Thyroid Disorders Community
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Avatar universal

Low TSH, Low Free T4, normal T3

I've had weird thyroid numbers for over a year.

My symptoms:

25 lb weight gain (unable to lose). I eat 1/3 of what I used to eat.
Debilitating fatigue
Irregular menstrual cycles
GI issues (including bloating despite what I eat, even a salad can swell me up like a balloon)
Cold hands and feet
Hair loss

August 2014 numbers:
TSH 0.10
T4 0.38
T3 3.47

Above Dr. absolutely refused to treat me. Worst doctor I've ever dealt with. I was so frustrated that I just gave up on the whole situation, since she was my third doctor and I ended up having to move anyway. She treated me with such disdain and lack of empathy that I swore off doctors at that point. I figured I would "man up" and deal with it, as if it were a business venture. I've always been a fighter and no way this was taking me down....Wrong!

My symptoms kept being the same for a few months, except the fatigue seemed to get better. A couple of months ago I started feeling extremely tired again, no matter how much I slept. Then I had a miscarriage and my fatigue got so bad that I'm basically between the couch and my bed. I can't work anymore, I can barely do chores around the house. I almost fainted while emptying the dishwasher a couple of days ago. I used to be active and full of life, now I'm a 90-year old inside a 30 year-old body. I need to catch my breath constantly while doing basic housework.

So, I went back to a different doctor. Just a GP. Told her about my thyroid and she tested it. Results as follows:

May 2015
TSH: 0.02
T4: 0.6
T3: 2.9

She referred me to an endo, but the soonest appointment is at the end of June. I got sick and tired waiting for any endo to take a look at me and of calling twice a day for a cancellation. So I decided to go to an internist who finally took me seriously, said I'm hypothyroid, and prescribed me a starter dose of synthroid 25 mcg. I took my first dose this morning on an empty stomach a couple of hours ago.

Question is, why are my numbers so wacky and when will the synthroid kick in? I can't wait to get back to being the overachieving, full of energy me. My husband can't wait either. He has been an angel putting up with me, but I can tell it has taken a toll to have an almost vegetable wife. I'm a shadow of my former self, and my husband is very active like I used to be. We can't do any of the activities we used to do together. Mentally I have been good, happy with my move and my marriage, but guilty because I can't be productive. I am very lucky to be able to stay home through this without it taking a financial toll, but the guilt for not being able to function is constantly hammering at me.
I did get depressed for a couple of days when I thought I'd be like this forever, but now that I see the light at the end of the tunnel I'm happy again. I just want my body back without all the weight and without all the issues. I want my energy back. When will I be normal again?

Also, when I finally see an endo, what should I ask?
5 Responses
Avatar universal
Sorry, I forgot to tell you guys that those are my Free T3 and T4 results. And these are the ranges, along with my most recent lab results:

TSH: 0.02 (.35-4.94)
Free T4: 0.63 (0.7-1.48)
Free T3: 2.9 (1.7-3.7)

Thanks in advance for your help.
Avatar universal
From your symptoms and those lab results you are obviously very hypothyroid.  It is surprising that your first few doctors did not accept that there was a problem.  So it is good that you found a doctor who recognized a problem and started you on thyroid med.  

There are two basic types of hypothyroidism.  One is primary, related to Hashimoto's Thyroiditis and characterized by increasing levels of TSH and inadequate levels of the biologically active thyroid hormones, Free T4 and Free T3.  The second type is central hypothyroidism associated with dysfunction in the hypothalamus/pituitary system resulting in inadequate output of TSH to stimulate the thyroid gland.  Your results are a bit unusual in that your TSH is so low, making me wonder how your thyroid gland is functioning at all.  Yet you still have some amount of T4 and T3.  That is kind of like an engine running without any gasoline.  

A good thyroid doctor will treat a hypo 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 lab results.   Going to an Endo doesn't guarantee a good thyroid doctor.  Since your internist has reacted correctly, I think I would go back in 4 weeks after starting on the Synthroid and re-test and get an increase in meds.  Then continue on that path until you get your Free T4 to the middle of its range, at minimum, and your Free T3 high enough in its range to relieve symptoms.  Since hypo patients are also frequently too low in the ranges for Vitamin D, B12 and ferritin, you should get those tested as well.  D should be about 55-60, B12 in the upper end of its range, and ferritin should be 60 minimum for women.  Low levels can cause symptoms that mimic hypothyroidism.  D and ferritin are very important in metabolizing thyroid hormone also.  

It might also be a good idea to ask the internist about the hypothalamus/pituitary dysfunction and what tests should be done to identify any issues there.  It may be that the internist will handle all of that for you, or at least refer you to someone that he is comfortable with.  That would be a lot better than just selecting an Endo without any assurance he  is a good thyroid doctor.  
Avatar universal
Thank you so much for your reply gimel. Coincidentally, an appointment with my new endocrinologist opened up yesterday. He looked at my tests and the previous ones from August and diagnosed me with central hypothyroidism. He said that my precious endo should've done more research and said he didn't want to scare me, but based on all my tests from August and my symptoms, I may have a pituitary tumor. He ordered a lot of labs and a pituitary MRI. I'm kinda scared. I'm keeping a positive attitude about the fact that I'm lucky to have gotten what seems like a good endo and a good internist, and I hope that if I do have a tumor, it won't be one of those that have spread but a little tiny one. Do you know of anyone with these same issues? Thanks so much for your help and support.
Avatar universal
No, sorry but I don't know of any current members with those same issues, however,  if you will go to the top right hand corner and type "pituitary tumor" in the search area, you will see that there has been lots of info posted over the years.

I'm glad you got to see the Endo quickly and it sounds like you got the right diagnosis of central hypothyroidism, possibly due to pituitary tumor.  You will know a lot more about the tumor possibility from the lab tests and the MRI.  The Endo may be everything you need short term, but keeping in mind my definition of a good thyroid doctor above, longer term you will need to find out if he is willing to treat clinically as described or if he is one of those that predominantly rely on the "Immaculate TSH Belief" and use "Reference Range Endocrinology".  That doesn't work.  If you want more insight into what I mean by this, have a look at this link written by a good thyroid doctor.  

Avatar universal
Thanks so much, I will check it out. I just received some of my tests back from the endo via an online automated system and my numbers were:

Cortisol: range (3.1 - 22.4 ug/d) = 23.3
Leutinizing Hormone: range (0.50 - 76.30 mIU/mL) = <0.07
TESTOSTERONE: range (14.0 - 76.0 ng/dL) = <10.0
ACTH: range (15 - 66 pg/mL) =9

Everywhere I've looked online for the meaning of these results say that a tumor is the primary reason, so now I'm concerned. I'm going to take your advice and post on the pituitary tumor forums.

Thanks so much for your help.
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