1094370 tn?1317134825

Have more test results on Thyroid Issues - need opinion please

Hello:  I wrote on January that I've been having issues with Nerve/muscle paint on and off for a while now.  At that time, I posted the following results that I'd just received.

TSH is 1.450                  (.450-4.506)
T4Free Direct is .92        (.82-1.77)
T3 Free Serum is 1.9       (2-4.4)

I saw an endo doc and she ordered some more tests.  The results are as follows:

Triiodothyronine (T3) is 72 (range is 71-180)

Thyroid Antibodies
Thyroid Peroxidase (Tpo) AB    <6   (Range is 0-34)
Thyroglobulin Antibody <1.0 (Range is 0.0-0.9)

Ca+Pth Intact
Calcium, Serum  is 8.8 (range is 8.7-10.2)
Pth, Intact is 30 (range is 15-65)

Vitamin D, 25-Hydroxy is 42.6 (Range is 30-100)

My doctor called me to discuss these yesterday (but of course she called my home and not my cell) and then I tried to call her back today and she is out sick today.  So, of course, I'm really curious as to what she thinks is going on and if any of my issues might be related to these tests.

Does anyone have anything they can tell me.  I know that it's all speculative, but I'd love to hear what you think and thank you.

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Avatar universal
I hope that your doctor was going to tell you that you are hypothyroid.  Your Free T4 is only about 10% of its range, and your Free T3 is actually below range, which is terribly low.  Your TSH is relatively low in the range, which along with the low Free T4 and Free T# is indicative of central hypothyroidism.  With central hypothyroidism, there 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 T4 and T3 hormone.

Many doctors only recognize primary hypothyroidism associated with Hashimoto's Thyroiditis, which is characterized by increasingly high TSH levels.  Your antibody tests were negative for that.  Also many doctors like to believe that FT4 and FT3 levels that are even at the bottom of the range are adequate.  That is very wrong.  But because of these two erroneous beliefs, you are going to have to convince the doctor of your hypothyroidism based on symptoms and also the low FT4 and FT3.  So please tell us about any other symptoms you have.
Helpful - 0
Hello Gimel and thanks for getting back to me.  I'm having a lot of flairs in pain.  It's like one minute something will start hurting and then a hurt everywhere.

Also, I've been noticing my toes getting numb at times and if I'm on my feet all day long, my feet feel a little hot.  I'm not diabetic at all.  I'm pretty physically fit actually.  

I also have been having crazy anxiety that just comes out of no where and I seriously cannot control myself when this happens.  I hate it.  I don't like myself at all when I feel like that.  And neither does my husband.  ha ha

Also, have been getting what I call "elvis" lip.  My lip just decides to start twitching upward.  It's the weirdest thing and I have to laugh about it really.  That comes and goes.

This sounds crazy, but my right palm will itch like crazy.  Along with my left ring finger.  It comes and goes but when it starts up, there is no stopping it.  Will last for a few days and then goes away.

Oh the joys of getting older.  I'm almost 55...yikes!!!  

Generally, I feel pretty good but when the pain acts up, it gets to me.

Also, I have no problem with weight gain and I'm actually considered really thin (I'm 5-10, 135 pounds), so that fortunately is not a symptom for me.

I'll let you know when I hear from the doc.

Do you think this could be a parathyroid problem?  hypoparathyroid maybe??  I saw something we research and the symptoms for that really matched up for me.  IDK
Avatar universal
With the calcium of 8.8 and the PTH result there is no need to think there is a parathyroid issue.  You need to get started on thyroid med  adequate to relieve hypo symptoms..  If the doctor gives you any trouble prescribing thyroid meds, you can use this link to prepare yourself, and even give the doctor a copy if needed.  I recommend reading at least the first two pages and more if you want to get into the discussion and scientific evidence.


Also, be aware that hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin.  You have confirmed that with a Vitamin D test, but you need to also test for B12 and ferritin and then supplement as needed to optimize.  D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 70.
Helpful - 0
Updated 04/28/17:
Based on the test results that I'd originally posted, my doctor wanted me to get a sleep study test before she would prescribe thyroid medication.  I know it sounds ridiculous, but I did it.  She thinks that some of my issues of joint pain, neuropathy in my feet, etc., could have been related to sleep apnea.

I wasn't happy about it but because another doctor at one time had suggested a sleep study, I did it.  I got the results of my study yesterday and they showed MILD sleep apnea but the doctor almost laughed when I told him what the ENT said and he said that it would not be causing my issues.

The ENT had also asked me to have my bloodwork redone 1-2 months after my original appt.  I just got these results yesterday.

I know already that she is going to say that all my numbers are within range.  I just thought I would get other opinions.

I'm just wondering if my issues could in-fact be caused by what looks like low T3??  

I have twitching in my face a lot, I have neuropathy in my feet and legs.  I am NOT diabetic. My feet tingle and get hot if I'm on them a long time.  I have joint pain that comes and goes...it flairs badly and then I'll be fine the next day....

I don't know if I should pursue another opiniion on this if she tells me she won't treat it or not.

I'd appreciate any opinions.

Thank you!!!  Carrie

Thyroxine (T4) Free, Direct, S

Test Low Normal High Reference Range Units
T4,Free(Direct) 0.91 0.82-1.77 ng/dL

Triiodothyronine (T3)

Test Low Normal High Reference Range Units
Triiodothyronine (T3) 85 71-180 ng/dL


Test Low Normal High Reference Range Units
Tsh 1.240 0.450-4.500 uIU/mL


Test Low Normal High Reference Range Units
Triiodothyronine,Free,Serum 2.0 2.0-4.4 pg/mL

As mentioned, from your test results you are very hypothyroid and need to be on thyroid medication adequate to relieve hypo symptoms.  Many of us have found that Free T4 needed to be at least mid-range, and Free T3 should be in the upper half of the range, and adjusted from there as needed to relieve symptoms   A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results.  If, after reading the link above, your doctor is unwilling to treat clinically then you you will need to find one that will do so.  

In addition, you need to find out your Vitamin D, B12 and ferritin levels and then supplement as needed to optimize.  
Thank you Gimel....
You are very welcome.  Please let us know how it goes for you.  
1094370 tn?1317134825
UPDATE as of 05/29/2019:

Hello All, I have a new update with new numbers.  I am still not on any thyroid meds.  Can I please have some feedback on these numbers:

TSH 2.020 (.450-4.500)
T4Free 1.00 (.82-1.77)
T3 Free Serum 2.5 (2.0 - 4.4)

I've been having tinnitus and ear nerve pain and just wondering if this could be contributing...I don't know but would love some feedback and thank you very much.
Helpful - 0
Avatar universal
Your test results for the thyroid hormones, Free T4 and Free T3 have been consistently low or below ranges that are far too broad and skewed to the low end.    Of course symptoms are the best indicator of thyroid status; however your results are also indicative of hypothyroidism and need to be acknowledged by your doctor and thyroid medication prescribed and increased as needed to raise yo0ur Free T4 and Free T3 levels as needed to relieve hypo symptoms.    Just continuing to test is not adequate.  You need to get the doctor to accept that you are hypothyroid and take appropriate action, or else find a good thyroid doctor that will do so.  

Were you also able to get tested for Vitamin D, B12 and ferritin?    
Helpful - 0
Hi Gimel:  Thank you for your response.  Unfortunately, every time I do these tests, I always get a call that everything is normal.  When I was tested for my thyroid, I asked for a test for my Vitamin D and she said insurance is no longer paying for those tests unless you have a reason.  They don't just "do it".  Ugh...so frustrating.  I've been to several endos and none of them will address my thyroid.  My biggest issue is with my tinnitus.  I don't know if it's thyroid related or not.  I suspect it's from dental work, but honestly, don't think I'll ever know.    

Thank you for your response Gimel.  
Hi Carrie!  I dealt with this same problem years ago. I was having terrible symptoms and my doctor said my labs were not low enough to consider thyroid a problem.  Finally I got a doctor that listened and I started meds. Most of my symptoms improved greatly on a very low does of thyroid meds. Your doctor has a reason to test for Vit D because you have so many things going on.  If she won't test you, maybe start taking a Vit D3 supplement.  I have been treated for hypothyroidism for almost a decade and still having symptoms  that my doctor wants to toss on fibro as a reason because me lab results are in range.  I upped my D3 and started taking magnesium which has helped and now finally she has agreed to refer me to an endo.   I hope you get answers soon and start feeling better!
Avatar universal
To carrie 235 and Turtle67:  I hope you will find answers to your questions and concerns in the following.  The most important concern for you both is to find a doctor (not necessarily an Endo) that will treat clinically, for symptoms, rather than just based on test results compared to their reference ranges.   I tried to make this comprehensive enough to cover most everything, but if there are further questions I will do my best to answer.  

There are a number of very serious flaws in the standard of care for hypothyroidism used by most doctors.  First is the almost total dependence on TSH to determine a patient's thyroid status.   This is very wrong because TSH is a pituitary hormone, and it is only used as a surrogate for Free T4.  There are lots of data available showing that except at extreme levels, TSH has only a very weak correlation with FT4, so it is not predictive of FT4 levels.   Also, TSH has a negligible correlation with hypothyroid symptoms, which are the patient's concern.  The same can be said for the lack of correlation of TSH with Free T3.  So except at extreme levels, TSH is not an adequate diagnostic for thyroid status.  

The next concern is that if testing goes beyond TSH it is usually for Free T4, and only occasionally Free T3.  Results are compared to the so-called "normal" range established by laboratories.    Unlike many tests, FT4/FT3 reference ranges are not adjudicated ranges.   "Adjudicated ranges are reported when the laboratory's scientists have accepted some professional group's opinion concerning the levels that are optimal for health (e.g.,LDL cholesterol, HgbA1C, fasting glucose, Vitamin D, etc.).  Adjudicated  ranges  are  intended  to  be used  as diagnostic and/or  therapeutic ranges(“decision limits”). Because some tests are reported with adjudicated ranges, physicians assume that experts have reviewed all tests’ reference  ranges and  determined that they represent  normality (i.e., optimal health).Therefore they believe  that  if any test  result is  normal  (within the  reference range) they need not diagnose or treat."

Unfortunately the ranges for FT4 (and also FT3) are not well standardised among
different test machine manufacturers, generally validated, or based on large databases
of healthy adults with no thyroid pathology.   Instead those ranges are locally
established from test data available at any given laboratory, excluding only data from
patients assumed to have thyroid issues based on the flawed TSH range. Clinically
hypothyroid patients with TSH within the reference range, people with hidden
pathologies such as undiagnosed central hypothyroidism or autoimmune disease, and
patients taking thyroid medication can all be included in the database.  This results in the range being very broad and skewed to the low end.  No wonder most test for FT4 (and FT3) are reported back from the lab as being within the "normal" range.  

Doctors tend to disregard symptoms, in favor of laboratory test results compared to those flawed ranges.   Thus it is no wonder that so many  patients with multiple symptoms frequently related to hypothyroidism are told their  test results were within the normal range, so their symptoms are not thyroid related, so no medication is needed.   It is true that a single symptom is non-specific, meaning it can have multiple causes; however, when there are multiple symptoms that are frequently related to hypothyroidism, and the patient's FT4 and FT3 results are in the lower part of their  flawed ranges that is strong evidence of the need for a therapeutic trial of thyroid medication adequate to raise FT4 and FT3 levels and determine the effect on symptoms.    If the symptoms ease that is further proof of hypothyroidism.  

If a patient is able to get a prescription for thyroid medication, the next problem is interpretation of results.  Most doctors titrate medication dosage based on getting TSH back within range.   (Obviously this only pertains to primary hypothyroidism (Hashi's), not to central, or other hypothyroidism, which are generally ignored anyway. )   This approach results in pervasive under-treatment, and lingering hypothyroid symptoms.  

If a patient is given thyroid med adequate to relieve symptoms, this usually results in suppression of TSH below its range.  This is because our body is used to a continuous low flow of thyroid hormone from the gland.   When taking a significant dose of thyroid med all at once, it results in a spike in thyroid levels  for a short time, but also resultant suppression of  TSH for most of the day.    This has been proved in scientific studies.  Taking the same, suppressive dose, and splitting it into multiple doses taken over the whole day does not suppress TSH.  However, most doctors erroneously interpret a suppressed TSH as being hyperthyroidism, due to an overdose of thyroid med, and will reduce the dosage, causing a deterioration in the patient's symptoms.  So instead, thyroid medication should be increased as needed to relieve hypothyroids symptoms, without creating any hyperthyroid symptoms.   That "sweet spot" is called euthyroidism.   That is the objective of treatment.

Hypothyroidism is correctly defined as insufficient T3 effect in tissue throughout the body, due to inadequate supply of, or response to, thyroid hormone.  There are a number of variables that affect a person's response to even adequate  thyroid hormone.  Among those are cortisol,  Vitamin D, Vitamin B12 and ferritin.  So it is important to test those and assure adequacy.    Cortisol should be neither too low or too high, Vitamin D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.     Of course it could be affected by the particular insurance company, but I know that with Medicare, they will cover any test for which the doctor adequately explains the need.   I suspect that this is generally the case, and the doctor needs to do these tests for a thyroid patient.  

I should also mention that many people taking T4 med find that due to conversion issues, they cannot get their FT3 to an adequate level without taking a large enough dose to raise their FT4 to the top of the range and above.   For that reason many hypothyroid patients find that a combination of T4 and T3 work best for them, either taken separately, or a desiccated type thyroid med.  

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