Low TSH High FT4

[Ellsbells09]

I had RAI in 2012 to destroy my thyroid as I was diagnosed with Graves’ disease.  Through the years my labs have always showed me on hyper end.  Drs have adjusted meds according but still don’t feel like I’m where I need to be.  I’m currently taking name brand Synthroid 50mcg.   Labs came back as follows: TSH 0.005 and T4 free 2.13.  Endo has now me splitting the Synthroid in half and retest in 6 weeks. Is it possible the radioactive iodine did not destroy my thyroid?    It would seem there’s something the drs are missing!  Anyone else have issues like this?

[gimel]

You should not have those TSH and FT4 levels while only taking 50 mcg of T4 med.   I would also not expect you to have symptoms typical of being hypothyroid with that FT4 result, unless your body is not converting hardly any T4 to T3.  One thing I should ask is whether you took your med right before the blood draw for the FT4 test?  If so, that will give a false high result.  

I am looking to see if there is a doctor I can recommend for you.  In the interim I suggest that you try to get the Endo to do an ultrasound of your thyroid gland area to see if there is functioning tissue remaining after the RAI.  

Since it is FT3 that largely regulates metabolism and determines the thyroid status in tissue throughout your body, I suggest that you also ask to be tested for FT3.  If the doctor tries to tell you that T4 converts to T3 as needed, tell him that has been refuted by scientific evidence, which is referenced in the link I gave you.  So you need to know FT3.   Since ferritin is also very important for conversion of T4 to T3, I would also ask to be tested for ferritin.  It should be at least 100.  Ferritin is the storage form of iron readily available for use by your body.  

Why are you getting injections for B12 instead of daily supplements?  Do you take D3 daily?

[Ellsbells09]

Let me also add that the  hyperthyroidism dx was May 2011 and Radioactive Iodine treatment was July 2011.   So here we are 12 years later with the exact same levels!  

Not sure if this makes a difference but Creatine level is high 1.07.  

[gimel]

You did not respond to my question about taking the T4 med before the blood draw for those tests.  Also, do you think you can get those tests I mentioned done?  From what I have read, Creatinine is elevated with hypothyroidism.  I have a doctor for you to consider.  Sending info in a PM.  To access, click on your name and then click on messages.  

[Ellsbells09]

Sorry.  I took synthroid at 6am and my bloodwork was done around 11:45am.  So 5 hours after taking.

[Ellsbells09]

Thank you for all your help.   The recommendation is truly appreciated and the Dr is only 30-40 minutes away.  Again, thank you!

[gimel]

You are very welcome.   Taking your thyroid med dosage in the morning before blood draw causes a short term spike, and  test results that are higher than they should be.  Always delay med until after blood draw.  Is there any chance you can get those tests done before seeing a new doctor, so that we can assess your situation and help prep you for doctor appointment?

[gimel]

It doesn't need to be an Endo, just a doctor that will diagnose and treat clinically, for symptoms, along with both FT4 and FT3.  Most Endos rigidly follow the ATA/AACE Guidelines for Hypothyroidism, which doesn't work for most people.    If you will answer my questions about symptoms and other test results above, and tell us your location, perhaps we can suggest a doctor that has been recommended by other thyroid patients.

[Ellsbells09]

Latest testing did not include anything except T3 and FT4.

I do receive B12 injections biweekly and take 50000 IU of D-3 monthly.  

Symptoms: migraines, insomnia, fatigue, weight gain, GI issues, hair loss and texture of hair changed to very course, itchy skin, I’m sure I’ve left something out.

Medical history:  Migraines, kidney stones, Graves’ disease and thyroid eye disease.  Recently I was diagnosed with hypertension.  BP was extremely elevated.   Post menopausal


Daily Medications:
Synthroid
Maxzide
Xanax
Trazadone
Amerge

I live in Montgomery, Alabama.  

[Ellsbells09]

Sorry last labs only  TSH and FT4 NOT T3.   Some of this is so over my head and confusing.  

[gimel]

TSH means nothing when taking thyroid hormone.  TSH has only a weak correlation  with the actual thyorid hormones, and a negligible correlation with symptoms typical of hypothyroidism.  In assessing your thyroid status an evaluation for symptoms, along with Free T4 and Free T3 are the most important.   In addition it is very helpful to know Vitamin D, B12 and ferritin levels.  

If you want to confirm this, have a look at our paper in this link.  

https://thyroiduk.org/wp-content/uploads/2022/10/Patients-Guide-Final-V5.pdf

Then before further discussion, please tell us about all your symptoms.   Also, have you been tested for FT3, Vitamin D, B12 and ferritin?  If so, please posts those results.

[Ellsbells09]

I obviously need to find another Endo.   Thanks for shedding a little light on my situation