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Concerned about Low TSH, Low FT4

I posted a question about my labs on July 19th...and since then, I decided to do some research. I am concerned that my TSH is low as well as my FT4 is always low...and wonder if that means that I could have rare pituitary secondary hypothyroidism? Research seems to show that when TSH and FT4 are both low, that's what it could be. After the birth of my son 16 years ago, I was diagnosed with Graves and immediately sent for RAI, though I now think it was a wrong diagnoses. I have been on Armour for most of that time and my labs are always low...when I look at them over the years.  My FT4 is almost always on the very low end of normal and sometimes even out of low normal range slightly. My last labs were TSH 0.03 on range of 0.5-5, Ft3 3.3 on range of 2.0-4.4 and Ft4 0.62 on range of 0.58-1.64.  I am currently on 120mgs of Armour. I tried a combination of 90mgs of Armour with 25mcg of Synthyroid a few months back and it made me worse hypo with a FT4 of 0.47.  I have heard that the TSH can become suppressed after being on Armour for so long, which is what I think may be happening; however, sometimes I wake up in the middle of the night and I feel like I can feel my heart racing enough that it wakes me up. It will slow back down quickly, but I am concerned about this. I do recall that even when I once had a TSH of 32 my heart would race and I would have hyper symptoms such as diarrhea, high blood pressure, anxiety even though I was obviously hypo. so, if I tell my doctor about racing heart at night, he will likely reduce my Armour meds...which might make me more hypo.  I'm not sure. My big concern is why does it seem that my FT4 never goes up very much?  What can I do to improve that...and does it mean that I could have a pitiutary issue? Should I be concerned that my TSH is so low?   Am I just worrying too much?   Thanks for some guidance here.
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Avatar universal
If you are going to go for a second opinion, perhaps we can suggest a doctor that has been recommended by other thyroid patients, if you will tell us your location.  
Helpful - 0
Avatar universal
Obviously your thyroid levels are inadequate and need to be increased.  With the sleep problems and other symptoms you mention it is possible there is a cortisol issue.  The best way to find out is a diurnal saliva cortisol test, which includes 4 tests taken during a day.  Doctors very seldom will order those, instead they always use a morning serum cortisol test, which is not as diagnostic.  If you want you can go to the ZRT Lab site and order the test for yourself for about $140.  They send a kit and you collect samples and return and they email results in about a week.  

Of course you can also ask the doctor to run a morning serum cortisol test as well.
Helpful - 0
1 Comments
I will ask my gyn dr. for the test. He did it before for me 5 years ago....maybe he will do it again...though I am thinking of getting a second opinion because I think he has kept me hypo for 15 years!
Avatar universal
Definitely hypo.  As for your heart beat, from a very long list of symptoms that may be related to being hypothyroid, have a look at this section on heart related symptoms.

  Heart:

    High blood pressure
    Low blood pressure
    Slow/weak pulse (under 60 bpm)
    Fast pulse (over 90 bpm at rest)
    Arrhythmia (irregular heartbeat)
    Skipped beats
    Heart flutters
    Heart palpitations
    Chest pain
    High cholesterol
    High triglycerides
    High LDL (“bad”) cholesterol
    Mitral Valve Prolapse
    Atherosclerosis
    Coronary Artery Disease
    Elevated C-Reactive Protein
    Fibrillations
    Plaque buildup
    Fluid retention
    Poor circulation
    Enlarged heart
    Congestive Heart Failure
    Stroke
    Heart Attack
Helpful - 0
2 Comments
Gimel,  I have another question I hope you will answer for me. Based on my history is there a chance that I also have adrenal fatique which would be causing my labs to stay low? It is so confusing, because when I went to read about adrenal fatique and thyroid, many of the symptoms can be similar. However, I think I have always lived a very stressed life. Type A personality for sure! I wake up in the middle of the night between 2-4 am at least a couple of times a week. I own my own business and do outside sales, which I enjoy! However by the end of the day, I force myself to cook dinner and I absolutely dread having to go to the grocery store. My hair has started shedding heavily..it must stop soon!!!!  I would like to loose about 10 lbs.  Sometimes I feel like I just don't want to deal with certain family members. And after being with the same doctor, that I think he may be keeping me hypo forever...I have decided to seek another opinion. I did that several years back and it was an Endo. disaster and I ended up going back to my doctor that prescribes Armour.  In seeking a second opinion should I ask about Adrenal Fatique...or will they think I'm crazy???  or maybe I just need an Armour increase and it will fix everything? Any advice is so greatly appreciated! :)
I also should say that some of my other symptoms are: I am very jumpy while driving,..I feel like other people are going to hit me. I also seem to be forgetful or foggy sometimes. I have decent energy....I can't tolerate the heat very well..however it's been around 100 degrees here and my husband wants me to go on a rock dig. I sometimes feel like I got it all together and other times like things are falling apart....Help!!!
Avatar universal
Your TSH is suppressed because of the thyroid med you are taking.  TSH means nothing for you because of the RAI, and taking thyroid med.  Your Free T4 and Free T3 are both too low in the range for many people.  Free T4 should be mid-range, at least, and Free T3 high enough to relieve symptoms.  

The reason your FT4 is not higher is that your Armour dose is too low.  When you switch from 120 mg to 90 mg plus 25 mcg of T4 your only added 5.5 mcg of T4.   One grain of Armour contains 39 mcg of T4.  You reduced by 1.2 grain, which contained 19.5 mcg of T4 and added 25 mcg.  I would expect little to no noticeable effect of that change.  

What you really need to do is to get your doctor to raise your Armour dosage enough.  You can get some good info on tht from this link written by a good thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html

In the link it is stated that, "in tests done about 24 to 28
hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that
are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level  
compensates for the lower FT4 levels on NDT."

Also you should make sure that you always defer your Armour dose until after the blood draw for testing.  That avoids false high results.  

You are worrying too much.  You don't have a pituitary issue causing your low TSH.  A suppressed TSH happens to most people taking desiccated thyroid med.
Helpful - 0
1 Comments
Gimel, Thank you so much for taking the time to respond to me again! I feel so much better from your answer. So looking at my labs, there is no way that I am hyper....right? My labs look more like I am hypo, correct? There is a good chance that I have been hypo ever since I was given RAI...just because my labs have never been optimal in 15 years! Yikes, crazy huh?  So my fast heart beat that wakes me up very occassionally; what could that be from? Maybe drinking too much wine???
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