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TSH w reflex to ft4 = 0.02 What does it mean?

I went to the doctor because I've been having headaches behind my eyes and in my sinus area.  I'm tired much more than I used to be, my fingernails have become paper thin, and I feel like I'm having a harder time focusing. My eyes get so dry at night that I have to wake up and put drops in them.I don't have an appetite, but I gain weight easily. (I am female, late 40's, 5'5", 110 lbs) I exercise vigorously most mornings.

He did this blood test: TSH 2 reflex to ft4 - the result was 0.02.
He is on vacation, but the nurse called to ask if I have heart palpitations, or excessive sweating.  I don't.  
She said I have an overactive thyroid, and requested blood tests to confirm it.  They also came back consistent with a hyperthyroid result, but I don't know what tests they did.  It confused me because I don't lose weight easily and I don't have a big appetite - I thought those were the main symptoms.
She said they will monitor it and have me tested in another 2 weeks to see if they number stays the same.

I'm curious to know what might be going on, because the doc won't be back for another week.  The headaches linger and often I have clear blurry spots in my vision when they begin.  It's starting to worry me a little.

I appreciate any feedback about that TSH test result.
Thanks.
Best Answer
Avatar universal
This is the tricky part about interpreting the TSI test.  The reference range is "<140%", so if your result is <140, you don't have Graves', right?  Nope, too logical, wrong, of course!  The fact of the matter is that people who don't have Graves' don't produce TSI and have TSI of <2%.  The whole gray area between 2% and 140% is where antibodies are active (i.e. you do have thyroid autoimmunity), but symptoms usually don't occur until levels get to around 140%.

Once under treatment for hyper, TSI can be used to monitor response to anti-thyroid drugs (ATMs) and to help predict remission.  Interestingly, levels should fall below 20% before discontinuing ATMs.  (I used to have a really good link for this, but the site seems to have shut down, so I'm paraphrasing from the printout I have.)    
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Avatar universal
Reference ("normal") ranges vary lab to lab, so they have to come from your own lab report.  Your results are posted above, but I need the range to see where in it you fall.  The range should be somewhere near the result on the report.  It's often in parentheses and should be something close to (0.8-1.8).

No FT3?
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Avatar universal
Years of hypo I was seeing a endo for years but I couldn't get him to help my symptoms. I am now seeing a internalist. I am confused with my TSH results. They are low but my Free T4 are ok now?
Thanks for your opinion, LorryK
See test results below:
Currently I take 88mcg levothyroxine
As of 10/27/15 I began 25mcg liothyronine
Bupropion Hal ear (do) 150mg TB24 (1 daily) depression

  Date.       TSH    Free T4
12/11/15    .010      0.8  
10/27/51    .010      0.9  88mcg levothyroxine and liothyronine
09/04/15    .032      1.3  150mcg
11/15/14    .037      1.4  here I was taking 150mcg
10/06/14  9.106      I was for years taking 125mcg  
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Avatar universal
What's the reference range on your FT4?  Ranges vary lab to lab, so you have to post them with results so we can see where in the range you are.  

Please also post FT3 results and ranges.

How are you feeling now?
Helpful - 0
Avatar universal
Sorry about the auto text.
levothyroxine 88mcg
Liothyronine 25mcg
Helpful - 0
Avatar universal
Years of hypo I was seeing a endo for years but I couldn't get him to help my symptoms. I am now seeing a internalist. I am confused with my TSH results. They are low but my Free T4 are ok now?
Thanks for your opinion, LorryK
See test results below:
Currently I take 88mcg levothyroxine
As of 10/27/15 I began 25mcg liothyronine
Bupropion Hal ear (do) 150mg TB24 (1 daily) depression

  Date.       TSH    Free T4
12/11/15    .010      0.8  
10/27/51    .010      0.9  88mcg levothyroxine and liothyronine
09/04/15    .032      1.3  150mcg
11/15/14    .037      1.4  here I was taking 150mcg
10/06/14  9.106      I was for years taking 125mcg  
Helpful - 0
Avatar universal
Yes, hypothyroid.  Your TSH is high, and as you can see your FT4, which is much more important, is on the bottom of the range.  Many of us find that FT4 has to be about the middle (1.3 on your range) of the range for us to feel well.

Do you have hypo symptoms?

Next time you have labs, insist of FT3 being included and start keeping copies of your lab reports so you have your own history.
Helpful - 0
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