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Low TSH, Low Free T4

Hello,

I was dx as hypothyroid in 2004. My TSH was 36 at that time. I was thin, irregular menstrual periods and felt cold.  Tired in the evenings - would fall asleep at 7pm.  But overall - no major symptoms.  Was put on synthroid 100mg and was having severe anxiety and panic attacks within 1-2 months.  Felt like I was dying.  Suffered with anxiety and air hunger, fatigue for almost a year until I found another doctor who adjusted my meds.   On synthroid I continued to just not feel right.  I found a doc who dx me with hashimotos in 2007.  She still wasn't listening to my symptoms, so I went from doctor to doctor until I found my current doc.  He looks at my iron levels, vitamin d, reverse T3 and focuses on my "frees."   Yet I continue to feel not great - especially my joint pain.  I have it mainly in my hands - but have kept under control somewhat by a good diet (vegetarian, gluten free) and supplements.  My iron is still low (44) and my vitamin d is 65.  I take supplements for both.

At one point my RT3 level was high (34) when it should have been below 33, but now it seems normal.  I guess I'm still confused about the whole ratio thing and what that all means.

Here are my other labs.  Do I need to be on cytomel?  Why is my TSH and Free T4 so low?  I started on armour last October.  Now I'm on naturethroid since March - started low and increased to 90mg (which I take now).   My doctor said my RT3 to TT3 ratio is 6.2.  Too low (he says optimal is 10-14).  Says I could increase my naturethroid but I feel kind of anxious so almost want to lower it.

TSH 0.198 (0.45-4.5)
Free T4 0.76 (.82 -1.77)
T3 144 (71-180)
Reverse T3 231 (90-350)
TPO 141 (0-34)
Antithyroglobulin <20 (0-40)
Free T3 3.9 (2-4.4)

Help me understand.  My doctor is good and tries explaining and suggested maybe going on cytomel but I'm still confused about "optimal levels" and why my thyroid is doing this in the first place.  Thanks...
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219241 tn?1413537765
Having both low TSH and low Ft4 can indicate what is known as Hypothyroidism secondary to Pituitary Disease. It means your pituitary gland is not responding to send out appropriate TSH. TSH is Thyroid Stimulating Hormone and comes from the gland in the base of the brain. If it is not working properly your body can not manufacture any appropriate other thyroid hormones.

Even taking T3 will not help in this case. Go back and ask your doctor about the Hypo secondary to Pit. Disease and he may even not have thought of that. It is not  a cancer by the way, just a glitch that can be treated!
Cheers!
Helpful - 0
Avatar universal
Thanks - that sounds bad. LOL -- just what I need.

Any idea how they treat that?  I will ask my doc about it tomorrow when I call..

Thanks again, redhead!
Helpful - 0
219241 tn?1413537765
It's  often just a small little tumour (don't freak!) which can block the release of the TSH.They usually can either blast it with laser or remove it (you'll hate this!) through the nostrils under general anesthetic. But I guarentee you will feel much better pretty much as soon as it is done, and your levels will get back on track.
Cheers
Helpful - 0
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