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Old 12-01-2009, 11:36 PM   #1
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Lithriel HB User
Low Free T4, "normal" TSH

I am a 24 year old female. I have been suffering from hypothyroidism symptoms for years but I finally started researching things when my hearing started to drop in my right ear. More than once I have had a doctor tell me my thyroid was "a little low but still normal". After things have gotten worse this past year, I finally decided to ask a doctor about what is going on.

Past and current symptoms:

Extremely pale dry flaky skin
Course hair
Icy extremities (to the point of pain because my hands and feet are so cold, all the time!!!!)
Always been at least 20 pounds overweight and had a hard time losing weight
Frequent muscle cramps in my legs
Bouts of Shoulder, knee, and finger and wrist pain (usually no more than a month at a time)
Bouts of hair loss
Thin eyebrows
Numbness and tingling in hands and feet
Swollen lips and puffy face, especially neck area
Heavy periods
Dry hard to pass stool
Low Libido
High Blood Pressure
High Cholesterol
Heart Palpitations

Recent/worsening symptoms (last 6 months or less):

Irritability, anxiety, moodiness
Noticeable hearing loss in my right ear
Much more puffiness in my face (eyes sometimes hard to open in the morning)
Swollen hands
Irregular and abnormally long periods
Constipation and IBS-like symptoms (have not yet been diagnosed)
Mild fatigue and sluggishness (I sleep 10 hours sometimes more and yet I still am sluggish all day)
Periods of extreme weakness (fainting spells) accompanied by blurred vision, and intense brain fog (usually lasting only and hour or so)


I just got some blood work done, I do not have the full results, I did get some numbers from him over the phone:

TSH: 3.3 (was told this is completely normal, yeah right)
Free T4: .6 (range of .8 to 2-ish?)

Those are the only numbers I received over the phone. I just did an antibody test today and will get the results in a couple of days.

My primary care physician wants to put me on anti-depressants, no!!! I know it is the low thyroid, I don't want unnecessary things. He says my thyroid is normal and he seems to be reluctant to listen (told me to stop listing my symptoms because he only has so much time in the day, was hesitant to order a sonogram of my neck despite me telling him that FIVE of my family members have nodules in their thyroid- TWO of them have thyroid cancer). I can barely understand him, and he makes me feel uncomfortable. He mentioned I might need some medication for the low t4, but then didn't give me anything.

My gut instinct is screaming that I have hypothyroidism. With the family history of it, and the blaring symptoms, despite my TSH, should I seek medication?

Any suggestions on where to go from here? Anyone know of a good endocrinologist willing to listen in the tri-city area?

Last edited by Lithriel; 12-02-2009 at 10:33 AM. Reason: Deleting extra space

 
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Old 12-02-2009, 05:08 AM   #2
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sparkie HB User
Re: Low Free T4, "normal" TSH

It is frustrating when you find an MD who knows what to test but goes strictly by lab ranges. I can suggest two ways to help find an MD. One is to do a search engine, search "top docs thyroid, _________" put in the city you wish on the line. We are not allowed to post web sites here and specific search engines. Another is to go to the Armour thyroid site. There you can search physicians who prescribe Armour thyroid. No guarantee here but these physicians tend to be more open minded. I found my physician by word of mouth but did see she was on the Armour site.

 
Old 12-02-2009, 06:17 AM   #3
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Location: AZ
Posts: 2,253
javelina HB Userjavelina HB Userjavelina HB User
Re: Low Free T4, "normal" TSH

If those labs you got over the phone are correct then you are severely hypo. Your FT4 is below range and your TSH is very high (even our very stodgy leading endocrine society in the US says 3 should be the top of range).

You must find a doctor who will treat you as your symptoms are very significant and your health is being compromised. Do some research on your treatment options and spend some time reading posts here to gather as much info as you can, we find that we have to be very well informed and our own advocates for the most part. Another way to find a good doc is call your local pharmacies and ask which docs prescribe natural desiccated thyroid hormones (Armour, Nature-throid, Westhroid), these docs tend to be more open minded and able to look outside the TSH box. Whether or not you want naturals for your treatment, they will be more likely to treat you.

You need to also get your Free T3 and your antibodies TPO and TG tested. Also ask for a vitamin D, B12 and your ferritin levels. All or most of these tend to be low with hypothyroidism. Since you've been hypo for a long period of time consider having your cortisol levels tested with saliva testing (blood and urine testing isn't sensitive enough). Adrneal fatigue is very, very common with long untreated hypo and until it's addressed you may not do well with your thyroid hormone replacement.

Hope this helps!

 
Old 12-02-2009, 07:39 AM   #4
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Summer2928 HB User
Re: Low Free T4, "normal" TSH

You do sound like hypo, and may need to re-check the tests in 2-3 months, along with T3 (better Free T3, but if the doctors are strongly reluctant to test free T3, at least total T3 is needed, + TSH + Free T4). If the numbers are the same (not better), it would suggest taking medication. Sometimes "top" doctors are not really the best. They may be too busy, having too many patients already, large practice, long wating time etc. Often, you may want just to find "your" endo or GP, and work with them.

Last edited by Summer2928; 12-02-2009 at 07:39 AM.

 
Old 12-02-2009, 10:30 AM   #5
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Lithriel HB User
Re: Low Free T4, "normal" TSH

Quote:
Originally Posted by Summer2928 View Post
You do sound like hypo, and may need to re-check the tests in 2-3 months, along with T3 (better Free T3, but if the doctors are strongly reluctant to test free T3, at least total T3 is needed, + TSH + Free T4). If the numbers are the same (not better), it would suggest taking medication. Sometimes "top" doctors are not really the best. They may be too busy, having too many patients already, large practice, long wating time etc. Often, you may want just to find "your" endo or GP, and work with them.
If I remember correctly, I have been sitting at a TSH of 3 or higher for at least 2 years now (could be longer, I was never tested before then). I don't know how much my free T4 has changed though. I did get all of the standard thyroid blood work done, but I never received a copy of it, so I only know the two results I got over the phone. I am assuming that means everything else is within range except my free T4.

Quote:
You need to also get your Free T3 and your antibodies TPO and TG tested. Also ask for a vitamin D, B12 and your ferritin levels. All or most of these tend to be low with hypothyroidism. Since you've been hypo for a long period of time consider having your cortisol levels tested with saliva testing (blood and urine testing isn't sensitive enough). Adrneal fatigue is very, very common with long untreated hypo and until it's addressed you may not do well with your thyroid hormone replacement.
Very interesting. Adrenal disease does kind of sound like me, but the overlap in symptoms makes it hard to distinguish what is really going on. I am going to try and see a different doctor before I get anymore tests.

I now have appointment to check for nodules next Tuesday and my PCP wants me to check in in two weeks. In the mean time, I want to get my hearing checked, and find an endocrinologist.

Anybody else have hearing loss? It's gotten so bad I can't understand what someone whispers in my right ear.

Quote:
Another is to go to the Armour thyroid site. There you can search physicians who prescribe Armour thyroid. No guarantee here but these physicians tend to be more open minded. I found my physician by word of mouth but did see she was on the Armour site.
Aw! One of my options for a PCP was on there! I should have gone with him instead, except that he has gotten a few so-so reviews.

I guess the thing to do is keep searching for someone that will listen and get things done. Patience is the key.

 
Old 12-07-2009, 06:52 PM   #6
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Lithriel HB User
Re: Low Free T4, "normal" TSH

I've had more tests done, here are the results:

t3 uptake: 33.7 (22.5-37.0) %
t4: 7.3 (5.0-12.0) ug/dL
FTI: 2.5 (1.1- 4.6)
TSH: 3.06 (.40-5.00)uIU/mL

ACTH Assay: 14 (0-46) pg/ML

Cortisol (urine) 7.8 (no reference range established)

Thyroglobulin Auto AB <20.0 (0.0-40.0) IU/mL
Thyroid Peroxidase <10.0 (0.0-35.0) IU/mL

So I take it I do NOT have an autoimmune disease then? From what I can tell all of these labs look normal, except that my TSH is a little high (they did not recheck the free t4 for some reason, which was at a .6). My PCP doesn't consider my TSH to be anything but completely normal.

I was starting to wonder if I have a wheat allergy contributing to my hypothyroidism, but I thought Celiac's was only associated with auto-immune induced hypothyroidism, if I don't have antibodies, does that mean I probably do NOT have celiacs?

I still have a neck sonogram tomorrow (hopefully as long as my insurance covers it), and if that doesn't show anything abnormal I am at a loss as to what is causing my low thyroid symptoms.

What do these ranges mean?

 
Old 12-08-2009, 06:58 AM   #7
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Location: AZ
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javelina HB Userjavelina HB Userjavelina HB User
Re: Low Free T4, "normal" TSH

It's a shame your doc wasted your insurance dollars on those useless thyroid tests: index, total, and uptake. They are very outmoded and some labs don't even perform them any more as a result. If your doc is going to go by them you will stay hypo forever. The only ones of any use at all are the antibodies (which you are showing negative result-- however the sensitivity of those tests isn't the best) and the TSH is still very high (look up the American Association of Clinical Endocrinologists statement that any TSH over 3 is hypothyroid and print out to bring to your doc).

You can still have Celiac's with negative thyroid antibodies. As I said, the thyroid antibodies are not 100% reliable tests, you still can have autoimmune disease with negative results. You should try going completely gluten-free for a period of a couple of months to see if this helps. But hypothyroidism can also cause Celiac-like symptoms and the only way to figure this out is by getting on thyroid hormone replacement.

If your doc refuses to treat you based on these last tests I strongly recommend you find another who will. Your FT4 is below range and this indicates a very significant low state of thyroid hormones in your system. There are many docs out there who order useless labs and ignore the valid ones and then disregard patient symptoms (I imagine the next step with this doc will be to write a prescription for an antidepressant). You deserve better than that.

 
Old 12-10-2009, 03:02 AM   #8
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Join Date: Dec 2009
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sooz6 HB User
Re: Low Free T4, "normal" TSH

Quote:
Originally Posted by Lithriel View Post
I am a 24 year old female. I have been suffering from hypothyroidism symptoms for years but I finally started researching things when my hearing started to drop in my right ear. More than once I have had a doctor tell me my thyroid was "a little low but still normal". After things have gotten worse this past year, I finally decided to ask a doctor about what is going on.

Past and current symptoms:

Extremely pale dry flaky skin
Course hair
Icy extremities (to the point of pain because my hands and feet are so cold, all the time!!!!)
Always been at least 20 pounds overweight and had a hard time losing weight
Frequent muscle cramps in my legs
Bouts of Shoulder, knee, and finger and wrist pain (usually no more than a month at a time)
Bouts of hair loss
Thin eyebrows
Numbness and tingling in hands and feet
Swollen lips and puffy face, especially neck area
Heavy periods
Dry hard to pass stool
Low Libido
High Blood Pressure
High Cholesterol
Heart Palpitations

Recent/worsening symptoms (last 6 months or less):

Irritability, anxiety, moodiness
Noticeable hearing loss in my right ear
Much more puffiness in my face (eyes sometimes hard to open in the morning)
Swollen hands
Irregular and abnormally long periods
Constipation and IBS-like symptoms (have not yet been diagnosed)
Mild fatigue and sluggishness (I sleep 10 hours sometimes more and yet I still am sluggish all day)
Periods of extreme weakness (fainting spells) accompanied by blurred vision, and intense brain fog (usually lasting only and hour or so)


I just got some blood work done, I do not have the full results, I did get some numbers from him over the phone:

TSH: 3.3 (was told this is completely normal, yeah right)
Free T4: .6 (range of .8 to 2-ish?)

Those are the only numbers I received over the phone. I just did an antibody test today and will get the results in a couple of days.

My primary care physician wants to put me on anti-depressants, no!!! I know it is the low thyroid, I don't want unnecessary things. He says my thyroid is normal and he seems to be reluctant to listen (told me to stop listing my symptoms because he only has so much time in the day, was hesitant to order a sonogram of my neck despite me telling him that FIVE of my family members have nodules in their thyroid- TWO of them have thyroid cancer). I can barely understand him, and he makes me feel uncomfortable. He mentioned I might need some medication for the low t4, but then didn't give me anything.

My gut instinct is screaming that I have hypothyroidism. With the family history of it, and the blaring symptoms, despite my TSH, should I seek medication?

Any suggestions on where to go from here? Anyone know of a good endocrinologist willing to listen in the tri-city area?
I can't help you with an endocrinologist, but I sincerely believe that you need to change doctors. You need to follow your gut. Even if your TSH results fall in the normal range, you are symptomatic. With the family history on top of it all...you should definitely find another opinion. My doctor tried to keep me on a low dose of Armour Thyroid because at 90 mg my TSH was on the high end of normal. I still had symptoms. I insisted. Now I've been taking 120 mg and although I still have lingering symptoms, I am starting to feel better after one month on this dose. I now have a normal TSH level ( lower, now), but my Free T4 showed too low yesterday. I'm researching now what that means before I go see her today. Your doctor should be your team mate in your health care - not your all-knowing dictator. Doctors need to listen to and respect their patients.

 
Old 01-01-2010, 06:23 PM   #9
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Sierra73 HB User
Re: Low Free T4, "normal" TSH

Lithriel,

Your TSH is high and your FT3 is awy too low. My TSH is currently 2.25 and my Free T4 is low and I feel so lousy I had to cancel all my Christmas plans this year. I'm on Synthroid (T4) and Cytomel (T3) and feel best when they are both mid to upper mid range and TSH is around 1 OR LESS!

You have classic hypothyroid symptoms and I'm afraid your doc doesn't sound open minded at all. Might be best to look for another opinion.

Good luck.

just noticed your added post showing the antibody tests. You still have a high TSH and low Free T4. It's good to get the sonogram and keep watch with all the Thyroid cancer in the family.

Last edited by moderator2; 01-01-2010 at 06:58 PM. Reason: please do not post websites except as described in the Posting Policy

 
Old 01-02-2010, 09:51 PM   #10
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Location: Kentucky
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freebird1 HB User
Re: Low Free T4, "normal" TSH

Hi Lithriel,
I also have hearing loss in my right ear. I have been diagnosed with thyroid autoimmune disease. I always thought that my hearing loss had something to do with my hypothyroidism, but I couldn't get any Dr.s to agree. I had an stapedectomy in August to correct my hearing loss and now I can hear much better in that ear. As for my thyroid autoimmune I really think that there is no help out there, it is almost impossible to get a Dr. to understand. I am on synthyroid 150 mcg. and I don't feel like it is helping whatsoever. I hope you get the help you need. Lots of luck to you.

 
Old 07-03-2010, 09:55 AM   #11
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Jen1984 HB User
Re: Low Free T4, "normal" TSH

I also have had normal antibodies testing along with low free t4 tests AND normal tsh

free t4 0.6 (0.71-1.66)
TSH 1.97 (normal)

I have ringing in my ears AND my vision is being compromised. How are you doing now and what more have the doctors found out??

 
Old 07-11-2010, 07:18 AM   #12
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freebird1 HB User
Re: Low Free T4, "normal" TSH

Quote:
Originally Posted by Jen1984 View Post
I also have had normal antibodies testing along with low free t4 tests AND normal tsh

free t4 0.6 (0.71-1.66)
TSH 1.97 (normal)

I have ringing in my ears AND my vision is being compromised. How are you doing now and what more have the doctors found out??
I would suggest you go to an ent doctor and have your hearing check. I am doing okay, I think that there is nothing that can be done except medicate on synthryoid. What kind of vision problems are you having?

 
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