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Old 10-28-2011, 06:20 PM   #1
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Normal T4(low) Normal TSH (low) HELP!!!

Hi Guys -

Desperately needing help here. My T4, free was 0.8 with a range of 0.8-1.8, so I am on the very low end of the normal and my TSH was 0.97 with a range of 0.40-4.50 so again on the lower end of the normal range. I had an emergency gall bladder surgery in October of 2010 and by February of this year I had gained 15 pounds. I have never had weight problems until my gall bladder surgery. I do not overeat and I eat correctly. I have even gone so far as to keep a food journal. I started going to the gym in February 2011 and started working out with a trainer. I work out 4-5 times a week with cardio and strength training. My weight continues to go up as well as my % of body fat. My trainer suggested that I have the thyroid test done. Dr. says it is in the normal ranges, but there are other symptoms and the continued weight gain is just getting ridiculous at this point. Any advice??

 
Old 10-29-2011, 11:44 PM   #2
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Re: Normal T4(low) Normal TSH (low) HELP!!!

Free T4 of .8 on a .8 scale is not normal for about 95-98% of the population. It's hypothyroid. And since that's an actual thyroid hormone, it's measurement is more revealing than any pituitary hormone (TSH) test. There are factors that can cause TSH to remain inappropriately "normal" even though the free Ts are inadequate.

To get a full picture of your thyroid status, you should insist on anti-TPO and anti-Tg tests.

 
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Old 10-30-2011, 12:05 AM   #3
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Re: Normal T4(low) Normal TSH (low) HELP!!!

I'm in the same boat :/ My FT4 is 0.73 (range 0.77-1.61) which is low but TSH is optimal at 0.95 (range 0.34-4.82) yet they still won't give me meds. I feel terrible & finally seeing an endo next week who can hopefully help me. You're hypo of some sort & my best advice would be to get a dr who will listen & treat you based on your symptoms, not your bloodwork. Hope you feel better soon & GL to ya!!

 
Old 10-31-2011, 02:34 PM   #4
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Re: Normal T4(low) Normal TSH (low) HELP!!!

With the levels y'all have, I'd be worried about potential pituitary issues, since low T4 + low TSH is considered a hallmark of secondary hypo.
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Old 10-31-2011, 03:14 PM   #5
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Re: Normal T4(low) Normal TSH (low) HELP!!!

I agree with everything that's been said already.

And, I have a few other things to offer.

Firstly, while most people here are familiar with TPOab's and TGab's that are commonly seen in Hashi's, hypothyroidism can also be caused by another type of antibody: TBII.

TBII is a form of TSH-receptor antibodies that can cause atrophic hypothyroidism. A person with this type of hypothyroidism will have low TSH and low FreeT4/T3 levels.

For whatever it's worth, a pituitary (or hypothalamus) problem is very rare.

And, hypothyroidism is treated the same, regardless of the cause.

The National Institute of Health has said that "TSH determination is diagnostically misleading and only free hormone measurements are reliable for thyroid function assessment."

For those that may be interested in reading the whole 2003 article from which I quoted the last sentence, here's a link:

http://www.ncbi.nlm.nih.gov/pubmed/12915350?ordinalpos=1&itool=EntrezSystem 2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pub med_SingleItemSupl.Pubmed_Discovery_RA&l inkpos=4&log$=relatedreviews&logdbfrom=p ubmed)

Bottom line, TSH should be ignored and doctors should be looking at the actual FreeT4 and FreeT3 levels to assess thyroid function and treat.
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Last edited by sammy64; 10-31-2011 at 03:25 PM.

 
Old 10-31-2011, 08:25 PM   #6
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Re: Normal T4(low) Normal TSH (low) HELP!!!

Thank you for posting that, it's very helpful as my antibodies test came back normal as well. Which I've read 50% of the time they don't show anyways but I've never heard of the other you mentioned. I'm desperate to run every test hoping something will clearly show an issue. Anyways, very helpful info. Thanks!

 
Old 11-01-2011, 05:02 AM   #7
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Re: Normal T4(low) Normal TSH (low) HELP!!!

Thank you everyone for your insight and suggestions!! I went to my PCP yesterday armed with my list of questions, lists's of symptoms and my research. My visit was GREAT!! WE went through the past several years of my medical history and together me and my PCP made some decisions. He has started me on a low dose synthroid and we're going to try it for several weeks so see if there is a relief of some symptoms or some inprovement. We are going to redo my blood work in 6 weeks and also do some additioinal testing to see if there are some additional underlying causes. I was extremely nervous about talking to my PCP armed with the information I had found, (he is a new PCP for me), but he was very receptive.

 
Old 11-01-2011, 05:07 AM   #8
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Re: Normal T4(low) Normal TSH (low) HELP!!!

This is all great news!

PCP's can often be better at treating thyroid disease than endos.

Please know that it's unrealistic to expect complete symptom relief after starting meds. In fact, if your starting dose was only 25mcg, you might find improvement with some symptoms and the development of new ones. This is typical.

It's great that you will be getting labs in 6 wks. - that's the amount of time it takes for your levels to stabilize after starting meds/dose adjustments.

It's very clear to us that you have hypothyroidism so, if your starting dose doesn't accomplish much, I'd still be inclined to tell the doctor you feel ever-so-slightly better and push for a dose increase after your next set of labs.

Your treatment goal should be to attain the thyroid hormone levels most healthy people have: FreeT4/FreeT3 in the upper half/upper third of the range, regardless of TSH.

Kudos to you for being the squeaky wheel!

Please keep us posted.
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Last edited by sammy64; 11-01-2011 at 05:07 AM.

 
Old 11-01-2011, 06:08 AM   #9
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Re: Normal T4(low) Normal TSH (low) HELP!!!

Thats awesome!! So many have a hard time getting drs of any sort to listen & prescribe meds mainly on symptoms not do much bloodwork. I'm glad yours is willing to work with you immediately! GL & I hope you feel better soon!

 
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