Diagnosis Purgatory, looking for a second opinion

[rsmith27]

27 y/o 5'2" female
symptoms/background: weight gain of 50+ pounds (particularly around face, neck hump, midsection) over last 5-6 years with extremely active lifestyle and balanced diet, depressive symptoms, amenorrhea/menstrual irregularities, occasional random muscular aches (not from physical activity), consistent issues sleeping, nonexistent libido, fatigue, decreased appetite but increased hunger (sometimes so bad it keeps me awake).
the only meds I'm taking are a multivitamin and occasional seasonal allergy meds

my doctors have dismissed my concerns as 'sometimes bodies just change' but got some bloodwork done that showed abnormal results, will share below. feel like I'm going crazy...just curious to hear others' thoughts.

-screened for cushings, negative
-cholesterol, blood sugar, kidney function all normal
-my TSH has always hovered around 2.4 uIU/mL I but has dropped from 2.4 in December 2019 to 1.7 in August 2021 to 0.9 in April 2022. but because its still technically in the 'normal' range of 0.4 - 4.2, my doctor won't do anything about it. to me, it's a pretty steep dropoff especially when viewed as a graph of all my past results
-hematocrit was 49.3%, normal range 34-46%; hemoglobin was 15.9g/dL, normal range 11.5-15 (and no, I wasn't dehydrated or had been travelling at elevation) doctor wants to monitor and retest in a month

TIA

[gimel]

I meant Total T3 is an outdated test.

[gimel]

That FT4 is lower than typically needed.  Total T4 is an outdated test.  You need to test for Free T3, which is the biologically active thyroid hormone that largely regulates metabolism throughout your body. Along with FT4 around midrange, FT3  typically needs to be around midrange or slightly above; however, everyone can have different levels at which they feel normal.  So adjustment may be needed from there.    In addition you also need to test for Vitamin D B12 and ferritin.  D should be at least 50 ng/ml, B12 in the upper part of its range and ferritin needs to be at least 100.   Deficiency in these can cause symptoms as well.

I suggest that you go to the Mayo Clinic site for hypothyroid symptoms and make a copy and give to your doctor, along with a copy of the link I gave above, and ask to be treated clinically for symptoms, as described.  I hope that works to get you treated, but I am not optimistic about that doctor.

[gimel]

You have multiple symptoms of hypothyroidism.  TSH is a pituitary hormone that doctors like to believe always accurately  reflects a persons thyroid status.  That is very wrong.  The only time TSH is useful as an indictor of thyroid status is when it at extreme values indicating overt primary hypothyroidism.  

In order to assess a person's thyroid status symptoms are the bet indicator, along with tests for the actual active thyroid hormones, Free T4 and Free T3, not Total T4 and T3.  So you need to get those tested along with Vitamin D, B12 and ferritin.  If in the future cortisol is a possible issue, it is best to run a diurnal saliva cortisol panel of 4 tests at different times of day.

Following are the Mayo Clinic list of typical hypothyroid symptoms

Fatigue
Increased sensitivity to cold
Constipation  (need to use laxative or fiber)
Dry skin  (need to use skin creme))
Weight gain (difficulty losing weight)
Puffy face
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
Impaired memory
Enlarged thyroid gland (goiter)

To confirm what I have said, read my paper in the following link.  If the doctor resists doing these tests give the doctor a copy and ask to be treated as described for symptoms.  If not, then you will need to find a good thyroid doctor that will do so.

https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/

[rsmith27]

Thanks for the response, @gimel. I did have my T3 and Free T4 tested last August, but sounds like it's worth testing them again:

Free T4 1.0 ng/dL (normal range 0.8 - 1.7 ng/dL)
T3, Total 109 ng/dL (normal range 50 - 170 ng/dL)

What's interesting here is that my mom has hypothyroidism, but her TSH levels were/are higher than normal, so I think my PCP has discounted hypothyroidism as a possibility for me.
Any thoughts on the borderline hematocrit/hemoglobin results?