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I have high tsh but normal free t 4 why?
My tsh was 10 but free t 4 was 1.8 with with a range ending in 1.9. What does this mean?
Yes, that seems to make more sense that it is Total T3. Understand the total includes all serum T3. Most of that is bound to protein. Only the small portion that is not bound to protein is biologically active and called Free T3. Free T3 essentially powers your body, as it is metabolized in all the cells of your body.
It is good that your doctor is at least increasing your thyroid med a small amount. You will need to re-test in about 4 weeks or so. At that time make sure they test for both Free T4 and Free T3. When you go for the blood draw, I would even go as far as asking the lab person what tests are to be done. You would be surprised at how often they operate on auto pilot and do the same tests as usual, which may not be what you are expecting.
Also, it is very important to find out your Vitamin D, B12 and ferritin levels and then supplement as needed to optimize.
It is good that your doctor is at least increasing your thyroid med a small amount. You will need to re-test in about 4 weeks or so. At that time make sure they test for both Free T4 and Free T3. When you go for the blood draw, I would even go as far as asking the lab person what tests are to be done. You would be surprised at how often they operate on auto pilot and do the same tests as usual, which may not be what you are expecting.
Also, it is very important to find out your Vitamin D, B12 and ferritin levels and then supplement as needed to optimize.
You're right it must be total t3 because she only said t3 she did not say free. I found this reference for total t3 so maybe she meant total t3
T 3 ( Triiodothyronine) Total (serum)
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Cord blood: 14 -86 ng/dL
1-7 days: 100 -470 ng/dL
8- 364 days: 105 -245 ng/dL
1 -9 years: 94 -269 ng/dL
10-19 years: 102 -200 ng/dL
> 20 years old: 80 -200 ng/dL
Adults: 0.8 - 2.0 ng/ml
0.9 - 2.8 nmol/L
T 3 ( Triiodothyronine) Total (serum)
top of page
Cord blood: 14 -86 ng/dL
1-7 days: 100 -470 ng/dL
8- 364 days: 105 -245 ng/dL
1 -9 years: 94 -269 ng/dL
10-19 years: 102 -200 ng/dL
> 20 years old: 80 -200 ng/dL
Adults: 0.8 - 2.0 ng/ml
0.9 - 2.8 nmol/L
I have never seen a Free T3 range anywhere close to that. If you have the lab report, please tell us what is shown as the measurement units, like Pg/mL or ng/d, or whatever.
Ok so I got my results: free t4 1.4 range is .7-1.8
Tsh is 9.14 range is .45-4.7.
And free t3 is 1.2 with a range of .79-1.45
She is upping my dose from .75 one day and .88 the next day to .88 every day.
Tsh is 9.14 range is .45-4.7.
And free t3 is 1.2 with a range of .79-1.45
She is upping my dose from .75 one day and .88 the next day to .88 every day.
I agree. You MUST get your Free T3 tested to get a better picture of what is going on.
It is possible that you have a conversion problem. That is, your FT4 is not being converted into T3 properly. This can be one of two things. One is a very low conversion rate leaving you low in Free T3 which is the ONLY thing your cells use. Or the other option is that it is converting to Reverse T3 which is unusable as well leaving you deficient of FT3 available for your cells.
in both cases it would leave your cellular level being starved of thyroid and thus Hypo.
Again this cannot be known unless you get your FT3 levels tested.
If I were to venture a complete guess. I would bet that you are not converting sufficiently. This would explain the "jamming up" of the FT4. You keep taking T4 medication and you literally have an over abundance of T4 in your blood. But since you have a problem actually converting that T4 into T3, you are left being hypo. (low FT3 levels would be evidence of this).
IF, and again we have no definitive proof this is the case, IF this is true. Then you would be better served by a medication with some or the addition of T3 directly because of your body's inability to properly convert the T4, and a further reduction in the T4 medication.
I would strongly recommend that you get tested for ALL of these at the same time.
TSH
FT4
FT3
and if possible to talk your Dr into it, Reverse T3
BTW: it takes up to SIX WEEKS to stabilize the levels of T4 in your blood. So only being one week on the lower dose had almost zero impact on your FT4 levels. Each dosage change will take about 6 weeks after the change to best reflect what that change has done to your blood levels.
T3 on the other hand is used up in literally a matter of hours. It peaks in the blood about 4 hours after taking it. And is why when taking T3 medication it makes sense to split the dose and take half in the morning and half in the early afternoon. To help level out the T3 level through the day.
It is possible that you have a conversion problem. That is, your FT4 is not being converted into T3 properly. This can be one of two things. One is a very low conversion rate leaving you low in Free T3 which is the ONLY thing your cells use. Or the other option is that it is converting to Reverse T3 which is unusable as well leaving you deficient of FT3 available for your cells.
in both cases it would leave your cellular level being starved of thyroid and thus Hypo.
Again this cannot be known unless you get your FT3 levels tested.
If I were to venture a complete guess. I would bet that you are not converting sufficiently. This would explain the "jamming up" of the FT4. You keep taking T4 medication and you literally have an over abundance of T4 in your blood. But since you have a problem actually converting that T4 into T3, you are left being hypo. (low FT3 levels would be evidence of this).
IF, and again we have no definitive proof this is the case, IF this is true. Then you would be better served by a medication with some or the addition of T3 directly because of your body's inability to properly convert the T4, and a further reduction in the T4 medication.
I would strongly recommend that you get tested for ALL of these at the same time.
TSH
FT4
FT3
and if possible to talk your Dr into it, Reverse T3
BTW: it takes up to SIX WEEKS to stabilize the levels of T4 in your blood. So only being one week on the lower dose had almost zero impact on your FT4 levels. Each dosage change will take about 6 weeks after the change to best reflect what that change has done to your blood levels.
T3 on the other hand is used up in literally a matter of hours. It peaks in the blood about 4 hours after taking it. And is why when taking T3 medication it makes sense to split the dose and take half in the morning and half in the early afternoon. To help level out the T3 level through the day.
As I said above, TSH does not correlate well with the biologically active thyroid hormones, and even less with symptoms. After starting on thyroid med, its usefulness is very limited. 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.
Weight gain can be related to a number of things, including of course low metabolism due to inadequate levels of Free T3 and Free T4. Even though your doctor has raised your Synthroid enough that your Free T4 is near the upper end of its range, it is possible that your body is not adequately converting the T4 to T3. Since T3 is metabolized throughout the cells of your body, to produce the needed energy, you need to know your Free T3 level. In fact you should make sure they always test for both Free T4 and Free T3 every time you go in for tests. Many of us have found through experience that symptom relief required Free T4 at least at the middle of its range, and Free T3 in the upper part of its range, or as needed to relieve symptoms. You can read about this in the first two pages of the following link.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
If, as I expect, you have relatively low Free T3 due to inadequate conversion, one of the important factors for good conversion is ferritin. So that is another reason to also test for ferritin, Vitamin D, and B12, 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.
So, do you think you can get your doctor to test for Free T3, D, B12 and ferritin? Do you also think your doctor would be willing to treat clinically as described above? Also, do you think your doctor would be willing to prescribe T3 type meds if your Free T3 is too low? If the answer to any of these questions is no, then you will need to find a good thyroid doctor that will do all three.
Weight gain can be related to a number of things, including of course low metabolism due to inadequate levels of Free T3 and Free T4. Even though your doctor has raised your Synthroid enough that your Free T4 is near the upper end of its range, it is possible that your body is not adequately converting the T4 to T3. Since T3 is metabolized throughout the cells of your body, to produce the needed energy, you need to know your Free T3 level. In fact you should make sure they always test for both Free T4 and Free T3 every time you go in for tests. Many of us have found through experience that symptom relief required Free T4 at least at the middle of its range, and Free T3 in the upper part of its range, or as needed to relieve symptoms. You can read about this in the first two pages of the following link.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
If, as I expect, you have relatively low Free T3 due to inadequate conversion, one of the important factors for good conversion is ferritin. So that is another reason to also test for ferritin, Vitamin D, and B12, 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.
So, do you think you can get your doctor to test for Free T3, D, B12 and ferritin? Do you also think your doctor would be willing to treat clinically as described above? Also, do you think your doctor would be willing to prescribe T3 type meds if your Free T3 is too low? If the answer to any of these questions is no, then you will need to find a good thyroid doctor that will do all three.
I don't think you can be diagnosed for your thyroid status at all without us knowing what, if any, symptoms you have and also what your Free T3 level is. TSH is a poor indicator of thyroid status. TSH does not correlate well with either of the biologically active thyroid hormones, Free T4 and Free T3, much less correlate well with symptoms. Your Free T4 is in the high end of the range, which is somewhat inconsistent with a high TSH.. So you also need to know your Free T3, since it is the thyroid hormone that is metabolized in all the cells of your body and produces needed energy. Once we know about your symptoms, other tests may be advisable.
1 Comments
Yeah, that is what is strange. FT4 is high normal but TSH is high. And I am on Syntroid now. Symptoms hard to tell. I have gained weight and I am irritable but I do not have the symptoms I normally get with hypo like achy joints. She is bumping me up from 75 to 88 mcg.
Its subclinical hypothyroidism, a mild form of hypothyroidism but treatment is similar to full blown hypothyroidism. Need to take thyroid hormone pill either levothyroxine or natural dessicated thyroid NDT. Starting dose need to be small and increase in steps till symptoms get better.
Also its worth to do these blood tests to rule out deficiencies, there is a chance that deficiency might be leading to this, some might disagree but its your health and not compromise doing these, even if its normal you can confirm it and be assured.
25-hydroxy Vitamin D3
Vitamin B12
Ferritin
Also its worth to do these blood tests to rule out deficiencies, there is a chance that deficiency might be leading to this, some might disagree but its your health and not compromise doing these, even if its normal you can confirm it and be assured.
25-hydroxy Vitamin D3
Vitamin B12
Ferritin
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