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Help with thyroid results, normal TSH, low FT4 & FT3

Hi, I've been officially diagnosed with hypothyroidism since I was pregnant with my son 3 years ago. I'm on the 50 mcg of levothyroxine. Sometimes I feel ok, sometimes I feel so bad I can barely function. Everytime I go back in to test my results, they say I'm fine. My TSH is consistently normal. My FT4 and FT3 are consistently low-normal in the range. But I'm still having horrible symptoms, so exhausted all the time, depressed, hair falling out, heart palps. I would greatly appreciate it if someone could look over my last 2 labs and give me some feedback. Thank you!

Labs June 28, 2016:
TSH: 1.82 (0.47-4.68)
FT4: 0.94 (0.60-1.80)
FT3: 2.91 (2.00-5.27)

Labs Feb 2016:
TSH: 1.32 (0.47-4.68)
FT4: 0.94 (0.60-1.80)
FT3: 3.40 (2.00-5.27)

I'm at a loss because my doctors seem to think I'm fine, but I definitely do not feel fine.
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649848 tn?1534633700
COMMUNITY LEADER
Your Free T3 has increased from 43% to 46%, which isn't all that bad... were the latest labs done before the increase to 100 mcg or after?

You don't need desiccated hormones to increase your Free T3 and it isn't wise to self medicate unless one knows what they're doing.  If your doctor is willing to prescribe it, you can add a small dose of T3 only, medication to your T4, but that might not be necessary either, depending on when those labs were done... When adding T3, one should always decrease the dosage of T4 medication, by 20-25 mcg.

Iron is necessary for the conversion of Free T4 to the usable Free T3.  A ferritin test will tell you whether you have adequate iron stores or not, or you can get an iron panel.  
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Avatar universal
Thank you so much!! I will ask my doctor to increase my dosage of levothyroxine.

What does it mean when the ft4 and ft3 are low but tsh is normal? I'm not very familiar with what ft4 and ft3 mean, if you can point me out to some books or other references I'd be very grateful!

Thank you!
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2 Comments
Hello, I am here to update my labs after my doctor increased my dosage of levothyroxine from 50mcg to 100mcg daily.

FT3: 3.52 (2.00-5.27)
FT4: 1.52 (0.60-1.80)
TSH: 1.30 (0.47-4.68)

I see that my FT4 has increased dramatically from 28% to 77%. Yippee! But my FT3 is only at 46%, not much of a change from previous labs. Why is this?

I feel a lot better, some days I am tired but not ANYWHERE near how I used to feel.

If anyone could shed light on why my FT3 is not improving but FT4 is, I'd appreciate it!

Thanks!!
Levothyroxine contain T4 only that's why your FT4 increased. For FT3 to increase need to convert the FT4 to FT3 and that depends on many factors. Anyway if you can get natural dessicated thyroid, NDT then it will increase your wellness as it contain not only T4 but also T3,T2,T1 and calcitonin. If you have'nt found a doctor willing to prescribe it or not available in your region then you can order it online, PM me for more info.

Anyway you can test these and bring it to optimal range by supplementing.

25-hydroxy vitamin D3
Vitamin B12
Ferritin

Hypothyroid people are often found deficient in Vitamin D. So if you are also in that category then supplementing will greatly improve.
Avatar universal
Most people to feel well seem to need BOTH of the following. Please note that these are both at least 50% of the range or higher. Simply being within range on the low end leaves MANY people feeling like terrible.

The Rule of thumb is:

1) Free T4 to be 50% of the range or slightly higher. Both of your tests are identical and is ONLY at 28.3% of the range.  So definate room for improvement here!

And - This means in addition to #1 above you also need:

2) Free T3 to be 50% to 66% of the range. With many more people seeming to need to be closer to the 66% of the range than 50%.  Your February was at 42.8% of the range, and your latest June test has worsened to only 27.8% of the range.  A FAR cry from the 50% to 66% that most people seen to need.

You are unfortunately in the all to common bermeuda triangle. Where your TSH is what Dr's are trained to believe is about perfect, AND BOTH of your Ft4 and FT3 are "within range".  
So many Dr's will tell you that you are fine and dismiss anything you say. This is especially true unfortunately with mothers with young kids. As the Drs will just say it is "normal" for mothers with young kids to be tired etc!

The truth is that you have to do one of three things.

1) accept the Dr's advice and continue to feel horrible.
2) Convince your Dr to up your dosage of T4 medication.  Typically they go up slowly in about 12.5 to 25 mcg increments.  And this is the best way to go.  You will have to state that you want to try to work your way up to "only" the MIDDLE of the range of Free T4.  You will have to advocate pretty strongly and that you are NOT asking to go crazy.  You are only asking for the MIDDLE of the road.  Your Dr may feel comfortable with increasing dosage as long as you are not going past the middle of the range.  Some Dr's however will dig in their heels and NOT increase dosage.  In which case
3) Go Dr shopping to find a Dr who will listen to you and treat you properly.

It appears that your Dr is suffering from "reference range endocrinology".  A term we use around here to "label" Dr's who believe that as long as you are within the established "normal" or "reference" range, that you are perfectly fine.

The problem is a fairly significant percentage of the population who are in the lower half of the ranges (due to faulty methodology to create the range) still feel like crap.

There are FAR too many people (mostly women) who remain feeling like crap because their Dr is ignorant of this fact.  In large part because of bad instruction in medical school. Along with the faulty establishment of the reference range limits.

Jut my 2 cents
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