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normal TSH, low free T4
Below are my lab levels. I am on lithium carbonate. Please explain!
TSH 2.900 uIU/mL (0.450-4.500)
Thyroxine (T4) 3.9 LOW ug/dL (4.5-12.0)
T3 Uptake 27 % (24-39)
Free Thyroxine Index 1.1 LOW (1.2-4.9 )
T4,Free(Direct) 0.73 LOW ng/dL (0.82-1.77)
Triiodothyronine,Free,Serum 2.7 pg/mL (2.0-4.4)
Do you treat the T4 even if the TSH is normal? I have experienced 10lb weight gain in the past year in spite of eating better but perhaps this is a reflection of my age (35). No other symptoms really to report.
Thank you so much in advance.
TSH 2.900 uIU/mL (0.450-4.500)
Thyroxine (T4) 3.9 LOW ug/dL (4.5-12.0)
T3 Uptake 27 % (24-39)
Free Thyroxine Index 1.1 LOW (1.2-4.9 )
T4,Free(Direct) 0.73 LOW ng/dL (0.82-1.77)
Triiodothyronine,Free,Serum 2.7 pg/mL (2.0-4.4)
Do you treat the T4 even if the TSH is normal? I have experienced 10lb weight gain in the past year in spite of eating better but perhaps this is a reflection of my age (35). No other symptoms really to report.
Thank you so much in advance.
I don't think he's doing lab work in 2 weeks. He's more of the alternative type who looks at symptoms. How often should lab work be done? Would the success of the drug be reflected in the increase in free T4? Should the TSH which was normal to begin with just be ignored even if it drops low? Thank you!!
I'm so glad to hear you're starting meds! I agree that you could have secondary hypothyroidism, which is actually a pituitary dysfunction.
You're starting out on a nice low dose, so there shouldn't be any big surprises. You'll probably have several adjustments before you find the right dose. Are you having blood drawn in two weeks or just re-evaluating meds?
You're starting out on a nice low dose, so there shouldn't be any big surprises. You'll probably have several adjustments before you find the right dose. Are you having blood drawn in two weeks or just re-evaluating meds?
Goolarra,
I can't thank you enough for your help. I finally saw another doc today who felt the labs warranted synthroid. I will start tomorrow at 25mcg and follow up in 2 weeks. He thought that there was a pituitary issue of sorts that is resulting in a high tsh but low free T4. Stay tuned. What should i keep in mind/expect, etc.? thank you again!!
I can't thank you enough for your help. I finally saw another doc today who felt the labs warranted synthroid. I will start tomorrow at 25mcg and follow up in 2 weeks. He thought that there was a pituitary issue of sorts that is resulting in a high tsh but low free T4. Stay tuned. What should i keep in mind/expect, etc.? thank you again!!
Hi Sarah,
Have you discussed this with the physician who is prescribing the Lithium? Or considering switching to another mood stabilizer?? It's not uncommon today for psychiatrists to prescribe T3 (Cytomel) as a boost to an SSRI.
Take care,
Sarah
Have you discussed this with the physician who is prescribing the Lithium? Or considering switching to another mood stabilizer?? It's not uncommon today for psychiatrists to prescribe T3 (Cytomel) as a boost to an SSRI.
Take care,
Sarah
Thanks Sarah! I was hoping that i could get synthroid to counteract the lithium impact but it seems rather difficult to be treated without an abnormal Tsh. (my free T4 is low). I really appreciate your input.
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Total T4 and T3U are considered obsolete test of little value.
Your FT4 is below range, which means your thyroid isn't making adequate amounts. FT3 is in the lower third of the range, and it belongs in the upper half.
TSH is a pituitary hormone and as such is affected by many factors other than thyroid hormone levels. So, it's the least important of the thyroid tests, although doctors have been taught that it's the gold standard in thyroid testing. FT3 correlates best with symptom, FT4 falls behind it, and TSH does not correlate at all. So, the most alarming number there is your FT4, which is below range. It can be difficult to find a doctor who will treat FT4 and ignore TSH.
It's the lithium:
http://www.ncbi.nlm.nih.gov/pubmed/9827658
How long have you been on lithium? The study suggests that the hypothalamus/pituitary/thyroid axis might be "reset" when starting lithium.