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Old 05-16-2012, 04:05 PM   #1
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low tsh- normal t3 &t4

My tsh is .01, very low but my t3 t4 are normal. tsh has been dropping steadily for over a year. my thyroid is clean no nodules. What other tests should I request?

 
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Old 05-16-2012, 10:16 PM   #2
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Re: low tsh- normal t3 &t4

Are you currently taking any thyroid hormone? Any desiccated product (like Armour) containing T3 will suppress your TSH.

TSI, TBII and TRAb (antibodies) can falsely lower or suppress your TSH as well.

Other tests... Have you had any thyroid antibody tests run?

TSI and TRAb for Graves disease (Hyperthyroidism)

I'm not familiar enough with Pituitary issues to comment, but that might be an avenue to explore.

Feel free to post thyroid lab results (with ref ranges) and we can help you interpret them. Good luck and please keep us updated on your progress.


 
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Old 05-17-2012, 07:17 AM   #3
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Re: low tsh- normal t3 &t4

No, I'm not taking any meds. I tried tapazol but my liver couldn't handle it. my Dr says there is no typical treatment for me. The only tests they have done are the tsh, t3 and t4. if the t3 and t4 are stable and in the normal ref range why is the tsh still dropping? could that mean its not my thyroid but something else?

 
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Old 05-17-2012, 09:00 PM   #4
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Re: low tsh- normal t3 &t4

When your doctor prescribed tapazole, were you diagnosed with HYPERthyroidism or Graves disease at that time? Were your FT4 and/or FT3 levels OVER the upper lab range?

You said your T3 and T4 are stable and within normal range now. Are they high in the range? Mid-range? Seeing your lab result history would be helpful for us to answer your questions. Without that info, we are just guessing.

It could be that you have sub-clinical hyperthyroidism ?! I hope sammy64 will cruise by here in the morning. She is much more knowledgeable about Graves disease, suppressed TSH etc.

Would you mind sharing your lab results ?

Hang in there.

 
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Old 05-19-2012, 09:30 PM   #5
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Re: low tsh- normal t3 &t4

Yes, subclinical hyperthyroidism is what the Dr said. T3 free was 3.2 ref range is 2.2- 5.0 and t4 free was1.1 ref range is .7 - 1.7. Tsh was .01 ref range .30 - 5.0. That was 5/19/12. The first time they did tests was 2/18/11 t3 free was 3.4, t4 free was 1.4 and tsh was .16. Thanks

 
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Old 05-20-2012, 05:28 AM   #6
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Re: low tsh- normal t3 &t4

Sorry to say, it seems you have a doctor that doesn't understand thyroid disease.

Yes, your labs back in Feb. 11 suggested subclinical hyperthyroidism (due to below-range TSH and "normal" (aka in-range) FreeT3 and FreeT4).

However, your most recent labs are hyPOthyroid.

Yes, your TSH has dropped even lower but, as ABQPam mentioned, antibodies can do that.

Thyroid status is never determined by pituitary hormone TSH but, rather the actual FreeT4 and FreeT3 thyroid hormone levels.

Your most recent levels are both below mid-range when most healthy people will have levels above mid-range and often closer to the high end of the range.

I suspect you are dealing with hypothyroidism symptoms - is this correct?
__________________
Graves' 2007...remission 2009....hypo 2010

Last edited by sammy64; 05-20-2012 at 05:33 AM.

 
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Old 05-20-2012, 07:55 AM   #7
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Re: low tsh- normal t3 &t4

I do have symptoms of of both, which he says I cannot have, but seems more are hypo than hyper. I am overweight and he seems more concerned wth that than my thyroid. I get frustrated with this whole thing, because I look fine people dont understand I dont feel fine. Thanks.

 
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Old 05-20-2012, 04:28 PM   #8
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Re: low tsh- normal t3 &t4

Hello slkrohn -

I agree with sammy64, your doctor doesn't seem to understand TD, it appears he's focusing on your TSH. Your Free levels were not over range, you should not have been Rx'd tapazole.

I completely understand your frustration! My journey to diagnosis took about 3 years and 5 doctors.

The symptoms hyper/hypo can overlap and it makes Dx difficult. At the onset of my decline in health, my symptoms "seemed" more hyperT; palpitations, anxiety, shaky weak legs, breathless etc. Eventually the hypoT ones set in as well; complete exhaustion, brain fog, muscle aches... Many of the symptoms we think are hyperT can actually be hypoT.

I have an enlarged thyroid, as well as numerous nodules. Went through every thyroid test available (ultrasound, FNA, RAIU, labs) but because my TSH, FT4 & FT3 were "within normal range" no doctor would consider a trial of thyroid hormone.

Finally after finding doctor #5 who is thyroid savvy enough to realize my Free T4 & T3 were below mid-range - she started me on Levothyroxine. Follow up lab tests included thyroid antibodies - these revealed I have elevated TSI (Thyroid Stimulating Immunoglobins). This suddenly explained why my Frees were low in the range, but my TSH was not elevated in relation to them.

My point is, your FT3 and FT4 are both below mid-range. Levels like this = HYPOthyroidism. Usually when your thyroid hormone levels are too low for your body, the TSH will rise. The Pituitary gland senses this and increases TSH - thus stimulating the thyroid to produce more hormones. (This is known as the HPT loop). But something is suppressing your TSH, so your pituitary thinks your thyroid levels are adequate.

I urge you to ask for antibody testing, particularly TSI, TRAb and TBII. These are all know to falsely lower or suppress TSH. It wouldn't be a bad idea to also test for TPO Ab and TG Ab. These are usually found in those with Hashimoto's, the most common cause of hypothyroidism. People with Hashimoto's will often swing back and forth between hyper and hypo while the antibodies are attacking and destroying your thyroid.

You may also want to consider looking for a new doctor. If a doctor isn't thyroid savvy enough to order proper tests and know how to interpret them, they likely won't be knowledgable in treating your thyroid disease either.

Good luck. I do hope you find some answers soon and much needed treatment. Please continue to keep us updated.

Pam

 
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Old 05-21-2012, 04:50 AM   #9
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Re: low tsh- normal t3 &t4

Thank you so much. It makes me feel better to hear I am not the only one struggling with this, and confusing symtoms. My Dr straight out told me " you can't have symtoms of both". I almost cried. He also thinks maybe I'm taking my husbands synthroid, I laughed at him, then he asked my husband if he was giving it to me without my knowing. I know I need to find a new Dr. Thanks again.

 
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Old 05-21-2012, 07:14 AM   #10
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Re: low tsh- normal t3 &t4

I totally agree with Sammy and Pam that your levels appear to be more hypothyroid than hyper. Your doctor may need to order antibody testing as well as a TRH stimulation test to rule out secondary or tertiary hypothyroidism, though not sure how often that test is performed.

ABQPam- Interesting that you felt hypoT with TSI antibodies. Would you mind sharing what your TSH was? I'm just wondering because I am negative for TG and TPO antibodies but never tested for TSI. My TSH has ranged from 2.3-3.3 and was once 1.25 (but no other tests were done at the time). I'm wondering if that TSH is too high to be influences by TSI antibodies.

 
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Old 05-21-2012, 09:08 AM   #11
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Re: low tsh- normal t3 &t4

Hello bee -

Yes, discovering the TSI was interesting since I was so Hypo at the time. My Frees were both about 28% (I had been on 25mcg LevoT for several weeeks). Here are my labs from that testing.

**** Dec. 2011 ****
TSH = 1.13 ...... (.358-3.74)
FT4 = 1.0 ........ (0.8-1.5)
FT3 = 2.7 ........ (2.2-4.0)
Anti TPO Ab = < 10 .... (< 40)
Anti TG Ab = < 20 .... (< 35)
...TSI Ab = 105 .... (=<110)

 
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Old 05-21-2012, 09:49 AM   #12
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Re: low tsh- normal t3 &t4

Hi slkrohn -

I'm so sorry you are struggling not only with symptoms but a clueless doctor too. ((Hugs))

The confusing symptoms are why it took so long for me to get dx. Once I educated myself (mostly with helpful people on this board) I was able to advocate for the proper testing and diagnosis ... And get started on LevoT.

I can now say symptoms are starting to improve or go away. . Please hang in there - I know it's so frustrating. We are here to help and support you along the way.

Pam

 
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