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Old 07-25-2005, 01:25 PM   #1
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Normal tsh but low ft4 help please

Hi,

I got some bloods back today and was told my tsh was normal at 1.02 but my free t4 was low at 5.6. (i'm in the UK)

Does anyone know what this means? The consultant is doing nothing at the moment as i have 5 weeks left until i have my baby, and was started on insulin today for gestational diabetes. He basically said i had enough to think about at the moment.

Previously i have had a prolactinoma and was retested in Dec last year but found to be clear. I was also tested for thyroid because i went to see the endocrinologist complaining of extreme fatigue and severe mood swings (amongst other things). I think he just tested tsh as precautionary because he was concentrating on the prolactin (because of last time). The tsh was normal, but then again it is now. Does anybody think i have cause to follow this up after the baby is born? I've looked all over the place but i can't find anywhere that tells me whether low ft4 would make me feel so tired and generally off colour (before pregnancy)

Many thanks
Helen

 
Old 07-25-2005, 02:06 PM   #2
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Re: Normal tsh but low ft4 help please

I would strongly encourage you to be tested for thyroid antibodies as soon as possible. These can predispose you to postpartum thyroiditis and your dr needs to be aware of this to monitor you closely.

Are you on any meds at the moment for thyroid (I'm assuming not)? You didn't post the lab range but I'm guess you mean the FT4 is out of range low. How nice of him to say you have enough to deal with right now so we're not going to help you . That doesn't make sense. Are you feeling any hypothyroid symptoms at all right now?

Untreated hypothyroidism puts you at risk for several obstetric complications. I don't understand why your dr is unconcerned. Insulin dependent diabetes can often go hand in hand with autoimmune thyroid disease. The gestational diabetes should be monitored even after delivery.

A low FT4 would definitely cause you to feel crummy!! It means you do not have enough circulating hormone. TSH isn't the best indicator of thyroid function. It needs to be included in the whole picture with the FT4, FT3 and antibody tests.

The history of prolactinoma very well may be playing a part in all of this too. I really think it would be worth your time to deal with it now (trust me I am pregnant with my 6th baby; it's easier to take them places when they're in than when they're out ).

Love and Prayers, Kelly

 
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Old 07-26-2005, 05:24 AM   #3
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Re: Normal tsh but low ft4 help please

Thanks ever so much for your reply.

I've booked an appointment with my GP for tomorrow

It's difficult to tell at the moment whether i still have the same symptoms or if it is the pregnancy hehe
I'm still very hormonal and exhausted all the time, but everyone seems to just put it down to being pregnant. I can tick a few of the other thyroid symptoms, brittle nails, dry/brittle hair (even though i deep condition once a week), dry skin, irritability (hubby will vouch for that ), and i think maybe sometimes i get a little depressed

I will definitely push for this to be followed up

Thanks again for your reply, good luck with your baby (wow 6!)

Helen x

 
Old 07-26-2005, 06:14 AM   #4
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Re: Normal tsh but low ft4 help please

I would get that TSH and Free T4 tested again to make sure the lab didn't mess up (it happens) before jumping to any conclusions. Whenever there is an odd discrepancy like that, you want to make sure the tests were correct before making any major decisions.

 
Old 07-27-2005, 02:38 AM   #5
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Re: Normal tsh but low ft4 help please

Hi Helen, I'm in the UK too and was diagnosed hypo just a few months ago. That FT4, if the lab ranges are the same as mine (and chances are they are) is the same as mine was, and my GP described it as "in my boots". Your TSH seems within range, but my GP says that we're aiming for the bottom of the range (0.35 - 5.0 is the range) with the TSH (it's currently 7) and top 1/3rd of the range (11 - 22) for FT4 (currently 12) and I'm not likely to feel much better till it's there and been there for a few months! I'm getting bloods done every 6 weeks and medication (levothyroxine) increases every 3 weeks.

From what I've read there's absolutely no reason not to treat a thyroid condition during pregnancy. Which consultant decided not to treat it - was it an obstetrician? I think you're right to go back to your GP, I hope he/she's as good as mine, who seems to be saying all the right things THANK GOD! Have you had your antibodies tested? My GP seemed to think that was important, they also tested for other auto-immune conditions, such as diabetes and lupus.

I hope your GP is as clued-up as mine seems to be, I really do consider myself fortunate with her after reading some people's awful stories here.

 
Old 07-27-2005, 11:09 AM   #6
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Re: Normal tsh but low ft4 help please

Helen, I'm so glad you're following up on this! It's not all that much to think about. Basically swallowing a very small pill every day and having your bloods checked every 4-6 weeks as Charis mentioned.

Please let us know how the visit goes!

Love and Prayers, Kelly

 
Old 07-27-2005, 11:25 AM   #7
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Re: Normal tsh but low ft4 help please

Hi Charis34,

Thanks for your reply

I was going to check the lab range today with the GP but never made it (long story but the midwife had a bit of a panic over my urine).
I'm hoping to get in tomorrow to see her. I think the midwife on Monday said 12-22 but i will check.

I hope you start feeling better soon. I asked my husband last night to describe how i have been lately, he said the only way to describe me was Jekyll and Hyde. I've been a bit better since i have been pregnant (maybe my hormones level out a bit) but i know myself i was horrendous before.

It was the obstetrician who dismissed it i get the feeling he wasn't too clued up on thyroid.

The daft thing is i saw an endocrinologist back in Dec because i was having the same symptoms i had when i had the pituitary adenoma, he tested a few things including thyroid, but i am guessing he missed out FT4. I know he said they looked at the thyroid gland when i had the MRI scan and it was not enlarged, but i read somewhere that with low FT4 it wouldn't neccessarily be.

I hope my GP is as good as yours! Good luck with getting yourself back to normal levels.

 
Old 07-27-2005, 03:48 PM   #8
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Re: Normal tsh but low ft4 help please

Hi Helen

I can definitely identify with the Jeckyll and Hyde stuff!! I've always considered myself to be quite calm and laid back but find myself in awful rages over next to nothing just recently

Hope the panic with your wee was unjustified panic and you and bub are ok At least the weather's cooled a bit, I remember late pregnancy being tortuous in the hot weather!!

Let us know how it goes when you get to speak to your GP about your test results. Take care.

 
Old 07-27-2005, 04:04 PM   #9
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Re: Normal tsh but low ft4 help please

Did you mean prolactinoma as in pituitary tumor? If so, I think that pituitary tumors cause your TSH to be low or low normal even if you are hypo. I have read that quite a bit and my dr confirmed it. My TSH was always okay but my t4 was low.

 
Old 07-28-2005, 03:35 AM   #10
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Re: Normal tsh but low ft4 help please

Hi,

Yes it was a pituitary tumour. I was prescribed Bromocriptine and then Cabergoline to shrink it. My prolactin has now thankfully gone back to normal. Thanks for that info, i'll add that to my list of stuff to talk to GP about (the more info i have the better).

Thanks for your message kelly, i will let you know how i get on. It's a nightmare trying to get in at our GP, i was hoping to get in today but have to wait until tomorrow. I'll be armed with loads of questions by then

I missed my appointment because i had protein in my urine and my blood sugars were high i've had my insulin upped so hopefully it will level out over the next couple of days

Thanks you guys, you've been brilliant. I now feel like i'm not wasting their time by pushing for it to be dealt with.

Helen x

 
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