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Could someone help me to better understand my thyroid test results?

I recently had my Thyroid levels checked. They performed the full workup and according to my doctor he says they are all within normal range. Some are on the lower side, but still normal. This all started about a year ago, around 6 months after I had a hysterectomy. I started with becoming very hoarse and having a tight or "something stuck" in my throat feeling. It progressed from there with the unexplained weight gain (now 40+lbs.) Just within the last few months I have developed new or worsening symptoms. I am always so exhausted. Wake up that way...suffer all day being tired, only to go to bed exhausted and start the cycle all over again. I now have terribly dry skin on my face with brown spots on my cheeks. I am thinning and loosing my hair and worst of all....the joint pain in my hands and feet. That just happens out of nowhere and ends in swelling. (I had to take off my wedding band which has always been too big.)

Here are my results:
TSH: 1.530 u/ml (ref range: 0.530-6.340)
Free T3: 3.4 pg/ml (ref range: 2.4-4.8)
Free T4: 0.68 ng/dl (Ref range:0.60-1.60)
Anti Thyroid Peroxidase ABS: <6 (ref range: 0-34)
Thyroglobulin Antibody-THY5: <1.0 (Ref Range:0.0-0.9)
Thyroglobulin by IMA:20.2ng/ml (Ref Range:1.5-38.5)

Please...any advice would be appreciated. I am so tired of feeling like I am in a fog, and totally unlike my self. Did I mention the terrible irritability and weird funk (mood wise) I have put my family through?
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649848 tn?1534633700
On first glance, everything looks peachy, but taking a closer look, your Free T4 is extremely low in it's range (8% of range when it should be about mid range), which indicates that your thyroid is barely producing any T4 at all.  T4 is the main hormone produced by the thyroid, which is then converted to T3 for use by individual cells in the body.   Your Free T3 is even less than is typically needed at only 42% of range, when it should be in the upper half to upper third of its range.  

Typically, with lower thyroid hormones, we'd expect to see higher TSH which would indicate hypothyroidism caused by thyroid malfunction.  However, there is another type of hypothyroidism called Central or Secondary hypothyroidism.  With Central hypothyroidism, the thyroid works fine, but there's inadequate TSH to stimulate the thyroid to produce hormones.  This is caused by malfunction in the pituitary or hypothalamus glands.

Many doctors miss Central hypothyroidism because they depend on TSH to determine if one is hypothyroid and since TSH is "normal" or low with Central hypothyroidism, they assume that all is fine, when in fact, actual thyroid hormones are typically way too low.

This is still hypothyroidism and needs to be treated with replacement thyroid medication just as any other type of hypothyroidism.  

If you haven't been tested for Vitamin B-12, Vitamin D and Ferritin, you should ask for those tests as well.  Vitamin B-12 deficiency can also cause debilitating exhaustion and all 3 are needed for proper production/metabolism of thyroid hormones.

Even though the antibody tests indicate you don't have Hashimoto's, a thyroid ultrasound would be in order to determine if you have nodules on your thyroid.
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Thank you so much for your insight and help.
Avatar universal
Most doctors have the "Immaculate TSH Belief", by which they only pay attention to TSH and if it is in range, they tell you your symptoms are not thyroid related.  This is very wrong.  TSH  is useful as a diagnostic only when it is at extreme levels.    TSH has only a weak correlation with the thyroid hormones Free T4 and Free T3, and a negligible correlation with the all important "tissue thyroid status" and related symptoms.   If the doctor goes beyond TSH it is usually to test for Free T4 and then use "Reference Range Endocrinology", by which they will tell you that a test that falls anywhere within its reference range is adequate.  This si also very wrong.   Due to the erroneous  way that Free T4 and Free T3 ranges are established, they are far too broad and skewed to the low end.   Also each person can have a different equilibrium among TSH, FT4, and FT3 at which they feel best.  

The best way to diagnose a potential hypothyroid patient is with an evaluation for signs and symptoms that occur more frequently with hypothyroidism than otherwise.   You have a long list of those.   The symptoms evaluation should be accompanied by testing for Free T4, Free T3,  TSH, TPO ab if TSH is high,  TG ab if TPO ab is normal, cortisol, Vitamin D, B12 and ferritin.  The latter 4 are because of their effect on thyroid and symptoms.  

Your test for TSH and TPO ab and TG ab  confirm you do not have Hashimoto's Thyroiditis, which is autoimmune system related     Your relatively low TSH is indicative of central hypothyroidism.  With central, there is a dysfunction in the hypothalamus/pituitary system resulting in inadequate output of TSH necessary to stimulate the thyroid gland to produce enough hormone.    Your FT4 of .68 is only at 10% of its range, which is too low for most people.  Your Free T3 of 3.4 is 42% of its range, which is too low for some people.  Your Free T3 being higher in range than Free T4 is indicative that your body is trying to convert T4 to the usable T3 as much as possible in an effort to meet your body's needs.  

So your signs/symptoms are indicative of hypothyroidism and your lab test results also are indicative of the same.   A good thyroid doctor would recognize this and treat you clinically with thyroid med (both T4 and T3 if needed) to raise your FT4 and FT3 levels above mid-range and then adjust FT3 from there as needed to relieve your hypo symptoms.   Symptom relief should be all important, not just test results, and especially not TSH results.

In addition you need to get the other listed tests done and see if you need to take action on any of those.   Most importantly you need a good thyroid doctor that will do all this.   If you think it would be futile to try t get your current doctor on board with clinical diagnosis and treatment, then we can try to help find a good thyroid doctor if you will give us your location.  

If you want to confirm any of this and also learn more about the subject, click on my name and then scroll down to my Journal and read at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.
Helpful - 0
Your knowledge and insight is so helpful. I’m so tired of feeling “foggy” and just not myself. I have 4 children, and a husband I want to be at my best for. My mother also suffers from hypothyroidism so I’ve been exposed to it and have saw the effects. I would love some insight on a good doctor in the North Carolina area. I am closer to Charlotte. I’m currently being tested by my ENT because rice had so many issues lately and after many tests hat have shown nothing abnormal, I demanded this test. They originally tried to tell me it was acid reflux because I have damage to my vocal cords. It’s so frustrating. I just want to be me again!
Acid reflux is a very common symptom of hypothyroidism.
That’s interesting. I wasn’t aware of that.
Avatar universal
Would Winston-Salem be close enough for you to go see a good thyroid doctor?  If not, please give me names of some towns near you.
Helpful - 0
Winston Salem is a little not far. We are closer to Hickory, Charlotte, Gastonia area. Could possibly even do Huntersville or Mooresville area.
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I am sending you info.  To access, just click on your name and then on your personal page, click on messages.
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Avatar universal
Hello. I have a feeling your symptoms should be addressed by consulting an OB/GYN. You mentioned a hysterectomy - I wouldn't be surprised if you would benefit from hormone replacement therapy and therefore a little testosterone .
Helpful - 0
The symptoms and test results indicate hypothyroidism which should be addressed first by getting her thyroid hormone levels adequate, along with optimizing Vitamin D, B12 and ferritin.  After that if there are remaining symptoms that could be related to the need for female hormone optimization,   would be the time to address bioidentical hormone replacement.      She needs a good thyroid doctor first.  
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