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Test Results - Normal TSH, low T4

So, I've been having trouble with depression and weight gain lately, so my doctor tested my Thyroid. I knew nothing about the testing, so I just trusted her and when it came back normal, went on.
Fast forward 6 months, my depression is worse, I get a new therapist and she wants me to get my thyroid checked. When I tell her I already did, she tells me to see what was tested and do some research, apparently doctors will often do one test that isn't super helpful. I started researching and looked at what I had tested: TSH only. (2.02 if it matters later). Huh.
I order a thyroid panel from a local lab, and I got the results today.

TSH                                         2.21 uIU/mL   (.45 - 4.5)
Triiodothyronine,Free,Serum      3.3 pg/mL       (2 - 4.4)
T4,Free(Direct)                         .88 ng/dL        (.82 - 1.77)
Thyroxine (T4)                          4.3 ug/dL        (4.5 - 12)
T3 Uptake                                27 %              (24 - 39)
Free Thyroxine Index                1.2                 (1.2 - 4.9)

So, my T4 is the only thing that is low. What does that mean? I've scheduled an appointment with my doctor (first available is December 11. part of the reason I didn't wait to get her to do the testing, that and I didn't want to go through the hassle of making sure she did the test I wanted) but now I'm freaking out? I mean, I know I won't die from waiting 3 more weeks since it's been over a year since my symptoms started being a problem, but this could be the answer to my issues???

List of symptoms that could be related and other pertinent info.
I'm a 25 year old female.
Worsening depression, on celexa 20 mg just upped to 40. (have had some level of gen anxiety disorder since I was 16, just recently has the depression started and worsening despite meds and therapy)
always cold extremities (and possible low basal body temp. I was told to use a mercury type thermometer, and I don't think I can read it right. It keeps coming up at 95 degrees under the armpit. Regular thermometer is around 97)
Extreme weight gain and difficult weight loss (depression plays a part, but even when I do everything perfectly, the pounds barely move, which often causes more depression and it's just a cluster)
Have trouble getting out of bed in the morning even though I used to be a morning person.
I could stay in bed for 12 hours a day and be perfectly happy.
Have to drink caffeine at work constantly just to stay focused

I think those are the relevant complaints. I also have pretty bad edema in my feet and ankles, but that showed up after I got Mirena, and my periods have always been irregular (and are now gone, thank you Mirena!) Oh, I've also got a really itchy scalp that showed up over the summer and is still here. Ruled out every thing I put on my hair, but I doubt it's related.

What do you guys think? Honestly, I don't even care about anything but the depression. It's hard not to feel hopeless all the time because I just felt like even when I had things under control, it slowly crept back up before I knew it I was crying all the time going to be at 8 o'clock every single night.
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Avatar universal
I am very doubtful that the change in diet is going to achieve what you need.  If your Free T4 is below normal that is a very severe deficiency.  Were you also tested for Free T3?  If not you should make sure they always test for both Free T4 and Free T3, which are the biologically active thyroid hormones.

Were you also tested for TSH?  The main value for a TSH test is to identify overt hypothyroidism (TSH >10) and to distinguish between primary and central hypothyroidism.  With primary the thyroid gland is being attacked and eventually destroyed by the antibodies of Hashimoto's Thyroiditis.  With central there is a dysfunction in the hypothalamus/pituitary system which results in low TSH and thus low Free T4 and Free T3.  

If you will please post all your thyroid related test results and their reference ranges shown on the lab report we will be glad to try and give you further info that you may need to know.

Helpful - 0
Avatar universal
What was the turn out of this issue? I am a 25 year old female with a very similar situation. Started having unusual weight gain, depression, and COULD NOT loose the weight to save my life. my gyno tested my thyroid and my cortisol (stress hormone) levels were super high, meaning my body was stressed. and my free T4 is below normal. She offered medicine to boost my thyroid but then my thyroid would forget how to work on its own and I would have to take the medication the rest of my life. So I did my research and I truly believe that food is the medicine for all. So I am trying a paleo diet now to see if removing all the crap and junk from my diet will help before committing to the medicine for life. I get my blood tested again in a few weeks after 6 weeks paleo.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Your Total T4 is low, because your thyroid isn't making very much.  Free T4 is converted to Free T3 prior to being used by the individual cells, so nearly everything your thyroid is making is being converted to Free T3, which is the hormone that correlates best with symptoms - that's what's keeping you going.  Many doctors don't really understand the way it works... my previous doctor thought Free T3 was for "research" purposes only - he hadn't a clue that without adequate Free T3, I could never get well.

Remember there are 2 antibody tests, TPOab and TgAb.  You need them both, because either of them are the basis for a Hashi's diagnosis and some of us only have one or the other, some have both.  
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Avatar universal
Thanks. I'll make sure to talk to her about the antibodies test.

Is it weird my total T4 is low, but my free T4 is within normal range (though, as you said, on the very bottom end of the spectrum) and my free T3 is in the middle of the range?
Seems...backwards. Ugh, I guess it doesn't matter. Things to ask my doctor. I am just impatient! I feel like I'm close to finally getting back on track.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
It's always helpful to do research and know what you want from your doctor.  Years ago, doctors would prescribe thyroid medication, based on symptoms, but back in the early 80's it was decided that a simple TSH test was sufficient to diagnose (or rule out) a thyroid issue and that's what has been being taught in med school, so that's what the majority of doctors are doing and calling it good.  They're leaving a lot of patients undiagnosed or being diagnosed with things such as depression, fibromyalgia, etc when what they really need is thyroid hormones.

Now that there are tests for the Free T3 and Free T4, some doctors are beginning to test for those as well as going back to treating by symptoms.

Another thing you should do right away is get your doctor to test thyroid antibodies, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb) to determine if you have Hashimoto's Thyroiditis.  Hashimoto's is an autoimmune disease in which the body sees the thyroid as foreign and produces antibodies to destroy it.  The destruction, typically, takes years, but as it progresses, the thyroid produces less and less thyroid hormones, T3 and T4.  

The thyroid produces mostly T4 and very little T3. Of the Total T4 produced, most is bound by protein and can't be used. This is why we test Free (unbound) T4.  Free T4 isn't used directly by the individual cells; it must converted to T3.  As with T4, most of the T3 in your blood is bound by protein and can't be used, so again, we test Free (unbound) T3 to determine what's available for the individual cells.

With Hashimoto's, eventually, the thyroid will be completely destroyed and it will produce no hormones on its own, at which time the body is completely dependent on thyroid replacement medication.

Forgot to mention that hair issues are also symptoms of hypothyroidism.
Helpful - 0
Avatar universal
My therapist is only a counselor, not a psychiatrist, so my GP will have to be the one that prescribes anything.
She seems like she's open to thyroid issues (she suggested the first TSH test) but I am a little worried since she apparently didn't know about the better tests. But, at least I know a little more about what I'm looking at, and if she's unwilling to look at options based on Free T3 and Free T4, I guess I'll find another doctor.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Your depression could very well be caused by under active thyroid (or at least partially so).

In the thyroid panel you ordered, the only tests that are really important are the Free T3 and Free T4 tests.  Thyroxine (T4) is Total T4 and not very useful; T3 Uptake and Free Thyroxine Index are both outdated methods of calculating Free T4.  TSH is a pituitary hormone that stimulates the thyroid to produce thyroid hormones.  So next time you have a thyroid panel, just get Free T3, Free T4 and TSH.  

Your other symptoms also are those of under active thyroid and even though your Free T3 and Free T4 are both "in range", they are quite low (your Free T4 is only at 6% of its range and rule of thumb is to have it at about mid range) in the ranges.  I would say you're definitely hypo.  Is your therapist willing to prescribe thyroid replacement hormones or will your primary doctor prescribe it?

Many doctors only go by TSH, so it might be difficult to get treatment, since your TSH is right where most doctors would consider it perfect.  In addition, many doctors think TSH is the only test that needs to be done for thyroid function, totally ignoring Free T3 and Free T4, which are the actual thyroid hormones.  
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