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Thyroid Issue or keep researching?
I am jumping through hoops trying to determine the cause of my fatigue. The more I research I would almost put money on it that I am hypo. Fatigue is not even the word to describe it, there are no words. I feel so out of my body. I cannot focus, can barely drive myself home from work, zero libido, hair falling out..ect Here are some of the test results, I have had 50 + done but thought these were relevant. Aparently total t3 is the only test available.
TSH 1.49 0.10 - 5.50 uIU/mL
TPO AB <10 <=35 IU/mL
Thyroglobulin 9.1 0.0 - 55.0 ng/mL
Thyroglobulin AB <20.0 <=20.0 IU/mL
T3, Total 67 50 - 170 ng/dL
CK 604 <=200 U/L
TPO AB <10 <=35 IU/mL
Free T4 0.8 0.8 - 1.7 ng/dL
TSH 1.49 0.10 - 5.50 uIU/mL
TPO AB <10 <=35 IU/mL
Thyroglobulin 9.1 0.0 - 55.0 ng/mL
Thyroglobulin AB <20.0 <=20.0 IU/mL
T3, Total 67 50 - 170 ng/dL
CK 604 <=200 U/L
TPO AB <10 <=35 IU/mL
Free T4 0.8 0.8 - 1.7 ng/dL
Best Answer
Did you get some other vitamin levels as well tested?
In particular:
Vit D3
Vit B-12
Iron
Ferritin
These also all contribute to fatigue.
Your tests show you do NOT have Hashimoto's.
Your Free T4 is at the VERY bottom of the range which many if not most people will feel Hypo.
You have only been tested for TOTAL T3 which is an outdated test of little value. However it shows that you are only 14% of the range which is also very low.
So both of the thyroid hormone tests show that you are low and are consistent with being Hypo as well as are all your symptoms.
The problem you have is that your TSH which is a virtually useless test that is a screening test at best shows what most Dr's would consider about PERFECT. Therefore I would not be suprised if your Dr is telling you that "youre normal". and that it isn't your thyroid and is refusing to treat you. Am I right?
If so I would HIGHLY recommend that you find another Dr. Any Dr that goes only by TSH will keep you feeling like crap!
Just my opinions!
In particular:
Vit D3
Vit B-12
Iron
Ferritin
These also all contribute to fatigue.
Your tests show you do NOT have Hashimoto's.
Your Free T4 is at the VERY bottom of the range which many if not most people will feel Hypo.
You have only been tested for TOTAL T3 which is an outdated test of little value. However it shows that you are only 14% of the range which is also very low.
So both of the thyroid hormone tests show that you are low and are consistent with being Hypo as well as are all your symptoms.
The problem you have is that your TSH which is a virtually useless test that is a screening test at best shows what most Dr's would consider about PERFECT. Therefore I would not be suprised if your Dr is telling you that "youre normal". and that it isn't your thyroid and is refusing to treat you. Am I right?
If so I would HIGHLY recommend that you find another Dr. Any Dr that goes only by TSH will keep you feeling like crap!
Just my opinions!
All of the tests you mentioned came back normal also. I have just recently started pushing for additional testing and waiting to hear back. I am guessing it’s going to be a battle, but I am ready. I read on Wikipedia that the ck is useful in determining hypo and has an adverse relationship with T3. Maybe with the ck being of the chart, they will do it. I am also testing for acth tomorrow. I have crazy low blood pressure and pulse. I was given a clean bill of health from the cardiologist.
Just want to say, some of the stuff I've seen, indicates that thyroid antibody tests aren't the end all be all for diagnosing autoimmune thyroid disease, since a significant fraction of normal people have elevated levels, and a very high percentage of especially hypothyroid patients have normal thyroid antibodies.
There is also central (pituitary related) hypothyroidism, not just autoimmune. In Central you have low or _normal_ TSH and low T3/T4.
Another suggestion is to get an ultrasound of your thyroid. Beware an US may show nodules, when then might need a biopsy.
Finally, what is important is for the doctor to fully investigate what's going on, so that you get the correct treatment. You don't want to prematurely focus on just the thyroid, since other conditions might be the real cause.
If everything else they check shows up okay, you might ask for a trial of a small dose of thyroid meds, and see if that helps and how your labs respond to that.
There is also central (pituitary related) hypothyroidism, not just autoimmune. In Central you have low or _normal_ TSH and low T3/T4.
Another suggestion is to get an ultrasound of your thyroid. Beware an US may show nodules, when then might need a biopsy.
Finally, what is important is for the doctor to fully investigate what's going on, so that you get the correct treatment. You don't want to prematurely focus on just the thyroid, since other conditions might be the real cause.
If everything else they check shows up okay, you might ask for a trial of a small dose of thyroid meds, and see if that helps and how your labs respond to that.
Doctors are generally more receptive to printed material, plus scientific studies, than they are to just verbal information from the patient. So I suggest that you take a copy of this link and mark on there which hypo symptoms you have. There are many others besides the 26 listed, but those are typical symptoms. Then you can give a copy to the doctor and show him all the hypo symptoms you have.
http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html
When he tells you that your thyroid test results are "normal", you can then explain that with secondary hypothyroidism, the TSH remains low and thus thyroid hormone levels are also low. If the doctor reminds you that your thyroid hormone levels are within the ranges, you can give him a copy of the following link that is a scientific study from which they concluded:
"High individuality causes laboratory reference ranges to be insensitive to changes in test results that are significant for the individual.
The width of the individual 95% confidence intervals were approximately half that of the group for all variables.
Our data indicate that each individual had a unique thyroid function. The individual reference ranges for test results were narrow, compared with group reference ranges used to develop laboratory reference ranges. Accordingly, a test result within laboratory reference limits is not necessarily normal for an individual."
Andersen S, Pedersen KM, Bruun NH, Laurberg P. Narrow individual variations in serum T(4) and T(3) in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab. 2002 Mar;87(3):1068-72.
Then you can tell him that from what you've learned, the best way to treat a hypo patient is clinically, by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can also give the doctor a copy of this letter, written by a good thyroid doctor, for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
You can also give the doctor a copy of this scientific study which concluded that the only thyroid test that correlates well with hypothyroid symptoms was Free T3. Free T4 and TSH did not correlate at all.
http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002
If all this fails to get through to your doctor and get you a prescription for thyroid meds, then obviously you need to find a good thyroid doctor that will treat clinically, as described.
http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html
When he tells you that your thyroid test results are "normal", you can then explain that with secondary hypothyroidism, the TSH remains low and thus thyroid hormone levels are also low. If the doctor reminds you that your thyroid hormone levels are within the ranges, you can give him a copy of the following link that is a scientific study from which they concluded:
"High individuality causes laboratory reference ranges to be insensitive to changes in test results that are significant for the individual.
The width of the individual 95% confidence intervals were approximately half that of the group for all variables.
Our data indicate that each individual had a unique thyroid function. The individual reference ranges for test results were narrow, compared with group reference ranges used to develop laboratory reference ranges. Accordingly, a test result within laboratory reference limits is not necessarily normal for an individual."
Andersen S, Pedersen KM, Bruun NH, Laurberg P. Narrow individual variations in serum T(4) and T(3) in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab. 2002 Mar;87(3):1068-72.
Then you can tell him that from what you've learned, the best way to treat a hypo patient is clinically, by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can also give the doctor a copy of this letter, written by a good thyroid doctor, for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
You can also give the doctor a copy of this scientific study which concluded that the only thyroid test that correlates well with hypothyroid symptoms was Free T3. Free T4 and TSH did not correlate at all.
http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002
If all this fails to get through to your doctor and get you a prescription for thyroid meds, then obviously you need to find a good thyroid doctor that will treat clinically, as described.
Thank you for all the great information. I just did an acth test this morning and waiting for results. If that doesnt pan out I will start pushing the thyroid issue. I really hope this is an adrenal issue because I can already tell its going to be a battle. The nurse said my thyroid levels look great.
COMMUNITY LEADER
Can you please post the actual results, and reference ranges, for the B12, D, Ferritin and iron?
Vitamin B12 >1000 > 200 pg/mL
VITAMIN D, 25-HYDROXY 43 20 - 79 ng/mL
Ferritin 44 22 - 291 ng/mL
WBC COUNT 7.3 3.5 - 12.5 K/uL
Red blood cells count 4.47 3.60 - 5.70 M/uL
Hgb 13.3 11.5 - 15.0 g/dL
Hematocrit 40.0 34.0 - 46.0 %
MCV 90 80 - 100 fL
RDW, RBC 13.1 12.0 - 16.5 %
Platelets count 281 140 - 400 K/uL
Neutrophils %, automated count 66 41 - 81 %
Lymphocytes %, automated count 28 13 - 46 %
Monos %, auto 6 4 - 12 %
Eosinophils %, automated count 0 0 - 4 %
Basophils %, automated count 0 0 - 1 %
Neutrophils auto count 4.8 2.1 - 7.7 K/uL
Iron 61 50 - 212 ug/dL
Iron binding capacity, unsaturated 357 110 - 370 ug/dL
Total iron binding capacity 418 228 - 428 ug/dL
Transferrin % saturation 15 14 - 57 %
VITAMIN D, 25-HYDROXY 43 20 - 79 ng/mL
Ferritin 44 22 - 291 ng/mL
WBC COUNT 7.3 3.5 - 12.5 K/uL
Red blood cells count 4.47 3.60 - 5.70 M/uL
Hgb 13.3 11.5 - 15.0 g/dL
Hematocrit 40.0 34.0 - 46.0 %
MCV 90 80 - 100 fL
RDW, RBC 13.1 12.0 - 16.5 %
Platelets count 281 140 - 400 K/uL
Neutrophils %, automated count 66 41 - 81 %
Lymphocytes %, automated count 28 13 - 46 %
Monos %, auto 6 4 - 12 %
Eosinophils %, automated count 0 0 - 4 %
Basophils %, automated count 0 0 - 1 %
Neutrophils auto count 4.8 2.1 - 7.7 K/uL
Iron 61 50 - 212 ug/dL
Iron binding capacity, unsaturated 357 110 - 370 ug/dL
Total iron binding capacity 418 228 - 428 ug/dL
Transferrin % saturation 15 14 - 57 %
COMMUNITY LEADER
Hmmm - your B12 is WAY up there, but it's not toxic, so shouldn't be an issue. Do you take a B12 supplement?
Your vitamin D is relatively low in the range; are you supplementing that? Low Vitamin D can cause many hypo like symptoms. It's recommended to keep vitamin D near the higher end of the range.
Your ferritin is also lower in the range, as is your actual iron. Do you take an iron supplement?
"Aparently total t3 is the only test available." No, all major labs in the U.S can run Free T3....... It's most likely that your doctor is not "up" on current protocol and is still ordering the Total T3, which is considered obsolete and of little value. Ask for another set of thyroid (TSH, FT3/FT4) labs and specify that you want Free T3, not total. If your doctor refuses, find another, asap.
Your vitamin D is relatively low in the range; are you supplementing that? Low Vitamin D can cause many hypo like symptoms. It's recommended to keep vitamin D near the higher end of the range.
Your ferritin is also lower in the range, as is your actual iron. Do you take an iron supplement?
"Aparently total t3 is the only test available." No, all major labs in the U.S can run Free T3....... It's most likely that your doctor is not "up" on current protocol and is still ordering the Total T3, which is considered obsolete and of little value. Ask for another set of thyroid (TSH, FT3/FT4) labs and specify that you want Free T3, not total. If your doctor refuses, find another, asap.
I think at the time I took the test I was drinking a lot of zip fizz to get by. That is loaded with b vitamins.. I do not supplement either iron or vit D. I take a pre natal multi vitamin. According to my fitness pal I am meeting my iron needs.
Now that I am working with the endocrinology department directly, I am guessing I will have better luck.
Now that I am working with the endocrinology department directly, I am guessing I will have better luck.
I am on a fitness facebook group and they keep telling me to go gluten free yadda yadda. I did for 2 weeks a while bag and it did nothing. At this point I am willing to consider anything. Its just a lot of work and planning and I am not sure I have the energy for it. Thoughts?
COMMUNITY LEADER
Aahh, well if you were doing the zip fizz, it's understandable that your B-12 would be high; apparently, you absorb it well, so that's not an issue.
"I take a pre natal multi vitamin." Are you pregnant?
How did you determine your iron needs on my fitness pal? While you may taking in enough iron to meet your goal, you may not be absorbing enough, which would tend to keep your levels lower. Additionally, ferritin is a a storage hormone for iron and yours is relatively low, meaning you don't have much in reserve, which is just as important and having enough circulating iron.
Low vitamin D levels can cause many hypo-like symptoms; if you don't treat it (supplement), you'll never know if symptoms are thyroid related or vitamin D related.
Gluten free is very controversial. There are groups that think g/f is almost a cure-all for thyroid disorders; however, there is no scientific evidence to prove that it does anything to improve thyroid function or reduce antibody levels. The only time people really need to go g/f is if they have a real intolerance or allergy to gluten (aka celiac). Of course, if a food bothers you, you'd stop eating it; however, why go to all that trouble if you don't have to? Embarking on a g/f diet is very difficult and can be expensive; *I* certainly wouldn't do it without a darn good reason.
Did you hear back on the ACTH test yet?
"I take a pre natal multi vitamin." Are you pregnant?
How did you determine your iron needs on my fitness pal? While you may taking in enough iron to meet your goal, you may not be absorbing enough, which would tend to keep your levels lower. Additionally, ferritin is a a storage hormone for iron and yours is relatively low, meaning you don't have much in reserve, which is just as important and having enough circulating iron.
Low vitamin D levels can cause many hypo-like symptoms; if you don't treat it (supplement), you'll never know if symptoms are thyroid related or vitamin D related.
Gluten free is very controversial. There are groups that think g/f is almost a cure-all for thyroid disorders; however, there is no scientific evidence to prove that it does anything to improve thyroid function or reduce antibody levels. The only time people really need to go g/f is if they have a real intolerance or allergy to gluten (aka celiac). Of course, if a food bothers you, you'd stop eating it; however, why go to all that trouble if you don't have to? Embarking on a g/f diet is very difficult and can be expensive; *I* certainly wouldn't do it without a darn good reason.
Did you hear back on the ACTH test yet?
I am not pregnant, but I figured the extra vitamins would be a good thing since I am running a lot right now. I was hoping to try for another baby after my race in October, but I still do not have a period. It must all be related. I stopped lactation completely at the end of February.
Thank you for bringing the iron to my attention because I just looked at the settings. It defaults to tell you what you should aim for. I never really looked until now. There are some flaws, when you add the supplements it puts the % instead of the mg. The recommendation I see online is 18 mg, the vitamin has 27 mg. Isnt that enough? That plus what I eat in a day? I eat a ton of green vegetables, fruit, chicken, and red meat. My diet is squeaky clean. To be honest, the way I eat I should be skinny minny. I have been struggling to lose bodyfat , actually its always been a stuggle.
I am not really sold on the GF as the cure all, but I am so desperate I thought I would bring it up. I tested for celiac. The group is telling me I could still have a gluten sensitivity. I did GF for 2 weeks with my son and felt no difference. That is why I am resistant to go there because it requires time/organization that I do not have the energy for.
I only have the baseline acth # 13.
Thank you for bringing the iron to my attention because I just looked at the settings. It defaults to tell you what you should aim for. I never really looked until now. There are some flaws, when you add the supplements it puts the % instead of the mg. The recommendation I see online is 18 mg, the vitamin has 27 mg. Isnt that enough? That plus what I eat in a day? I eat a ton of green vegetables, fruit, chicken, and red meat. My diet is squeaky clean. To be honest, the way I eat I should be skinny minny. I have been struggling to lose bodyfat , actually its always been a stuggle.
I am not really sold on the GF as the cure all, but I am so desperate I thought I would bring it up. I tested for celiac. The group is telling me I could still have a gluten sensitivity. I did GF for 2 weeks with my son and felt no difference. That is why I am resistant to go there because it requires time/organization that I do not have the energy for.
I only have the baseline acth # 13.
COMMUNITY LEADER
With what you're taking for iron, it should be enough, so the question arises as to whether or not you are absorbing it properly.
I don't know how much vitamin D is in your caltrate, but probably not enough, even if it says it's 100% of the RDA. Most of us need up 2000 IU/day, in order to keep levels higher.
"I eat a ton of green vegetables, fruit, chicken, and red meat." Whether or not you would lose weight, depends on other factors, too. How are you preparing that chicken? Or the veggies? While the veggies are great, adding sauces, etc makes them completely different. Fruit, typically, has a lot of sugar in it, which through blood sugar levels out of whack, causing insulin spikes.
Do you get much exercise? While some people find that they can lose/control weight with just diet, I find that if I don't get some exercise, at least 3 times/week, I can't lose an ounce.
It's possible to have gluten intolerance, even without celiac; however, few people really do. If you didn't feel any different after 2 weeks, it's probably not going to help you. It's possible to actually cause yourself to become gluten sensitive, by going g/f when you don't need to.
I don't know how much vitamin D is in your caltrate, but probably not enough, even if it says it's 100% of the RDA. Most of us need up 2000 IU/day, in order to keep levels higher.
"I eat a ton of green vegetables, fruit, chicken, and red meat." Whether or not you would lose weight, depends on other factors, too. How are you preparing that chicken? Or the veggies? While the veggies are great, adding sauces, etc makes them completely different. Fruit, typically, has a lot of sugar in it, which through blood sugar levels out of whack, causing insulin spikes.
Do you get much exercise? While some people find that they can lose/control weight with just diet, I find that if I don't get some exercise, at least 3 times/week, I can't lose an ounce.
It's possible to have gluten intolerance, even without celiac; however, few people really do. If you didn't feel any different after 2 weeks, it's probably not going to help you. It's possible to actually cause yourself to become gluten sensitive, by going g/f when you don't need to.
Between the 2 I am getting 800 iu. Not sure how much I am getting from my diet. The chicken is always grilled with mrs dash and my vegetables are always plain. I eat a ton of broccoli and that is boiled.
I run 6 days a week and training for my 4th marathon. I have always been very active.
I run 6 days a week and training for my 4th marathon. I have always been very active.
just started more vitamin d today. feeling like giving up. the endo that reviewed my chart says there is nothing else she can offer me. thinking of getting another opinion. Something has to give. i am struggling everyday just to be awake.
Hello, I just wanna add this idea into this thread.. Looks like your thyroid studies are fine. It looks like Magnesium Deficiency instead. Much easier to treat.
Its cut and paste since I can't put in the website link: Just to illustrate about the importance of Mg in our bodies.
More on Youtube: Search Magnesium Deficiency. I think its what you need
In the following study we see that nearly half of patients complaining of chronic fatigue symptoms and fibromyalgia (companion diseases to hypothyroidism) have magnesium deficiencies.
Magnes Res 1997 Dec;10(4):329-37
Magnesium deficit in a sample of the Belgian population presenting with chronic fatigue.
Department of Internal Medicine, University Hospital, Antwerp, Belgium.
97 patients (25 per cent males, ages ranging from 14 to 73 years, median 38 years) with complaints of chronic fatigue (chronic fatigue syndrome, fibromyalgia or/and spasmophilia) have been enrolled in a prospective study to evaluate the Mg status and the dietary intake of Mg. An IV loading test (performed following the Ryzen protocol) showed a Mg deficit in 44 patients. After Mg supplementation in 24 patients, the loading test showed a significant decrease (p = 0.0018) in Mg retention. Mean values of serum Mg, red blood cell Mg and magnesuria showed no significant difference between patients with or without Mg deficiency. No association was found between Mg deficiency, CFS or FM. However serum Mg level was significantly lower in the patients with spasmophilia than in the other patients.
The following study also shows that fibromyalgia is associated with magnesium deficiency. Very importantly it also indicates that magnesium deficiency may be a consequence of thiamine (vitamin B-1) deficiency and that selenium status is slightly correlated with magnesium levels. This shows that there is some interdependence of selenium and magnesium and that thiamine may be critical for magnesium metabolism and possibly selenium metabolism.
Its cut and paste since I can't put in the website link: Just to illustrate about the importance of Mg in our bodies.
More on Youtube: Search Magnesium Deficiency. I think its what you need
In the following study we see that nearly half of patients complaining of chronic fatigue symptoms and fibromyalgia (companion diseases to hypothyroidism) have magnesium deficiencies.
Magnes Res 1997 Dec;10(4):329-37
Magnesium deficit in a sample of the Belgian population presenting with chronic fatigue.
Department of Internal Medicine, University Hospital, Antwerp, Belgium.
97 patients (25 per cent males, ages ranging from 14 to 73 years, median 38 years) with complaints of chronic fatigue (chronic fatigue syndrome, fibromyalgia or/and spasmophilia) have been enrolled in a prospective study to evaluate the Mg status and the dietary intake of Mg. An IV loading test (performed following the Ryzen protocol) showed a Mg deficit in 44 patients. After Mg supplementation in 24 patients, the loading test showed a significant decrease (p = 0.0018) in Mg retention. Mean values of serum Mg, red blood cell Mg and magnesuria showed no significant difference between patients with or without Mg deficiency. No association was found between Mg deficiency, CFS or FM. However serum Mg level was significantly lower in the patients with spasmophilia than in the other patients.
The following study also shows that fibromyalgia is associated with magnesium deficiency. Very importantly it also indicates that magnesium deficiency may be a consequence of thiamine (vitamin B-1) deficiency and that selenium status is slightly correlated with magnesium levels. This shows that there is some interdependence of selenium and magnesium and that thiamine may be critical for magnesium metabolism and possibly selenium metabolism.
COMMUNITY LEADER
800 IU of vitamin D daily is probably not enough to actually bring your levels up.
A second opinion is always a good idea. You probably wouldn't need to repeat ALL of the blood tests, but do repeat TSH and FT4 and be sure to ask for Free T3. You could also ask for a trial of thyroid hormone, just to see if it helps you feel better. Some doctors will do that; others won't.
A second opinion is always a good idea. You probably wouldn't need to repeat ALL of the blood tests, but do repeat TSH and FT4 and be sure to ask for Free T3. You could also ask for a trial of thyroid hormone, just to see if it helps you feel better. Some doctors will do that; others won't.
With those hypo symptoms, and your Free T4 so low in the range, I think you will find that when tested, your Free T3 will also be low in the range, which is often the cause for hypothyroid symptoms. You need to get your doctor to always test for Free T3 along with the Free T4, and as Barb suggested, you need to get your doctor to start you on a therapeutic trial of thyroid med to see what effect it has on your symptoms. If the doctor is unwilling to test for Free T3 and also to treat clinically, as described in this link I previously gave you, then you need to find a good thyroid doctor that will do so.
http://hormonerestoration.com/files/ThyroidPMD.pdf
http://hormonerestoration.com/files/ThyroidPMD.pdf
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This is because the "normal" ranges are established poorly or just plain incorectly.
the "normal" ranges are established by taking the data of all the people in the area of the lab that takes the tests. Then they throw out the Highest 2.5% and the lowest 2.5% and call the remaining 95% as "normal".
The problem with that is the only people likely to get tested for Free T4 and Free T3 are people that are likely showing signs of being at least suspected of having INCORRECT thyroid levels.
So the population of the data they are using are LIKELY people who have ABNORMAL thyroid. So the ranges are simply messed up.
As has been found here over and over again that most people who have symptoms need to have their ranges well up into the range. That is 50% or higher of the range in order to feel well.
Same is true with something line B-12. Which has a tremendously wide range. Many people need to be way up towards the top end of the range to feel well. And they were told by their Dr that simply because they were near the bottom end but still within the range that they were "normal". What a load of dung!
You will find that you need to be your own best advocate in this journey you are on. You cannot just accept the Dr telling you the tests were normal. Ask for a copy of the tests, In the USA they are leagally required to give them to you if you ask for them. I would recommend that you do that and keep a record of the tests. Write down on them how you are feeling and what medications you are taking and at what dosages.
This medical record associating symptoms and dosages with lab results is absolutely invaluable. Especially if you have to find a new Dr due to a retirement or moving out of the area etc.
The rule of thumb that has proven to work for many people here is to have BOTH of the following.
1) Free T4 to be in the MIDDLE of the range (50%) or slightly higher.
AND- that means in addition to
2) Free T3 to be in the UPPER 1/3 (66.7%) of the range
Notice that these are both WELL up into the range and not simply "somewhere" within the range.
This is a rule of thumb and each person feels well at a different level. It is best to start slow and low dosages and work up to a point where you feel well.
But that all assumes you can convince a Dr to at least start you out on medication in the first place.