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low tsh, low free t4, normal free t3 - what does it all mean?

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Old 06-28-2011, 08:06 PM   #1
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low tsh, low free t4, normal free t3 - what does it all mean?

Hi, Newbie here. Endo thinks I have hyperthyroidism because of toxic multinodular thryoid, but the blood work is throwing me off. Any ideas?

Blood work:
Low TSH - 0.05 - (0.27-4.20 = normal range)
Normal to high end Free t3 - 3.14 (1.80-4.60 = normal range)
Low Free t4 - 0.8 (0.9-1.8 = normal range)

He said the t4 is low because the nodule is sending some messages to the brain....I swear - I still don't understand what he is saying.....

Wants me to do Radioactive Iodine Pill....My tsh has steadily been decreasing - 6 months ago it was 0.11....

I'm overweight, have heat intolerance, sometimes I'm exhausted (can sleep 8-9 hours), sometimes I'm hyper (can't sleep more than 4 hrs).

Any feedback would be great!!! Thanks, Denise

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Old 06-29-2011, 06:59 AM   #2
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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 07:03 AM.

Old 06-29-2011, 08:15 AM   #3
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Re: low tsh, low free t4, normal free t3 - what does it all mean?

If one does the math, she'll find that the FT3 is definitely not "high end" and may not be normal for you. It's only 48% of its range, lower than a lot of people find comfortable.

I'm not entirely sure what's going on, but you definitely are not hyperthyroid. I would never accept the recommendation to fry my thyroid gland based on those labs. I would want an investigation into my pituitary function and would want tests done for TPO, Tg, and TSI antibodies.

Get other opinions. As many as it takes until someone acknowledges that you aren't hyperT and don't need RAI.

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