TSH Probleot not? Going crazy!

[MAH4]

Good afternoon everyone. I'm hoping to get some insight as to what all these numbers truly mean, as my symptoms are only getting worse, but I keep getting a "normal" TSH level. I don't know if to keep pursing answers or not.  I am a 46 y/o female. I have gained 24 pounds in the last year, my hair has been falling out to the point where my husband claims to be able to make a wig with what falls daily, I live in 85-105 degree weather and have to walk around with a sweater everywhere, I'm always tired, have painful joints, irregular and painful menses, and become very forgetful. Due to my constant complaint of something being wrong, my doctor ordered a TSH panel (non-fasting). The first time it was:
TSH 1.242  Range: 0.350-4.500
T4 Free: 0.89. Range 0.62-1.12
T3 Free: 2.4 Range: 2.3-4.2
B12: 310 Range: 211-911
Vitamin D: 21 Range: 30-89

Those results above yielded in a "normal" reading from the doctor and warranted no further action. As symptoms progressed over time, labs were repeated over a year later with the following results (non-fasting):
TSH: 0.91 Range: 0.35-4.94
T4 Free: 1.17 Range 0.70-1.48
T3 Free: 2.48 Range: 1.71-3.71
Vitamin D: 24 Range: 30-96
Vitamin B12: 829 Range: 213-816 (I had received six B12 injections for very low level within the last 6 months)
Ferritin: 25 Range: 10-190
Iron: 47 Range: 50-170

Once again, these results yielded in a "normal" diagnosis warranting no further evaluation or treatment.

I simply would just like to know if I should continue to pursue this, is there something else that isn't being tested or being overlooked, which could be causing me to feel the way I have for over a year now.

I thank you all in advance fort skin the time to review this!

[gimel]

Your doctor is following the usual practice and going by TSH level, which doesn't work for many people.  TSH is a pituitary hormone that is affected by so many things that at best it is only 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.   Then the next problem is that most doctors only want to use "Reference Range Endocrinology", by which they will try to tell you that a test result that falls anywhere within the range is adequate.  Wrong again.  The ranges are far too broad due to the erroneous assumptions used to establish them.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve hypo symptoms like those you have in abundance.  Symptom relief should be all important, not just test results, and especially not TSH.  

Your Free T4 is adequate, at over 50% of its range in both sets of tests.   Your main problems in the test results are your relatively low Free T3, low Vitamin D and low ferritin.  Your Free T3 in the first results was only at 5% of its range, when it should be in the upper third, or as needed to relieve symptoms.  I am not sure why the range is different in the second set of results.  Please double check that.  Even if correct range, your Free T3 is clearly too low for you, in view of all those symptoms.  Scientific studies have shown that Free T3 correlated best with hypothyroid symptoms.  

Your lower Free T3, with adequate Free T4 shows that your body is not adequately converting T4 to T3.  Since conversion is affected a lot by ferritin and selenium, and your ferritin is terribly low, The first thing I suggest is that you start supplementing with a good form of iron like ferrous bisglycinate, or ferrous fumarate, or ferrous sulfate, as needed to raise your ferritin to about 70.  That may require about 50-75 mg of iron daily, along with Vitamin C or magnesium to avoid stomach distress.  I also suggest that you need to supplement with about 3000-4000 IU of D3 daily to raise your D up to about 55.  You should see the benefit of this from both an increase in your Free T3 levels as well as reduced hair loss from the ferritin.  

Once you have given this a couple of months to see the effect you should return and get tested again for Free T4 and Free T3 along with the D, and ferritin and selenium.  In view of your FT4 and fT3 levels at that time I would also suggest that you get tested for Reverse T3 also.  RT3 is the mirror image molecule of T3, but biologically inactive.  Excess RT3 can offset the effect of Free T3 and also cause hypo symptoms.  It occurs infrequently, but for you I think it is worth checking for it.  I would also ask your doctor if he is willing to treat clinically as described above and also to prescribe T3 med should that become necessary.  

When you have new test results, please post them along with ranges and we will be glad to help interpret and advise further.  

[MAH4]

I was afraid she had not ordered the complete labs. I hope to be able to get a hold of her before my labs on Friday morning :/

[gimel]

The TSH test will do nothing but give the doctor a warm feeling.  LOL  I would push for the Free T4 and Free T3, and don't take no for an answer since they are the biologically active thyroid hormones.  

[MAH4]

Thank you for all the information you provided. The first set of labs were done about a year ago, and the last set of labs were done 6 months ago. I will be having new labs in 2 days with a new doctor, as the previous doctor has decided to move to a "concierge-Type" (private with fee) practice. The new doctor has ordered (not sure if the free T3 and T4 are included in this?):

cmp
lipid panel with direct LDL in serum or plasma
Thyroid stimulating hormone
25-hydroxavitsmin D in serum or plasma
CBC W auto differential panel in blood
Cardio IQ lipoproteins