Doctors seem to have been taught in med school that TSH accurately reflects thyroid status and that it is the only thing required to diagnose and treat potential hypothyroid patients. That is very wrong. In addition, if the TSH exceeds the range limit, then a Free T4 test will be done and if within range, the patient is typically told that symptoms are not thyroid related, but must be due to something else. Due to the erroneous methods by which ranges are established, that is also wrong. When you examine the ranges labs use for Free T4, for example, you will see that the upper range limit is typically about double the lower limit. There is just no logic to ignoring symptoms and assuming that being just anywhere within such a range is adequate for the patient. Instead, if a patient has symptoms that are frequently related to being hypothyroid and their Free T4, and Free T3, are in the lower half of their ranges, hypothyroidism should be suspected.
Adequately diagnosing and treating a potential hypothyroid patient requires much more than the typical approach described above. If this practice were valid, it could be done more effectively with a computer. No experience or judgment is required to look at test results and compare to a reference range. Good thyroid doctors have found this approach to be ineffective for their hypothyroid patients and instead they will evaluate the patient's history, evaluate for signs and symptoms, and test and adjust the biologically active thyroid hormones, Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. These doctors also understand that there are also other variables that can contribute to how the patient feels, such as Vitamin D, B12 and ferritin, so they will also test and optimize those as well. Everything should be about symptom relief and making the patient feel well.
I just sent you a PM with some doctor info. To access, just click on your name and then from your personal page, click on messages.
Your thyroid hormones, Free T4 and Free T3 are much too low. Free T4 needs to be at the middle of its range, at minimum and Free T3 in the upper third of its range, or as needed to relieve symptoms. In addition your ferritin and Vitamin D are terribly low. D should be about 55 and ferritin should be about 70. Note that low Vitamin d has been identified as a contributor to depression. Also, low ferritin can cause the following symptoms.
Minor aches
Fatigue
Weakness
Heart palpitations
Increased pulse
Loss of energy
Loss of libido
Confusion
Irritability
Shortness of breath
Your thyroid med dose of 25 mcg is almost nothing. You need to find a doctor that will treat clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, You also need to get your D and ferritin levels optimized. As low as your levels are, you may want to try to get the doctor to give you injections of both to speed up getting your levels optimal, and then you can supplement with OTC D3 and iron.
If you will give us your location perhaps there is a good thyroid doctor that we can recommend, based on other thyroid patients' feedback.
Did you ever start on thyroid medication? If so, what med and what dosage? Both your FT3 and FT4 are too low in their ranges; it's no wonder you don't feel well.
Both your ferritin and vitamin D are too low, also. You said you were taking iron; perhaps you need to try a different type that's more absorbable or a higher dosage. Iron is necessary for proper thyroid hormone synthesis. You should also supplement vitamin D. Vitamin D deficiency can cause many hypo-like symptoms...
You're very welcome.
I might recommend that you ask your doctor for a vitamin D test to make sure your levels are adequate. A good share of people with hypothyroidism do not have adequate levels.
By the way thank you Barb, you are very informative!
No I don't know what Vitamin D is. Never had that test.
Well, ferritin is the iron storage hormone and with your iron and % saturation levels as low as they are, your ferritin levels may be low, anyway because there's nothing to store. Of course, ferritin can be high, even with low(er) iron levels, if inflammation in the body is high, which is often the case with hypothyroidism.
For thyroid levels, rule of thumb is for Free T4 to be about mid range and Free T3 should be in the upper half to upper third of its range. Your FT4 is only at 24% of range and your FT3 is only at 21% of range. FT3 should be higher in its range than FT4 in its. You have a ways to go to get to either of these targets.
Do you know what your vitamin D level is? Vitamin D is necessary for proper metabolism of thyroid hormones, as is iron.
12/26/15 labs
Thyroid was 3.81uIU/mL lab range is .358-3.74
Iron was 32 ug/dL lab range is 50-170
IBC was 398 ug/dL lab range is 250-450
% Iron saturation was 8% lab range is 15-50%
HCT was 31.7% lab range is 35-46%
HGB 10.6 lab range is 11.8-15.8
2/10/16 labs
Thyroid was 3.84 uIU/mL lab range is .358-3.74
Free T4 was .93 ng/dL lab range is .76-1.46
Free T3 was 2.70 pg/mL lab range is 2.30-4.20
Iron was 14 ug/dL lab range is 50-170
IBC was 345 ug/dL lab range is 250-450
% iron saturation was 4% lab range is 15-50%
HCT 32.8% lab range is 35-46%
HGB is 10.8g/dL lab range is 11.8-15.8
No I didn't have a ferritin drawn. I have requested that for next week when I do my month check up on the iron issue, as I had to increase to 2 iron tablets per day since my numbers are half of what they were in december.
My thyroid tests aren't to be rechecked until April.
What are the reference ranges for your Free T3 and Free T4? Reference ranges vary from lab to lab and have to come from your own report.
Your TSH is higher than it should be and your Free T3 and Free T4 are, most likely, too low in their ranges, so your doctor is right to start you on medication.
Your symptoms are those of hypothyroidism, except the weight loss, which is something we, typically, see with hyperthyroidism, not hypo, though it does happen on occasion.
Do you know your exact iron level and did you have a full iron panel, including ferritin? If so, can you, please, post those results, with the reference ranges here, for us? Iron is necessary for metabolism of thyroid hormones, specifically, the proper conversion of Free T4 to the usable Free T3.
Hypothyroidism can cause anxiety and of course, the more worried you are, the more exacerbated your anxiety becomes. It can become a vicious circle that's very hard to break.
Hi, it would be helpful if you would post your test results with lab ranges and when you say T3 is that a total or free test? When you say your thyroid ranged I assume you mean your TSH values....
I'm new to all of this but I have read TSH can vary 75% during the day. It might be worth repeating that and getting your free T3 and free T4 done if you don't already have those results. But you do have some symptoms that could be hypo...do you feel like something is wrong?
My experience...my TSH was not tested much over the years but I was over 3 for a few years and then it was 4. I thought the last few years I was dealing with perimenopause but then I got really sick last year when my TSH was 4. I realize now that I am on meds, the "peri" problems were never peri..it was thyroid the whole time.
Hope this helps, the thought of meds are scary I know but my case, I have come to accept I don't have a choice, I cannot go back to feeling like I was ... I am grateful these meds exist.
Hope this helps, Kel