Hypothyroid symptoms for years! Lab test opinions please?

[Tv2323]

Hello all. I am a 28 year old female that has been experiencing the following symptoms for the past 6 years or so: Weight gain for no reason, even with dieting and working out 5x week. Extreme difficulty losing weight. Brain fogginess, difficulty concentrating, forgetfulness, thinning of eyebrows, cold feet (even the summer), change in voice, feeling of lump in throat with difficulty swallowing, obvious enlarged neck, extremely low energy, chronic insomnia, low sex drive, brittle nails that will not grow. The list goes on and on.

In the past 5 years, I have been to 4 different doctors who all ran separate labs. All 4 of them said my results were normal and that I was fine. Most recently, in December 2016, I saw a naturopathic doctor who decided to run my blood tests again.  I will post those most recent labs here:

December 2016
TSH 0.75 (reference range 0.40 - 4.50)
T3 2.7 (reference range 2.3 - 4.2)
T4 1.0 (reference range 0.8 - 1.8)
My Vitamin D levels were low (26 to be exact, the doc says I should be at 70 or so)

I also had an ultrasound of my thyroid in April of 2016 (different doctor) and the results showed multiple thyroid lesions, a small cyst and another small nodule on my left lobe. My doctor at that time said we would watch and wait and that no treatment was necessary. My blood work was very similar then to my most recent lab results.

Interesting enough, the naturopathic doctor I saw recently felt 2 more modules during my exam. He states that even though my test results show that I am in the normal range, he recommends starting me on a low does Armour Thyroid Medication.

I am really nervous. Is it common to have lab results "normal range" like this and still have hypothyroid symptoms? What else could it possibly be? My previous doctors said that my results show that I lean more towards the hyperthyroid side than hypo, but how can I experience hypo symptoms with hyperthyroid levels?

[des900]

Based on this result you are still hypothyroid and need to start on low dose levothyroxine or natural dessicated thyroid. The goal is to bring the Free T4 value in middle range without giving regard to TSH value. Also bring your Vitamin D value in between 50 to 80 which is also crucial when treating hypothyroidism.

[gimel]

No, I recognized that those were FT4 and fT3, based on the reference ranges shown.  

[gimel]

I also meant to mention that in suggestion 6 on page 2 of the paper there are suggested tests.  Of those you won't need the antibodies tests, but I do recommend always testing for Free T4 and Free T3 (not Total T4 and Total T3), along with testing at least once Reverse T3, and cortisol.  

[Tv2323]

Thank you so much for your response! I wanted to mention that the test results I posted above were for T3 free and T4 free, I'm sorry, I forgot to type that. Does that change any of your recommendations?

[gimel]

It is quite common for a person to have hypothyroid symptoms even though their test results fall within the so-called "normal" ranges, and have their  doctors tell them they are fine.   This is because doctors have been trained to recognize only primary hypothyroidism (Hashimoto's Thyroiditis).  They erroneously believe that central hypothyroidism, like your case, is a rare event.  In reality, central hypothyroidism is rare only because it is overlooked so often.  With central 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 hormone.  

Even though the doctor said your test results are fine, in reality your Free T4 and Free T3 are too low in the ranges, resulting in hypo symptoms.   Due to the erroneous assumptions used to establish the ranges, they are far too broad.  You can read about all this in the following link.  I highly recommend reading at least the first two pages, and more if you want to get into the discussion and scientific evidence supporting all that is recommended for thyroid patients.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

In the paper you will find that a good thyroid doctor will treat clinically (for symptoms), by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH results.  Symptom relief should be all important, not just test results.  You can also read why the ranges are too broad and why Free T4, Free T3, and TSH do not correlate well with hypo symptoms, and why patients should be treated clinically.  

So you need a good thyroid doctor that will treat clinically,   Many of us have found that Free T4 should be at least mid-range, and Free T3 in the upper part of its range, and adjusted from there as needed to relieve symptoms.  I should mention that with central hypothyroidism, this usually results in suppressed TSH, which then causes many doctors to decide you have become hyper and want to reduce your med dosage.  That is wrong.  There is a scientific study that showed a suppressed TSH happened almost every time when a central hypothyroid patient was adequately medicated.  You can also find that in the paper.  

Hypothyroid patients are also frequently too low in the ranges for Vitamin D, B12 and ferritin.  I urge you to test for those and supplement as needed to optimize.  D should be at least 50, B12 in the upper end of the range, and ferritin should be at least 70.  

I should also point out that a good thyroid doctor does not automatically men an Endo.  It sounds like your Naturopath might be the type you need, and after reading the link above you can help guide your treatment.