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Old 05-17-2004, 07:23 PM   #1
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Test results: TSH normal, T4 low, T3 low

I just got my blood test results back from the doctor and here are the thyroid related numbers:

TSH = 1.4 uIU/mL Lab Reference Range = 0.465 - 4.68

Total T4 = 2.60 ug/dL Lab Reference Range = 5.50 - 11.00

Total T3 = 73 ng/dL Lab Reference Range = 85 - 205

A little background: I'm a 38 year old male, no medications, low energy levels/drive in the past year, slightly overweight and difficulty losing excess weight, mother and her siblings have hypothyroidism. Also, I just spent the past 4 years working a 12 hour rotating shift of 3 days one week, 3 nights the next week - suspect this may be part of my problem due to erratic and poor sleep patterns and fortunately I don't work that type of shift now.

Doctor is recommending that I get a thyroid scan done using radioactive iodine. Is that a good idea? Will it tell me/him anything of use? Any drawbacks to this test?

I did some research on this and one possible cause for the normal TSH level and low T4 and T3 levels is adrenal fatigue/insufficiency. Does that sound like a possible cause for these weird numbers? What kinds of followup testing should I have done? A 24 hour cortisol test sounds like the way to check for adrenal fatique. What about testing for thyroid antibodies? Free T4? Free T3? (I assume that since my total T4 and T3 are low that my free T4 and T3 will also be low, but that may not be the case).

Any input would be appreciated.

Alan
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Old 05-17-2004, 07:39 PM   #2
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Re: Test results: TSH normal, T4 low, T3 low

Im still not fixed yet myself, but have found a lot of info. I would ask the doc for the Free T3 and Free T4.

I think from reading these boards you might be borderline Hypo. Even though your TSH is well into the normal range, your total numbers should probably be higher but I would not do anything until you get the antibodies and the Free's tested first. Free and Totals are not necessarily the same:

My Free T3 was in the high range of normal and my Total T3 was abnormally high - a little change makes a difference.

 
Old 05-17-2004, 09:16 PM   #3
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Re: Test results: TSH normal, T4 low, T3 low

Hello arkie... I've seen your excellent advice on the high cholesterol board.

All I really know about adrenal fatigue is that it should be corrected before thyroid treatment can begin.

You still may have a primary hypoT problem, though. The fact that your family history is riddled with thyroid disease makes you more prone to it, too. As you likely know, autoimmune disease has a strong genetic component, so Hashimoto's hypoT is a strong possibility. TSH fluctuates wildly in Hashi's, so it's possible that yours was low on the day you tested, and might have risen as much as 3 points before that day was over, putting you squarely in the range that the American Assn of Clinical Endos says is hypo. That fluctuation is why TSH isn't the valuable test it's been made out to be. Get TPO and Tg antibodies tests done to find out if you have Hashi's. You're correct in assuming your free Ts are low because the totals are; but you should still have the frees tested.

As for the RAI scan, it isn't a typical test to have done for diagnosis of suspected hypoT. It's most often done when palpable nodules are present, to determine whether they're hot [often the cause of hyperT] or cold [often malignant]. From most everything I've read, the amount of RAI is minimal, and should carry no lingering side effects; but I honestly don't know what your doctor hopes to accomplish by it.

Use the advanced search for Meep's archived posts about adrenal issues. He's our resident whiz about everything endocrine... Unfortunately his life has become busier, and he isn't here quite as often as he used to be. It still might be worth reposting your questions in a new thread, putting his name in the title so he's more apt to see it.
Hope I was at least a small help.

 
Old 05-19-2004, 03:40 AM   #4
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Re: Test results: TSH normal, T4 low, T3 low

Thanks for the input everyone. This is an example where the TSH test is not the "gold standard" that most docs claim it to be regarding thyroid function. My T4 levels are less than half of the bottom limit with a TSH level that just about everyone would consider healthy. Also, about 6 months ago I felt something wasn't quite right and had a different doctor at that time pull some blood to check my thyroid among other things. The only thyroid related test he did was TSH which came back at 2.7 and he said that was normal. I suspect my thyroid hormones were low then like they are now.

I went ahead and scheduled the thyroid uptake and scan next week. After those test results come back and I discuss them with my doctor I'm going to suggest we also check free T4 and free T3 levels, thyroid antibodies, adrenal function, and pituitary function.

After doing some more research (thanks for the pointers to Meep's threads here discussing adrenal insufficiency), I definitely want to treat any potential adrenal problems first before considering taking thyroid medication.

Thanks again everyone.

Alan
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Old 05-19-2004, 09:26 AM   #5
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Re: Test results: TSH normal, T4 low, T3 low

Normal TSH and low T4 can be a possible pituitary problem. I have the same thing and am going in for a MRI & CT-Scan to check out my pituitary gland along with getting blood work done.

 
Old 07-30-2005, 08:30 AM   #6
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Re: Test results: TSH normal, T4 low, T3 low

Hello,

Can anyone enlighten me on my test results? I don't look hypo thyroid but I feel crappy all the time.

TSH- 1.1
FT4- 1.05
FT3 - 2.4
TPO - 16 (0-34)

 
Old 07-30-2005, 09:01 AM   #7
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Re: Test results: TSH normal, T4 low, T3 low

Hello Minihorselove!

If you start a new thread rather than replying to this post with your numbers I think you'll get a lot more replies .

Just so you know too, posting under someone else's thread when it's not related to their thread is called "hijacking" so it's always a good idea to start a new thread if you'd like to ask questions about your health specifically and aren't addressing the original poster's question . That is one *long* run-on sentence isn't it . Anyway, I hope it makes sense .

Also when you post, if you could give the labs ranges that would give us a better idea. Every lab has it's own set of ranges.

By the way, WELCOME TO THE BOARDS! I'm glad you found us. The people here are great and super helpful.

I'll be watching for your new thread!

Love and Prayers, Kelly

Last edited by ASDGRMama; 07-30-2005 at 09:02 AM. Reason: forgot to include person's name I was addressing :)

 
Old 07-30-2005, 10:28 AM   #8
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Re: Test results: TSH normal, T4 low, T3 low

With your total T3 and T4 being so low, it is still quite possible that your free T3 and Free T4 are within range, but I bet they are low in the range Something like 99% of thyroid hormones in a person's blood are bound to proteins that make them unavailable for tissues to use. An enzyme breaks the thyroid hormones free as they are needed. Not everyone follows this 99% rule, though. In cases where Total Ts are lower than normal, the body can respond by breaking more thyroid hormone free from the proteins so that Free T3 and Free T4 are actually "normal". Like I said, I bet yours are low-normal at best, and still warrant attention, but I wonder if they are in range, will your doctor say "in range means OK." That is a common mistake that many doctors make.

Quote:
Originally Posted by arkie6
The only thyroid related test he did was TSH which came back at 2.7 and he said that was normal. I suspect my thyroid hormones were low then like they are now.
My TSH was 2.6 when I was diagnosed. I woudl place my bets that you DO have a thyroid issue going on.

Quote:
I went ahead and scheduled the thyroid uptake and scan next week. After those test results come back and I discuss them with my doctor I'm going to suggest we also check free T4 and free T3 levels, thyroid antibodies, adrenal function, and pituitary function.
Why not go ahead and get those done before the scan so that the results can all be looked at together with less waiting for the results. Maybe seeing the bigger picture would help?

Quote:
After doing some more research (thanks for the pointers to Meep's threads here discussing adrenal insufficiency), I definitely want to treat any potential adrenal problems first before considering taking thyroid medication.
The book, Adrenal Fatigue: 21st Century Stress Syndrome is a great place to start researching this. The 24 hour urine cortisol test will give you an average picture of what your cortisol level is, but it can't show you patterns that indicate problems and may actually look "normal" even if you have a problem (sound familiar?).

Cortisol should be highest in the morning and fall steadily throughout the day, peaking occasionally in response to stressors and meals. Any deviation from this pattern spells symptoms. The blood tests that your doc can do for Cortisol also pose a problem. Just the stress of having to drive to the office and be stuck with a needle can cause cortisol to rise in response to the stress, making you look "normal", when in fact in your normal environment, your Cortisol would be too low.

That said, the best evaluation of Cortisol levels is a kit that you take home and use to collect saliva samples at various times througout the day (Your doctor can order it from such places as Great Smokies Labs). They usually have 4 samples (8am, noon, 5 pm and 10pm), but some have 6. This way you can see if you are too low in the morning and Cortisol rises throughout the day, which is common in adrenal fatigue's earlier stages. You may only be low at noon or at 5, or not at all, but you would never know if you used the urine test or the blood tests at the doctor's office.

I hope this helps. Good luck to you!
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