Low T4 normal TSH but symptoms

[tompok]

Hi
I have a consistently low free T4 reading (0.72 ng/dl, normal range 0.77-2.19) but normal TSH (0.81, normal range 0.46-4.68 mUI/l).  Suffer from clinical depression, poor memory/concentration and debilitating fatigue - physical and mental.  Doc thinks depression and prescribes SSRIs/SSNRIs.  I think fatigue is causing depression and not vice versa. My morning blood sugar is just over the norm but other blood tests for diabetes are normal.  I am lean and muscular - which is genetic plus eat very healthy food and athletic background - so a Doc looks at me and my TSH and thinks 'normal.'  Any thoughts please?

[tompok]

Many thanks - excellent post and the link to Lindner's site very informative.  My vitamin D is always in the low range.  Is it possible to get an online consultation with a thyroid doctor?  I'll have to convince my doctor to retest my T4 and T3 despite low TSH.  Proof in the pudding if I take Levothyroxine, T4 comes up and my symptoms subside.

[gimel]

My first thought is that you need a good thyroid doctor.  Your doctor is ignoring that your Free T4 is actually below range, and only looking at your TSH.  That is ridiculous.  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.  The best use of TSH is to distinguish between primary hypothyroidism (Hashi's related) and central hypothyroidism, which is a dysfunction in the hypothalamus/pituitary system that results in relatively low TSH, and thus low Free T4 and Free T3, because the thyroid gland is not being stimulated adequately to produce thyroid hormone,  

Even though you have not been tested for Free T3, your Free T4 and symptoms point to hypothyroidism. In the words of a good thyroid doctor, ""The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important not just test results.  You can get some good insight from this link written by a good thyroid doctor.  So what options are available to you to get another doctor that will do the necessary testing and treatment.

http://www.hormonerestoration.com/Thyroid.html

So you need to insist on being tested for Free T4 and also Free T3 every time you test.  Also, since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, I also suggest testing those to see if you need to supplement to bring them up to optimal.  D needs to be about 55-60, B12 in the very upper end of its range, and ferritin should be about 70 minimum.