Question about TSH with reflex to FT4

[AshelyVida]

Hello,

I've been having several issues but the most notable are for the past 2 years my periods have become more and more irregular. I am 28 years old and am moderately active (exercise 2x a week and have a job with a lot of standing, walking). I eat a fairly healthy diet.
My period will skip every 3 months or so, sometimes more. I used to have very regular cycles, every 28 days for 5 days. Now I never know when it is happening. I am on an oral contraceptive, Torina. I've never had issues with BCP changing my cycles UNLESS I intentionally skipped the placebo week and went on to a new pack. Which is something I haven't done for quite some time.
I've been to the urgent care and ER several times for severe abdominal/back (in between the shoulder blades) pain - and constipation was determined to be the cause.
I've been having a lot of difficulty with my memory - I can't remember things the way I used to. I have been finding myself becoming more anxious lately, and having panic attacks. I've been disoriented on 4 occasions within this month where I don't know where I am. My ears ring all the time but sometimes it gets so loud it's unbearable.
My libido has completely disappeared.
I am tired all the time, despite how much sleep I get. I am thirsty all the time, despite how much water I drink. I feel very depressed and just "not right".
Blood draw on Monday came with these results:

TSH with reflex to FT4- thyroid stimulating hormone, serum 1.55 u[iU]/mL

My doctor hasn't called me to discuss my results yet. My reading from last year at this same time was 1.35
Any advice?
Any advice would be appreciated

[AshelyVida]

I didn't realize there were two types of hypo. Thus far, I've felt my doctors have been very unhelpful and dismissive towards me. I first started noticing symptoms when I was 24 and they've only gotten worse and it just feels like no one wants to help me get to the bottom of things. I will call and see if I can get those additional tests done.

[gimel]

There are two types of hypothyroidism.  First is primary, due to Hashimot's Thyroiditis, characterized by diminishing levels of Free T4 and Free T3, and increasing levels of TSH.  The other type is central hypothyroidism, which is causes by a dysfunction in the hypothalamus/pituitary system, characterized by relatively low TSH and resultant low levels of Free T4 and Free T3, which are the biologically active thyroid hormones.  Levels of FT4 and FT3 in the lower half of their ranges is frequently associated with having hypo symptoms.  Central hypothyroidism is thought to be much less frequent than primary so doctors are not as alert to it as you would expect.

TSH with reflex to FT4 is a test that will usually identify Hashi's, but not central hypothyroidism.  Because the TSH is fairly low, no further testing is done.  You will have to get the doctor to test for Free T4 and Free T3, regardless of the TSH level.  If there is resistance, point out all the symptoms you have that can be related to being hypothyroid and insist on checking FT4 and FT3 to see if they are indeed in the lower half of their ranges.  If you can get those done and then post results and their reference ranges shown on the lab report we will be happy to help interpret and advise further.