good and informative so far i feel its exactly what im going through. i wanted to let all know. :)
kellieann, I just felt the need to say to you that there are a number of supposed "cures" for Hashimoto's. As far as I have been able to determine there is no scientific evidence supporting that possibility, only anecdotal information . Also, even if Hashi's could be put into remission, any prior damage to the thyroid gland cannot be recovered, requiring thyroid med to compensate for that loss of function.
As for Marc Ryan, he is not a doctor as far as I can determine, but instead a Licensed Acupuncturist and Herbalist who has continued to do a lot of study apparently and decided to sell a book. His plan includes diet as a foundation, herbs and supplements and, in some cases, acupuncture treatment. He says he also tries to work on people’s thinking and default behavior because he finds that this is also really important for healing. "Mindset is absolutely critical when you are battling a chronic problem like Hashimoto’s." And of course if it doesn't work it is always because some part was not done correctly by the patient. To me, even it it did work this procedure for diet, herbs, and supplements and sometimes acupuncture sounds more difficult than just taking my thyroid med every day. Just my honest opinion.
I would argue that it is not being lazy, but realistic about treatment. But that is just my opinion. Please stay in touch and let us know how you are doing.