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High Free T3 and Low Free T4 with normal TSH -????

Hello Fellow Thyroid Friends...

I need your help and expertise. I have some funky labs that I don't understand. I am hoping you can help.

My FT3 is High and my FT4 is low and my TSH is normal. I am confused...and I just don't feel right. I feel "off" which is know is vague....but I feel hypo off? Although I know hyper can mimic the same symptoms, so again, I am confused.

I have joint pain, extreme fatigue (like can sleep 12 hours and still be tired), feel off, groggy, some muscle weakness, decreased endurance, that thyroid band you get around your chest and can't lose an ounce of weight despite great intake and output. Doing weight watchers and Jillian Michaels daily weight training plus 60 mins cardio 5 days a week!!!!

Anyway....for the labs. Please see below:

TSH 0.832
FT3 4.7 (2.0-3.6)
FT4 0.8 (0.8-1.5)

No other thyroid panel labs were drawn, but my Vit D is finally normal, although my Calcium and Magnesium are still a bit low which I am supplementing for.

So what do you all think of the labs? It's like a dichotomy...Hyper (T3) and Hypo (T4) at the same time with a normal TSH (My doc likes my TSH at around 1)

I have researched the net and can't find any chart that even gives the above as an option for possible diagnosis. Please help. What do you think?

Hypo for 3 years, on Armour Thyroid 90mgs per day in am 30 mins before meals, 1 hour before vitamins
Pretty good health
44years old - and just found out my estrogen is low and my FSH/LH is out of whack

Thats about it!!

Thank you all so much. Look forward to hearing from everyone

17 Responses
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Avatar universal
Had you taken your Armour before these labs?  If so, how long before?
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Avatar universal
Hi there ~

Yes I had taken my Armour 90mg previous to the labs by about 2 hours?

My labs done in Feb when I didn't take it before the test were just as wacky too....One doc in the office says "Take meds" before lab - the other says "Don't take meds" which is very Bipolar from the same office.

Feb Labs are as follow without Armour that day:
FT4 1.1
FT3 4.6
TSH 0.342
**Same ranges as it is the same lab**

Thank you goolarra for your response. It is SO appreciated!! Any help to not feeling so out of it is appreciated!!

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Avatar universal
It appears to me that you don't need all the T3 that's in Armour.  Had you been on anything else prior to the Armour?  Did you convert slowly?

Nothing like a bipolar doctor's office...LOL

While FT3 is the test that correlates best with symptoms, I think that an appropriate balance of FT3 to FT4 is very important.  Your FT4 has dropped significantly since your February labs, and it's now on the floor.

Also, have you tried splitting your dose of Armour into two half doses, one first thing in the morning, the other late morning or early afternoon?

Is this a new occurence?  You said that you've been hypo for 3 years...was your FT3 always high?

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I too have low Free T4 (0.66) and high Free T3 (3.5) ng/dL 0.58 and pg/ml 3.9. My TSH of scale of 0.340-5.6 is 1.7....I was two years in heavily sprayed Agent Orange Vietnam area. All my body hair is gone.......I am depressed.....on Lexapro.....cant sleep......VA will soon add hypothyroidism to list of Agent Orange diseases........help!!!!
I too have low Free T4 (0.66) and high Free T3 (3.5) ng/dL 0.58 and pg/ml 3.9. My TSH of scale of 0.340-5.6 is 1.7....I was two years in heavily sprayed Agent Orange Vietnam area. All my body hair is gone.......I am depressed.....on Lexapro.....cant sleep......VA will soon add hypothyroidism to list of Agent Orange diseases........help!!!!
Please list the reference ranges shown on the lab report for those test results.  Also, I am bit confused by the numbers you show.  What is the .58 and 3.9?  
Avatar universal
Hi Goolarra ~

Thanks again for your feedback. Yes this is new. I was on Synthroid before I switched to the Armour, but I didn't follow my labs then...But my TSH was always higher - I do know that much, Like in the 3s or 2s, so when I moved out here the doc said she liked the TSH at around 1 and liked the Armour better so I switched.

That FT4 is a bottom feeder now!! That is not right is it? It should be more mid-range?

What do you think? Too much Armour? Back down on it - but then my FT4 is so low, will it drop more? Will I feel worse?

Could it be a Hashi's thing? (Never diagnosed with it but my sis has it)

What are your thoughts? I don't really understand it all. I just know I feel off...and my labs are an oxymoron. My FT3 seems hyper yet my FT4 seems hypo. And I feel like I'm in a slow moving fog....

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Avatar universal
Duh - Sorry;  to clarify, I have been on Armour for the last two years. Synthroid that first year while in Arizona. I am not sure if that doc even did the FTs?

The weird wacky dichotomy labs have been happening since December-ish (I think I do labs every 3 months?)
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Avatar universal
Yes, the FT4 shouldn't be on the bottom (midrange is the rule of thumb).  If it is, when the T3 from your meds desserts you, which it does within several hours, there's nothing there to convert.  Do you split?

TSH is a terrible indicator of thyroid status.  Meds with T3 in them frequently suppress TSH, but that's meaningless.  You have to look at FT3 and FT4 and discount TSH as much as possible when it doesn't agree.

I wouldn't necessarily back down on the Armour.  That would lower both your FT3 and FT4, and we don't want your FT4 going down.  I think you have two alternatives:  add some synthetic T4 to your regimen to bring your FT4 up a bit (you might have to lower Armour a bit to accomodate this) or switch to a T4-only med again.  Did you do okay on Synthroid when you were on that?

Auotimmune diseases tend to run in families.  TPOab and TGab tests would confirm or rule out Hashi's.  But, no, I don't think this is a Hashi's thing.  However, it's always goot to know.

Anything at all you can think of that changed in December-ish (or somewhat before)?  New meds/supplements, discontinuing meds/ supplements, changes in general health/stress level, weight/diet changes, anything (even if it appears insignificant)?
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Avatar universal
Hi goolarra ~

I think I did okay on Synthroid - but not great. With that said, I wouldn't object to adding a T4 to the mix, but probably wouldn't change altogether.

Well, I ramped up my workouts because I wasn't seeing any changes, so I increased intensity.

I started to feel depressed, so emotionally I have been feeling down since then...but I thought it was hormones.

My TSH had gone up so my MD added a small 15mh to the mix and I tried it for a month until I saw the labs showing my high FT3..then I backed off back down to 90mg.

I also felt a few palpitations which is also why I backed off the additional 15mg.

That is about it, nothing really significant. My supplements have stayed the same, B12, Bcomplex, Vit D, Multivitamin, Magnesium, Calcium all taken at least 1 hour after medication.

So do these labs mean I am hyper? Or still hypo? That's the part I don't understand.

I will try your idea of splitting. I have never done that before. I wasn't sure how to do so as I will have food on my stomach from eating throughout the day....But I will try to take my morning one on an empty stomach and then take the other half an hour before lunch?

Thank you again - Just not understanding what the labs mean since discounting the TSH shows me at both hypo and hyper?

I so appreciate you and all of your feedback. Very much!! Thank you for your kindness!!

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Avatar universal
Ramping up your workouts could have affected how well you convert, although I do think the ramping would have to have been fairly significant.

It's hard to classify you as hypo or hyper.  Usually, FT3 is the test that correlates best with symptoms.  So, on the basis of that, we'd say you were hyper.  However, FT4 can't be totally ignored.  The balance between the two is key to feeling well.  What often happens when FT3 is high is that you feel hyper (or maybe just "normal") for a short time until the T3 wears off.  Then, when your body is dependent on conversion, there's nothing there to convert, so you feel hypo.

Yes, I'd try splitting.  That tends to smooth out FT3 levels throughout the day a little more.  Armour doesn't have to be taken on an empty stomach.  I think most people probably take the early morning dose on an empty stomach but don't worry too much about when the second is taken relative to food.  11:00 am-3:00 pm (on a "normal" sleep cycle) is when most people take the second half dose.  After about 3:00, it can affect sleep.  However, you can experiment with when works best for you.  Some people seem to be able to take it right before bed with no ill effects on sleep.

I think the first thing I'd try is adding some straight T4 to the mix.  With your FT3 so high, you're probably going to have to decrease Armour a bit to compensate.  It takes T4 a while to build in the blood, so you usually want to add the T4 a while before decreasing the T3.

Something else you might look into is RT3 (reverse T3) dominance.  Our bodies rid themselves of T4 in two ways:  They convert it to FT3, or they convert it to RT3.  RT3 is inert, but it can block T3 receptors in cells, making us hypo at the cellular level.  With your FT3 so high, however, I doubt this is a problem.  With FT3 so high, there isn't a whole lot of FT4 left over to convert to RT3.  RT3 can be tested, although mainstream medicine tends to dismiss it, so it can be hard to get your doctor to order it.  It's the ratio of FT3 to RT3 that's important, not the raw numbers.  

Another possibility is thyroid hormone resistance (THR).  With THR, FT3 levels have to be very high (sometimes several TIMES the top of the FT3 range) before the person loses her hypo symptoms.  THR is a genetic mutation.  It's quite rare.

So, I think I'd start by trying to split your dose and balance out your FT3:FT4 by asking your doctor to add in a little T4.  If that doesn't help, you might then think about RT3 dominance and THR.    
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Avatar universal
Wow! Thank you so much for the incredible information. I am really grateful. And Thank you for taking your time to help me and answer my question. That was very kind! If I could buy you a Hallmark Card I would! lol

You are amazing! You seem to know so much, and even better - really understand it. Your explanation of (I guess you'd call it) Hormone "Half Life" helped me understand the reason to split, and the FT4 issue a little better.

It is still a mystery as to why (which my Type A needs to let go of) Although your theories of RT3 Dominance or THR could be the culprit, but perhaps it is just a fluke and the splitting the dose will help. I will start tomorrow. Thank you!! And I appreciate the clarification of the empty stomach rule. That really helps.

I think I am going to copy and print the info as my MD office is over worked and tends to balk at over the phone questions about change...but then when you get there, everyone is so rushed you don;t seem to be given time to ask questions or discuss care...so having some ammunition and being armed with knowledge will be very helpful. Thank you!

I again (hope it's not overkill) want to thank you for your response and all of your help.

Kind Regards,


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Avatar universal
Hi there, I heard that if your T4 level is too low for 'you', your body can start over converting it into T3. This over conversion is to make as much T3 hormone available for your body to use, as it can, because it thinks it doesn't have enough, based on a low T4. Could simply be you need more T4.
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Avatar universal
Have you resolved this? I was told in the Hospital that the LH/FSH issue is a whole nother ballgame like perhaps the Parathyroid. I would look further. These are measurements from the Hypothalamus I believe. There is a TON of info if you google low LH/FSH in hypo women.
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Avatar universal
Hi Archi,

you have to take your Armour 24h BEFORE the lab-test... if you took your armour 2h before the test, the test will indicate your armour-peak after you took it.. so your fT3 is false-high... AND your reference is strange.. normally fT3 is going until 4.2
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Avatar universal

I came across this thread.  I have nearly the identical labs and problem with Lowish T4 and high T4.  Were you able to find a solution?  

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Avatar universal
Opps correction to above.  Low t4 and high t3.  :-)
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Avatar universal
I have low ft4.09 -1.0 but my ft3 is 3.9 tsh .016 I feel fine so numbers always don't mean much..
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Avatar universal
This is an interesting concept to explain the paradox of a high freeT3 in the presence of low free T4. In other words, the body, somehow, is trying to meet a supply and demand situation in which it senses that it needs/demands more T3, so, uses up as much of the free T4 supply as it can, resulting in a subnormal T4. This is  very interesting concept - thank you :)

Might I add another concept?

If reverse T3 (rT3) is elevated, as it is in physiologic stress conditions, secondary to elevated body deiodinase 3 (D3) and depressed deiodinase 2 (D2) activity, more rT3 than freeT3 is produced , resulting in competitive inhibition of freeT3 at the cellular binding sites. This results in physiologic HYPOthyroidism, but, the TSH is normal, because, under the very same stress conditions, pituitary D3 activity goes up, pituitary free T3 levels go up, and, so, pituitary TSH goes down, despite the body's hypothyroid condition. What is needed in this scenario is a TSH, free T4, free T3, AND, and rT3.

Currently, I have two or three clinically hypothyroid patients, who have the aforementioned paradoxical normal TSH, low T4, and comfortably normal or high free T3. In these cases, rT3 might provide the answer to the apparent pardox.

Also, I would check AM and PM cortisol, as they might shed some light on what is going on (cortisol levels tend to go up in physiologic stress conditions, including the stress of hypothyroidism).

I also check 25-hydroxy vitamin D levels, serum iron and ferritin levels, although they should be normal, as there does not appear to be any problem with D2 activity, at least, under the supply and demand hypothesis.
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I am this person....at upper range FT3 and at bottom of FT4....TSH normal....I have lost all all body hair......what can I do? I have tried two endos who blew me off......said I was in normal ranges......jeez

Avatar universal
Before discussing further, please respond to my reply to your first posts.  
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