Are Fluctuation of Thyroid Hormones Normal? (no treatment or medication yet)

[ElleHolloway]

I haven't posted for a very long time due to not being able to locate an endocrinologist.
I have my first appointment March 13th and had lab work drawn on March 5th.  
I just got the results and I'm totally confused.  I realize I only have 5 days til my appointment but I've never had results be as normal as the current levels and I'm beginning to think either I'm nuts or idk... I'm listing the last 4 lab draws and the one from March 5th is for the endocrinologist all others were from primary visits. I still have all the symptoms I've had for years and the only change I made was starting a Ketogenic Diet 2 weeks ago.
Any information is appreciated.

March 5th 2019 collection time approximate 12pm
TSH 2.69 mIU/L
RR   0.40-4.50
T4, FREE 1.1
RR=0.8-1.8 ng/dL
T3, Total 160
RR 76-181 ng/dL

November 26th 2018 collection time approximate 10:53 am
TSH   4.71 mIU/L
RR   0.40-4.50
T4, FREE 0.9
RR=0.8-1.8 ng/dL
T3, TOTAL not done.  
RR 76-181 ng/dL

May 22nd  2018 collection time approximate 9:40 a.m.
TSH 3.87 mIU/L
RR   0.40-4.50
T3 Total not done
T4 FREE 1.1
RR=0.8-1.8 ng/Dl

April 2018 collection time approximate 11:30 a.m.
TSH 3.92 mIU/L
RR   0.40-4.50
T3 Total not done
T4 FREE not done
RR=0.8-1.8 ng/Dl

Thank you!

[ElleHolloway]

@Barb135, @gimel @Jenn1302
Sorry it took me so long to get back to y'all.  I went to the “endocrinologist” yesterday.  This professed specialist ONLY looked at my March TSH levels and said my thyroid was normal.

He didn’t take anything else into consideration including very dry skin, extreme fatigue, dry hair falling out, joint pain, weight gain, autoimmune disorders including rheumatoid arthritis, family history of thyroid disorders, inability to think clearly etc.   He didn’t palpate my thyroid gland at all which I felt was kind of weird.  He asked if I ever took diet pills for my weight and offered to prescribe something I don’t recall the name of. He repeated there were other things that could cause fatigue which wasn’t my only complaint.


He ignored the lab work that was sent to him by the primary doctor from November which was the TSH of 4.71 and Free T4 0.9. and said I was sick when that was done?   He didn’t want to look at any other labs which showed my TSH levels hovering around 3.8-3.9 and Free T4 between 0.8-1.1
He said 3.8-3.9 was normal.  He didn’t consider the Free T4 because it was in the normal reference ranges.  I asked about what he considered optimal levels and he said 1-3 on the TSH. This guy doesn’t look at anything else other than TSH levels apparently.

He said if I did have hypo, it was only subclinical.  I don’t get it.  
Long story short, I wasn’t prescribed any medication.  

After me asking questions about how I could have "normal" thyroid levels and a history of high normal then the most recent which is the most normal I've ever had; he did order a thyroglobulin panel? and thyroid peroxidase ab and vit d along with another TSH test.  I thought these should’ve been done prior to this visit and seemed overly focused on my weight (SMH I’ve lost 8lbs doing a keto plan (20 g of carbs or less) for the past few weeks.) I will be getting the labs done 1 week before I’m supposed to go back but I’m not sure if I SHOULD go back.

I'm sure there is more I can't remember because I was shocked at how this doctor operates SMH...
Thank you all and I'm not giving up I'm just frustrated.  =/

[Jenn1302]

We've all been there. Many doctors look at the TSH and ignore everything else. 3.9 is barely in the normal range. 4.7 is considered high by most labs. Any value over 2.5 should be suspicious. Your FT4 is really close to the lower end of the reference range at 10%. No wonder you're having symptoms. You want it at 50%+. Subclinical hypothyroidism can definitely be clinically significant! The symptoms you describe sound a lot like Hashimoto's. I would go get a second opinion. Also, you could try asking your PCP to check your FT3, FT4, TPO and TG.

Honestly, some PCPs have more knowledge about the thyroid than the average endo. You mentioned that your neck feels weird. A good PCP can feel your neck and refer you to an ultrasound if it feels like there's something going on there.

[Jenn1302]

Your test results look a lot like mine did before I was put on medication. Have you been tested for Hashimoto's? (TG and TPO)

[gimel]

In your prior thread I explained that hypothyroidism is not just inadequate thyroid hormone.   Instead it is correctly defined as "inadequate T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone.    Inadequate supply can be from an autoimmune disorder called Hashimoto's Thyroiditis, or from hypothalamus/pituitary system dysfunction resulting in a TSH that is too low to adequately stimulate the thyroid gland to produce hormone.    Your TSH results being typically on the higher side could be an early indication of Hashi's, so you should get the doctor to test for the antibodies of Hashi's.  Those tests are Thyroid Peroxidase antibodies (TPO ab) and Thyroglobulin antibodies (TG ab).  You should also make sure they always test for Free T3 along with Free T4 every time youare tested.  

Even if your serum levels are within the so-called "normal" ranges does not mean they are optimal for you.  First, the ranges are far too broad, due to reasons explained in the paper linked in my Journal.  As a result, when a person has multiple symptoms that are typically hypothyroid, then FT4 and FT3 levels in the lower half of the range should be further confirmation of the possibility of hypothyroidism.  

Also, this is a bit technical, but you can use it with your doctor.  As mentioned, it is not just the serum T4/T3 levels that are important.  Following are the steps required to produce the necessary T3 effect:

Sufficient T4 and T3 in the serum
Active T4 and T3 transport across cell membranes
Intracellular T4-to-T3 conversion vs. T4/T3 deactivation by deiodinases
Rapid T3 effects on mitochondria and other cellular processes
Binding of T3 to cytoplasmic thyroid receptors (TRs)
Interactions of T3-receptor complexes with co-regulators
Translocation of T3-receptor complexes to the nucleus
Binding of T3-receptor complexes to DNA response elements
Production of gene-transcription-related proteins and their effects

So for a doctor to look at your test results only and decide you cannot be hypothyroid is wrong.    The most important indicator of thyroid status is an evaluation for symptoms that are typically related to hypothyroidism.  You have a number of those and you should make sure that you make the doctor fully aware of those and insist that you need to have a trial of thyroid med adequate to raise your Free T4 and Free T3 into the upper half of their ranges, and if symptoms ease, then that is proof of hypothyroidism.  From there the med dosage can be adjusted as required to relieve symptoms. For medication I suggest that you ask for a desiccated type like NatureThroid, or NP Thyroid, or Armour (more expensive).   These all contain T3 as well as T4, so they have a greater effect on your FT3 level than a T4 only med.  

[Barb135]

Hello there - it has been a while since you've posted.  It's very unfortunate that the doctors aren't testing adequately.  Instead of Total T3 (or none at all), they should be testing Free T3, along with the TSH and Free T4, "every" time you have blood work.  Free T3 is the hormone that's used by individual cells in the body and the most important of the thyroid hormones.  

Since it's been a long time since you posted, please tell us what your symptoms are so we'll be up to date.  

Also please tell us if you've been tested for Vitamin B-12, vitamin D and Ferritin, as those are necessary for proper thyroid hormone production/metabolism.  If you've been tested for them, please tell us how long ago and post the results with reference ranges.