Normal Low TSH But Have All The Symptoms

[bishwhere]

Okay so a year ago my gastroenterologist tested my thyroid via TSH blood test. A year ago it tested as 0.454 and it was notated as low on the report but nothing was ever done on it. I was test again a week ago and it was 0.854 while fasting if that matters. I don't have a PDH but I am almost absolutely positive I have something wrong with my thyroid. I have all the symptoms for both hyper and hypothyroidism but I gain weight instead of lose weight. It's VERY difficult for me to lose weight. I gained about 50 pounds in 2 months without change in activity level or eating habits. Now I am CONSTANTLY hungry and I am so tired all the time. My doctor sent me to mental thinking it's all in my head but I swear it's something physically wrong. I don't know what to do.

[gimel]

Getting in to just any Endo is not necessarily what you need.  Many of them specialize in diabetes, not thyroid.  Also many of them have the "Immaculate TSH Belief" and use "Reference Range Endocrinology", both of which usually preclude adequate treatment for hypothyroidism.  You need a good thyroid doctor.  I have the name of a doctor that was recommended by another member.   Sending PM with info.  To access, just click on your name and then from your personal page, click on messages.  

[gimel]

Assuming that the labels were switched, your Free T4 is mid-range, which is adequate.  Your Free T3 is at 75% of its range, which is adequate for many people.    Your Free T3 being higher in range than your Free T4 makes me wonder about the possibility of a different problem called "pooling of T3 in the blood", which keeps it from adequately getting into cells, and thus can cause hypothyroidism. The cause of T-3 pooling can be any one of the following or a combination of the following:

    High cortisol
    Low cortisol
    High iron
    Low iron
    Medications
        beta blockers
        Amiodarone
        Iodinated contrast media
        Lithium

So, unless you are on one of the listed meds, I suggest that you get tested for cortisol and ferritin (iron test).  Also it would be a good idea to test for Vitamins D and B12.   Can you arrange to get those done?

[bishwhere]

I will ask the doctor. I'm trying to get into an endocrinologist but it's hard because I have to really show a need to before I'll get a referral.

[bishwhere]

I'm not on any of those medicines but I was severely iron anemic when I was in middle school. I had to go to the hospital because my hemoglobin was dangerously low.

[gimel]

From the ranges listed, I think you reversed the two labels.  I expect it was Free T4 at 1.11, correct?

[bishwhere]

I'm going to try and ask for the Free T3 and T4 tests but I'm 98% sure it will get shot down since my TSH test weren't necessarily abnormal.

[bishwhere]

So I finally got my tests done. I got the Free T3, Free T4, TSH w/reflex, and T4F+T3 Free. I have results so far for 2 of them.

Free T3: 1.11(0.76-1.46)
Free T4: 3.8(2.0-4.4)

[gimel]

The first thing you need to do is understand that TSH is a pituitary hormone that is affected by so many things that, at best, it is only an indicator to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  Having symptoms that are typical of being hypothyroidism, along with a low TSH, may only mean that you have central hypothyroidism, which is a dysfunction in the hypothalamus/pituitary system that results in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.

The next thing you need to do is to get tested for Free T4 and Free T3, which are not the same as Total T4 and Total T3, so make sure they test for the Frees.  While there you should also request to be tested for Vitamin D, B12 and ferritin.  The reason being that they are so frequently loo in the range for hypothyroid patients.  When results become available, please post results and reference ranges and we will be glad to help interpret and advise further.  

I would also keep in mind that a good thyroid doctor will treat a hypo patient 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, not just test results.    When you next see your doctor it would be a good idea to find out if he is going to be willing to treat clinically as described.  If not, then you will need to find a good thyroid doctor  that will do so.