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Old 05-18-2011, 02:30 PM   #1
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Normal TSH, Low FT4- possible hypothyroidism?

Hello all. My husband and I are trying to have another baby, and recently began seeing a reproductive endocrinologist. He ran a lot of blood tests (amongst other tests), including a test of Free T4, and TSH. My TSH levels are 1.54 mcIU/mL. My Free T4 level was .69ng/dL. From all of the reading I've been doing, this is a low result. I have several questions:
1) Is it possible to be hypothyroid and still have "normal" TSH levels? Do my levels suggest hypothyroidism?
2) When I see my GP for a follow up, what tests should I ask her to run?
3) I am symptomatic, and likely have been for quite a while. I had a severe B12 deficiency, the cause of which has never been determined, though it's likely pernicious anemia. It seems to be under control now, and the main neurological symptoms have disappeared, but I'm still tired, and still gaining/holding on to weight (17 pounds in the last 11 months). The fatigue is indescribable. I gave up caffeine when we began trying for a baby, but I cannot function without it. Period. Is it possible the B12 deficiency and potential hypothyroidism are related?
4) Why does the lab list .58-1.64 as their reference range, when everything online starts at .7 or greater?
5) If I am hypothyroid, what am I looking at? What kind of treatment options are there? Diet? Meds? Will I be able to lose the weight I've gained? Long term issues?
Thanks for any and all help!

 
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Old 05-18-2011, 02:43 PM   #2
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Re: Normal TSH, Low FT4- possible hypothyroidism?

Different labs have different ranges...it's important to see where your result falls within your lab's ranges.

TSH isn't a reliable indicator of thyroid function....it is a pituitary hormone. It's much better to look at the actual thyroid hormone levels - FreeT4 being the primary one.

And, yes, it's entirely possible to have hypothyroidism with results in the normal range...."normal" (aka in-range) results don't mean they are YOUR normal.

When you think about the fact that the thyroid is the master regulator of virtually every body system, each of us will have his/her own normal level within the ranges of normal.

Your FreeT4 level is towards the bottom end of your range - you are hypothyroid. (most people have FreeT4 levels above mid-range, if not in the upper third of the range).

Your symptoms indicate hypothyroidism. Anemia can be caused by hypothyroidism.

Two great "starter books" are "Thyroid for Dummies" and "What Your Doctor May Not Tell You About Hypothyroidism". Both were written by endos.

The tests you'll want your GP to run would be:

FreeT4 (T4 or thyroxine, free, direct)
FreeT3 (tri-iodothyronine, free, serum)
TSH

You also might want some antibody testing to see if the cause of your hypothyroidism is Hashimoto's disease, an autoimmune condition with is the most common cause of hypothyroidism.

Antibody tests are:

TPOab (thyroid peroxidase antibody)
TGab (thyroglobulin antibody)

Diet can help hypothyroidism but, you will still need to replace the hormones not being produced in adequate amounts by your thyroid. You'd want to avoid foods called goitrogens...you can Google for a list. A big thyroid no-no is soy.

Most people fare well with levothyroxine, a T4 hormone replacement med (synthroid). Some people need to add Cytomel/liothyronine (a T3 med). Others opt for a natural dessicated thyroid product made from porcine thyroids such as Armour or NatureThroid - these meds contain both T4 & T3 but in different proportions than human thyroids make so, there can be an occasion to add levothyroxine to balance things out.

Your doctor should adjust your dose until your FreeT4 (and FreeT3) levels are in the upper third of the range....these are the levels needed for a successful pregnancy.

I highly recommend you optimize your levels before trying to conceive...hypothyroidism can affect a developing fetus's IQ.

If your levels are optimized, you can expect resolution of your symptoms and the ability to lose the weight with proper diet and exercise.
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Last edited by sammy64; 05-18-2011 at 02:47 PM.

 
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Old 05-21-2011, 08:10 AM   #3
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Re: Normal TSH, Low FT4- possible hypothyroidism?

I saw my GP on Friday night, and she did a repeat test. My TSH has gone down in the last year (1.74 in June 2010, to 1.54 in March 2011), and since my Free T4 was techinically outside of the range, she ran that again. She actually ran all of the tests I asked her to run (the ones you listed, Sammy), and I should have the results by Monday afternoon. I trust her to listen to me, and help me figure out how to fix this.
She did say that she thinks the B12 deficiency and possible thyroid issues might be related, in that they may both have a similar root cause- and now I have an appointment to see a gastroenterologist at the end of June. She told me to ask about IBS, Celiacs, IBD, and to request scopes (ugh), and checks for pernicious anemia. My family has a long history of stomach troubles (IBS, colitis), and I have a history of ulcers, so I guess it won't hurt.

 
Old 05-23-2011, 11:47 AM   #4
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Re: Normal TSH, Low FT4- possible hypothyroidism? *med question added*

B12=1200 (which is a HUGE jump from Octobers 464) *ref range 254-1320*
fT4=0.9 *ref range 0.8-1.5*
fT3=1.4 (not Free T3, total T3 d'oh) *Ref Range .70-1.90*
TSH=1.38 (downward trend 1.74, 1.54 and now 1.38) *Ref Range .350-5.000)
TPOab=35.4 *ref range <60*
Tgab=34.5 *ref range <60*

Dr said that I am within range, but on the low side in all of it. Was hesitant to diagnose me as hypothyroid (since my TSH is going down, not up, and my TSH is technically within their range- which starts at .8), but said that starting medication was an option. I asked if this could be managed at this point with diet changes and more exercise. She said probably not, but it won't hurt anything to try if that's what I'd like to do. If I don't feel better in a month, I am to call back, and she'll start me on a low dose of medication (and I didn't ask which medication). When I have to call back in a month, what medication should I ask for, and what dose will be most helpful?

Last edited by Boymom78; 05-24-2011 at 10:36 AM.

 
Old 05-23-2011, 12:36 PM   #5
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Re: Normal TSH, Low FT4- possible hypothyroidism?

I wouldn't even think about conceiving with FT4 that low. For the best chance at a successful pregnancy and healthy baby, it needs to be in the 1.4 range.

There is no difference between TSH of 1.5 and 1.7. If this MD believes there is, she isn't very thyroid-smart. TSH isn't static. It varies almost hourly, in a circadian pattern, and has been known to change up to three full points within 24 hours.

You need to be taking thyroid hormone in preparation for pregnancy. You need for it will increase during the gestation period. Levothyroxine is the most commonly prescribed hormone to treat hypothyroidism. Synthroid is the most commonly prescribed brand, but there are others. Don't take a generic if you can at all help it. They just aren't that dependable. The average starting dose is 50 mcgs. Dosing has to start low and be increase gradually at 6-8 week intervals, according to how the FT4 and FT3 respond. It should NOT be dosed according only to TSH. TSH is not a dependable measure of thyroid status.

To get a better sense of what you'll be facing regarding hypothyroidism with pregnancy, get a copy of Living Well with Hypothyroidism: What Your Doctor Doesn't Tell You That You Need To Know. It has a sizeable chapter on conception and pregnancy that will help you to help guide your MD in treating you the proper way. Sad to say, MDs are not as knowledgable as they need to be in treating this disorder.

BTW, when you post lab results for interpretation, we need to see the lab ranges too. They vary lab to lab. The results have to be taken in context to their respective ranges.

Last edited by midwest1; 05-23-2011 at 12:38 PM.

 
Old 05-23-2011, 01:57 PM   #6
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Re: Normal TSH, Low FT4- possible hypothyroidism?

Please help, I am having similar problems. I have the feeling of a lump in my throat/ fullness that causes me discomfort. I had a sono on my thyroid that indicated I had a nodule/lesion on my right side. I then had lab work done. My TSH & Free T3 levels are normal, however, my free T4 level is low. (.67) My GP referred me to an ENT. I'm curious what the next step is? Is this considered hypothyroid? How do I get this feeling to go away? Will medication help with the lump in my throat. Any info is greatly appreciated!

 
Old 05-23-2011, 02:22 PM   #7
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Re: Normal TSH, Low FT4- possible hypothyroidism?

Your FreeT4 level is very low - you have hypothyroidism and need thyroid hormone replacement.

Your nodule(s) should shrink when your hypothyroidism is properly treated.
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Old 05-23-2011, 02:42 PM   #8
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Re: Normal TSH, Low FT4- possible hypothyroidism?

Thanks, Midwest. This doctor is my GP. I'm not sure what the reference ranges are, I just got the numbers from my GP when she called this afternoon to talk about the results. We're going to see another reproductive endocrinologist next week, and I plan to talk to him about the thyroid test results, too. For whatever it's worth, the GP suggested starting off on a low dose of medication, if I felt I wanted to try it. I wanted to research a little more carefully and find out what I should be taking, before jumping in.
Any thoughts on why my TSH would be low, and apparently going lower, if my T4 is low, too?

 
Old 05-24-2011, 10:38 AM   #9
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Re: Normal TSH, Low FT4- possible hypothyroidism?

Reference Ranges added. And it looks like she ordered Total T3 instead of Free T3. It's my fault, she asked me to check over the orders before I left to make sure they were what I wanted, and I said they were fine.

 
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