TSH 4.71 and FT4 was 0.9. Is this Hypothyroid?

[ElleHolloway]

I've had multiple symptoms of hypothyroidism for years (except being cold I'm usually hot, my temp is usually 96.7-97.5)also a familial history of Hashimoto's among other autoimmune disorders, but my TSH has always lingered around 3.8-3.9 and FT4 around 0.8-1.1.  Even with symptoms I have never been referred to an endocrinologist until last week.  
I'm just trying to figure out if this is in fact hypothyroidism I've been experiencing or just a fluke?  I don't think my T3 has ever been tested by primary doctors and the only thing I was told was I needed to see an endocrinologist?  Help please.  Thank you.

[gimel]

Elle,
There are two very important things that a doctor must be willing to do, in order to be a good thyroid doctor.  

1. Be willing to order full labs, including Free T3, Free T4, Reverse T3, in addition to TSH and thyroid antibodies if needed, and for diagnosis, be responsive to patient symptom evaluation, not just blood test results, and especially not TSH.

2. Be willing to prescribe treatment such as natural desiccated thyroid, T3-only medication (e.g. liothyronine, compounded T3), AND/OR combination methods of T3+T4 medication, as needed to relieve hypothyroid symptoms.​

Good thyroid doctors are hard to find.  You can try locally, by using the above and asking if the doctor is willing to do those 2 things.  If unsuccessful, you may need to travel a bit to find one, that you need so badly.   I am sending you a PM with info on some prospects that are in Corpus Christi.  To access, just click on my name and then from your personal page click on messages.  

[ElleHolloway]

gimel Thank you very much for being soooo very helpful!!! Yes Corpus is an hour + away but I have had to go there to see any specialist.   I guess if it has to be done that way I will.  Feeling as weak and tired as I do, its soooo hard to make myself lol.

I'm gonna try to find a PCP that give a crap here first.  I know there are a select few in this town its just a matter of whether they're taking new patient's =/  Seriously though I have thought I may need to move in order to get good health care not just for myself but my 11 year old as well.

God bless and I will update as soon as I can.  You're awesome!!!

[gimel]

Elle, with all those symptoms that are frequently related to hypothyroidism, plus the limited test data you have, I suggest that you get in to your doctor soon and request to be tested for the actual, biologically active thyroid hormones, Free T4 and Free T3.  Don't take no for an answer.   You should also request to be tested for cortisol and Reverse T3.  You have already tested for B12 and ferritin, so you should also request to be tested for Vitamin D.  I expect that you will find out that your Free T4 and Free T3 are in the lower part of their ranges, further indicating hypothyroidism.  

A good thyroid doctor (does not need to be an Endo) will diagnose and treat clinically, by testing and adjusting your Free T4 and Free T3 levels as needed to relieve hypo symptoms.  A good thyroid doctor is also willing to prescribe T3 type meds such as Armour Thyroid, NatureThroid and Cytomel.   You should ask your doctor if he is willing to do both.  If the doctor is resistant, then you will need to persuade him to give you a trial of thyroid med adequate to raise your Free T4 and Free T# levels and confirm that symptoms are improved.   Otherwise you will need to find another doctor that will do these things for you.  

To confirm what I have said and also to have info to give your doctor to persuade him, if necessary, please click on my name and then scroll down to my Journal and read the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.

[ElleHolloway]

gismel Thank you so much!!!
I've been looking for a new Primary doctor today since I don't get how my current PCP would just blow me off like she did.   Its very unfortunate that in many areas its difficult to locate a doctor that listens and doesn't refer every little thing out to a specialist.
  
I had done a little research and according to even the minimal amount of lab work I have right now she could have prescribed a small dose of thyroid medication to see if I felt any better.  

My insurance said to find a new one after I informed them of the last visit I had with my current PCP.  I will definitely look on your profile as well for the Overview.  It would be nice to feel human again lol!  You ROCK!

[ElleHolloway]

Ooops misspelled your name lol  

[Red_Star]

I went in to test for Hashimoto's thyroiditis when I strongly suspected I had this autoimmune diseases from my symptoms. TSH was in the mid 2's so right there was a problem! My TSH had been tested for decades and never was below 1.4 or above 1.6 mU/L. Both antibodies were high confirming the diagnosis. My mother and sister have Hashimoto's thyroiditis as well. I've HLADR/DQ gene testing and my genes for Hashimoto's thyroiditis are HLADR4 and DQB1*0301.

***

Hashimoto's thyroiditis...

"In Asians, HLA class I (A2, B16, B35, B46, B51, B54, C3) and HLA class II (DR2, DR9, DR53, DQ4) genes showed an association with the disease [31, 100, 101, 102, 103, 104, 105].

In Caucasians, HT is associated with HLA class II genes such as DR3, DR4, DR5, DQA1*0301, DQB1*0201 and DQB1*0301 [106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120] but not with the HLA-DP and HLA class I (HLA-A, HLA-B and HLA-C) genes [113, 114, 121]."*

*Immunogenetics of Hashimoto's thyroiditis -
J Autoimmune Dis. 2005; 2: 1.
PMID: 15762980

[ElleHolloway]

Red_Star  Thank you for the information. I'm not sure what that all means, I just remember my daughter having the goiter and being tested for the antibodies? Im super weak and tired right now, well most of the time, I have very dry skin, brittle nails, (had a piece of my tooth chip a few days ago, not sure if its related) weight gain in the past year I'm too embarrassed to even say, joint pain, edema in my face , hands, and sometimes legs, vision issues sometimes blurry.  I have more but I don't want to list things that may not be related because I do have other diagnoses.  When my brain starts working again (or maybe thats part of this too IDK) I can be more clear.  God bless you all and I will check back soon.

[gimel]

TSH is affected by so many variables that it is useful as a diagnostic only when at extreme levels.   A TSH within range does not preclude hypothyroidism.  Contrary to the common belief that hypothyroidism is just "inadequate thyroid hormone", in reality the correct definition is "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone".    Since there are no direct measures of TISSUE T3 EFFECT that can be used for diagnosis and treatment, indirect measures must be used instead.  The best indirect measures start with an evaluation for symptoms that occur more frequently with hypothyroidism, supported by expanded testing.  Tests should include Free T4 and Free T3 (not the same as Total T4 and Total T3),  Reverse T3 and cortisol (at least at the start of testing), Vitamin D, B12 and ferritin.   The need for these additional tests is due to their  effect on the body's response to thyroid hormone.  

So, before more discussion, please list all the symptoms you have currently.  

[ElleHolloway]

gimel, Thank you for your explanation and information.  I will post my symptoms as soon as I feel better which I hope will be soon.  I have some type of gastrointestinal going on right now.  I have had Vit D levels tested and most recent was in May Vid D OH?  it was 27 I think?  prior to that it was 32 and prior to that it was 12.  I take a supplement some days.  My B12 and ferritin were also tested in May 2018.  Below are the levels for some of the test including my T4 and TSH 6 months ago.
FERRITIN
85
Reference Range
10-232 ng/mL

FOLATE, ...
8.9
Reference Range
Low:           5.4

T4, FREE
1.1
Reference Range
0.8-1.8 ng/dL

TSH
3.87
Reference Range
0.4 - 4.5 mIU/L

VITAMIN B12
507
Reference Range
200-1100 pg/m

[ElleHolloway]

sorry copied and pasted that so I don't think it looks right.

[Sarahjogs]

Hi ElleHolloway,

I can't answer for sure if you are hypothyroid or not, but I was diagnosed with Hashimoto's with a TSH at 3.44 (range 0.45-4.5), with lots of hypothyroidism symptoms even though my TSH was considered "normal".  

Even if your test range considers up to 5 normal, you are on the very high end of that range and there is some disagreement among the medical field as to whether to treat hypothyroidism at a TSH at 5 or at a lower number since the 95% of people with normal thyroid function will have a TSH below 2.5.

In order to analyze your free T4, we need to know the test range because ranges vary from lab to lab.  If your freeT4 range is similar to my lab's, 0.8 to 1.1 would put you at below 50% of the range.  Many people experience hypo symptoms if their freeT4 is below 50% of the range.

The fact that you are experiencing hypo symptoms, and your TSH is on the high end of normal, (and depending on your FT4 range - if you are on the low end that is also an indicator of a thyroid problem), I would say there is a good chance you have a hypothyroidism issue.  Your doctor has probably referred you to an endocrinologist because your TSH is at the high end of normal (or above normal depending on your range).  Your endocrinologist may want to start you out on a low dose of Synthroid (synthetic T4) and see if that helps with your symptoms and bring your thyroid hormone levels back to a "more normal" level.

Have you ever had the thyroid antibody test for Hashimoto's?  Hashimoto's is a major cause of hypothyroidism in the US and other countries with iodized salt.  If your endocrinologist does not order this test for you, I would push to have it done..  

As for not being cold -  I have gone from "subclinical hypothyroidism" to "full blown hypothyroidism" after having thyroid surgery, with my TSH going up to a peak around 16.  I have experienced a lot of hypothyroidism symptoms while I was subclinical and onwards from that, but never constipation, and my PCP kept asking me if I had constipation problems since that is a major hypo symptom.  I wouldn't worry that you don't have all the symptoms on the list.

Good luck with your appointment, and I hope you get the answers you are looking for and feel better soon.

[ElleHolloway]

Thank you so much Sarahjogs  . Idk when I'll be able to get into the endocrinologist because the area I live in doesn't have many specialist and it takes months to get in.  (I guess that was another reason for me asking  I'm not very patient.)  

The reference range on the  TSH is 040-4.50 (Mine was 4.71) and FT4 is 0.8-1.8 (Mine was 0.9)

I did look back on some labs from a few years ago and there was a T3 Uptake at 25%  I have in an excel document but I didn't put ref. ranges and its not current, on the same date the FreeThyroixine Index was 1.5  and my prolactin was 1.1.  Weird I need to find the actual papers on those cuz thats the only time I had those tests done.

I've never had testing for Hashimoto's but my daughter was diagnosed several years ago,  She had (she passed a 6 years ago) an excellent primary who tested her just based on her goiter and symptoms.  

I don't want this, but I do want to be treated for it if I have it because the older I get the worse my symptoms get and I have a lot of out of whack labs this year.  

Thank you so much again!  

[Sarahjogs]

If it going to be such a long wait to get in to see an endocrinologist, you could see if your primary care provider would be willing to order the antibody test for Hashimoto's and start you on a low dose of Synthroid now.  You can point out that your TSH is out of range, and the main cause of hypothyroidism (at least in US and other countries with iodized salt) is Hashimoto's, and that you are experiencing many hypo symptoms now, and if you wait another 3-4 months, you will likely be more out of range and have to suffer these symptoms for an extended period of time.  

Additionally, I don't know if your primary care provider uses freeT4 to assess thyroid function, but most people feel best when their freeT4 is in the top 50% of the range.  At 0.9, you are in the bottom 10% of the range, and it is not surprising that you are experiencing many hypo symptoms.  (Your freeT4 is actually much lower than mine was when I had a TSH of 16, all people are different, but bottom 10% sounds like you are probably experiencing a lot of hypo symptoms now).

I'm sorry to hear that it is such a long wait for an endocrinologist - that's really frustrating - and for some reason doctors seem really reluctant to order the thyroid antibody test; I had to ask my PCP twice and finally got my ENT to reluctantly order the test.  If you do have Hashi's, the sooner you can start getting treated for it, the better, in my opinion.

I hope you can get some treatment soon!

[ElleHolloway]

Thank you so much.  I have been sick as a dog recently.  I really appreciate your reply! I've got to get over this virus before I even feel well enough to get back to the doctor. =(