Thyroid Issue? And recommendations

[WG_THY]

I have had virtually every hypothyroid symptom for years but my tests always come back “normal”.

Fatigue, hair loss (including extremities almost hairless), constipation, brain fog, joint issues, weight gain and many more.

Most recently I have developed pretty severe high blood pressure and am currently on medication trying to get it under control.  

As part of that they did a TSH w/ reflex. It came back at 2.1 mIU/L (0.4-4.5).  No FT4 bc the TSH was normal.

Last time it was done it was 1.22 on the same scale, which was the lowest I’d seen it. Again, no FT4.

My TSH has hovered around 1.6-1.8 for years.  My FT4 has been 1.1 (8.8-1.8) for years, however the very last one I got it dropped to 1.0 (0.8-1.8). I don’t recall my handful of FT3 but know they were below mid-range but not quite as low as the FT4 was in its range. I got one RT3 done and it was high. All discounted by my doctor.

I’ve had some personal distractions and with the high BP I am refocusing on my health. Skipping docs for thyroid now and am trying for getting the testing done myself. (Any recs how/where?)

So with this limited info, should I truly discount a thyroid issue?  My symptoms all point that way but each could be something else, so maybe I have 7-8-9 other issues?

Testing was going to do to see if I should consider going thousands OOP to see a naturopath are TSH, FT4, FT3, RT3. Is this enough to get a feel?  Anything else?

I have a positive ANA, but no anti-thyroid antibodies — think lupus or RA.

High BP feels more hyper but read it can appear after untreated hypo, too.

Thoughts?  Questions?  Appreciate any help. Thank you.

[gimel]

FT4 is a pro-hormone that must be converted to T3 before it is used by the body.  Free T3 largely regulates metabolism and determines a person's thyroid status.   However you need adequate FT4 to be available for conversion.   So in assessing a person's thyroid status, symptom evaluation is primary, followed by tests for FT4 and FT3 taken together.  

Note that everyone can be different in the thyroid levels at which they feel normal.  That said, your FT3 was at mid-range, while  your FT4 was only 20% of its range.  Taken together, they are too low for many people.   In addition your FT3 being that much higher in range than FT4 may indicate that your body is converting extra T4, trying to maintain thyroid function as best possible.  

In addition, don't overlook the importance of having adequate levels of Vitamin D, B12 and ferritin, as mentioned previously.   If not tested for those, I highly recommend getting that done ASAP.   If tested for either, please post results.  And you also need to locate a good thyroid doctor who will pay attention to symptoms, and both FT4 and FT3 instead of just TSH.  I hope you can locate one in the link I gave you above.  

To answer your question on RT3, at your level I see no reason for any concern there.   Lab variability won't change that.

[gimel]

https://www.thyroidchange.org/patient-recommended-doctor-list-us.html

[gimel]

Too difficult fo  me to try and hit an area for you.  There is a site that lists doctors recommended by thyroid patients.  The criteria required for listing are the following:I  

1. ​Orders Full Thyroid Labs
Willing to order comprehensive thyroid testing (not just TSH) including Free T3, Free T4, Reverse T3, in addition to TSH and thyroid antibodies.


2. ​Open To Treatment Options
Willing to treat with T3-containing medication options such as liothyronine (T3), liothyronine plus levothyroxine (T4), and/or natural desiccated thyroid.​​

3. Patient-Centered Approach
Listens carefully and has an  emphasis on the patient symptom report. While this is subjective, the listed practitioners were thought to exhibit this quality.


Following is a link.  When you have it shown, click on the column for states, and it will put them in order, to make it easier for you to locate a doctor in your area.  

Please let us know how things progress for you.

[WG_THY]

Hello, thank you for this.

Just got my test results

TSH  1.52 (0.4-4.5)
FT3  3.3 (2.3-4.2)
FT4 1.0 (0.8-1.8)
RT3 13  (8-25)

So RT3 doesn’t seem a problem. All are normal.

Only question I have is whether it matters the RT3 was done at a different lab. Assume not…probably not every lab can do it.

Thanks for the help.

[gimel]

I suggest an early morning  blood draw for those tests.   Do make sure to get tested for Vitamin D, B12 and ferritin for sure.  Important.   I am looking for doctor recommendations.

[gimel]

You certainly have a number of typical hypothyroid symptoms.  Your FT4 is too low in the range for many people.  You do need to get tested for FT3 every time you  go for tests.   Everyone can be different in their thyroid needs, but most people seem to do best when their FT3 is mid-range or slightly above, and RT3 is not high.    In addition Vitamin D should be at least 50 ng/ml, B12 in the upper part of its range, and ferritin should be at least 100.  Low ferritin can cause some symptoms that mimic hypothyroidism.   So you need to get those tested and supplement as needed to optimize.  

In case you do need to find a good thyroid doctor, tell us your location and perhaps we can suggest one near you.  

[WG_THY]

Thanks Gimel!  

I have a hard time getting past the TSH w/ reflex.

I’ve ordered my own TSH, FT4, FT3 and RT3. Wondering if it makes a difference what time of day I get them done. Can you make a recommendation?

I’ll try to get my PCP to get a current Vit D and B12. Post menopausal so unlikely ferritin is low. I have had it checked a few years ago. I’d have to double check the result but believe it was 70-90.  

Will report back when I have my results.

If there’s anything else I should check/do, please lmk. Thanks!

FYI, I’m in southern NY area. Could do CT, NY or N. NJ.

[WG_THY]

Should also mention cold all the time and have battled vit D and vit b12 deficiency for several years as well.