Re: low tsh, low free t4, normal free t3 - what does it all mean?
We don't look at TSH to evaluate thyroid function - it can give *some* indication as to what's going on with the thyroid but, much better to look at the actual thyroid hormone levels.
TSH levels can change in the body's attempts to maintain stable thyroid hormone levels so, even though your level dropped, the only thing it's telling us is that you *might* be hyperthyroid.
Now, your FreeT4 level (storage hormone level) is below-range which definitely indicates hyPOthyroidism.
Your FreeT3 (active hormone level) is at a place in the range that many people would find comfortable.
So, you are clearly NOT hyperthyroid.
Nodules can be hyperfunctioning which means they "throw off" thyroid hormones and this can cause hyper symptoms.
His statement about your FreeT4 level being low because of the nodule makes no sense whatsoever.
I suspect your doctor thinks you'd be better off without your thyroid but, RAI really isn't the best choice. A recent, very large study showed that RAI causes increased risk for cancer and cardiac mortility. Of course, if you had thyroid cancer, you'd need RAI to prevent spread/recurrence.
Sorry to say but, you're in a tough spot.....
If we were to look at your labs, your FreeT4 level could use some improvement with a T4 hormone replacement med such as Synthroid/levothyroxine.
Since T4 is converted by our bodies to T3, there's a chance your FreeT3 level might increase - some people would be fine with this but, I'm not sure if your FreeT3 level is causing the hyper symptoms....or a nodule.
Surgery might be a viable option for you.
No matter what, I think a second (or third) opinion is warranted because the doctor you saw did not explain things clearly enough to you....and is suggesting a less-than-optimal treatment (rather than giving you ALL options).
Best of luck to you - please keep us posted.
Graves' 2007...remission 2009....hypo 2010
Last edited by sammy64; 06-29-2011 at 08:03 AM.