Is Hypothyroid possible with Normal TSH and T4 Free but...

[durrenm]

I'm suffering from the following symptoms
Joint pain (knees, big toes, elbow)
Severe tendonitis in both elbows
Muscle cramps
Heart palp
Big temp swings (like hot flashes but I'm a guy :-)

My research points to HypoThyroid but yesterday's TSH and T4 Free came back in the normal range. My mother has Hashimodos Disease - diagnosed ~25 years ago. I'm 51, male.

Started feeling strange pains and aches in fall of 2011 and was tested for Lyme (negative) along with the TSH.

TSH
10/2009 1.82
10/2011 2.09
9/2012 2.10

T4 Free
9/2012 0.94

[durrenm]

Thanks. My next appointment  with my primary is Oct 1. I'll insist on the tests you suggested and I'll return here with results as soon as I am able.

[gimel]

Just because your lab results are in the so-called "normal" range does not mean that all is well.  First, TSH is a pituitary hormone that is affected by so many variables that it is totally inadequate as the main diagnostic for thyroid issues.  At best TSH is an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  Of these Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  Second

Your TSH being in the lower end of its range does not normally point to Hasimoto's.  When having hypo symptoms, a low TSH may only indicate secondary hypothyroidism, rather than primary hypothyroidism like with Hashi's.  Please have a look at this list of 26 typical hypo symptoms and tell us if you have others as well.

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

Second, even if Free T3 and Free T4 are within their ranges, that does not mean all is well either.  The ranges are far too broad because they were erroneously established.  Because of that, many members report that symptom relief for them required that Free T3 was adjusted into the upper part of its range and Free T4 adjusted to around the middle of its range.

So the first thing I would recommend is to go back and ask to be tested for both Free T3 and Free T4.  If the doctor resists, then you should insist on it and don't take no for an answer.    While there I also suggest that you should test for Vitamin A, D, B12, magnesium and ferritin (even though you are male).  Deficiencies in these areas can cause symptoms that mimic hypothyroidism.  

Another thing to keep in mind is that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and certainly not TSH results.  So clinically treatment is something you should explore with your doctor also, to get his position on it.  

When test results are available, if you will post results and reference ranges shown on the alb report, members will be glad to help interpret and advise further.