Hypothyroid with "normal" TSH?

[Erin1010]

Hello.  I have been having hypo-thyroid symptoms for several years now; however, my TSH always come back "normal" 2.3 (0.38-5.5) mU/L, therefore, my doctor hasn't recognized me as having low thyroid function.  I recently convinced her to check my Free T3 and Free T4.  My results are FT3 4.6 (3.5-6.5) pmol/L and FT4 14.7 (10.5-20.0) pmol/L.  I've read Stop the Thyroid Madness and am convinced that I am hypothyroid and that I am also experiencing adrenal issues.   I realize my FT3 and my FT4should be in the top of the range.  I am on my way to an endocrinologist tomorrow, as my GP has no idea what to do.  Do you feel my FT3 and FT4 results warrant further testing and/or treatment for hypothyroid?  After doing A LOT of research, I do, but there are so many ranges out there on the net and also so many units of measure, that I am having a difficult time comparing my results with other people's results.   Also, I have recently paid for a 4 times per day cortosol sample which will help me figure out if I have adrenal disfunction, but I don't have the results yet.  Any advise?  Thank you in advance.

[FTB4]

Good Luck Erin, and I hope you find the right MD and get well, keep in touch and let us know if you need any more assistance. FTB4

[Erin1010]

Thank you!  I will be dumping him shortly.  I am located in BC, Canada.  I've had some people suggest going to a naturopath, and I have one that I love.  In fact, it has been my naturopath that is the only person in 15 years to acknowledge my hypo condition and help me to get any temporary relief from symptoms.  I'm not sure, though, if Naturopaths in BC can "prescribe" dessicated thyroid.  Anyone know?
If anyone out there happens to know of a doc in my area (Vancouver Island), or even Vancouver, that is open to treating patients clinically with dessicated thyroid, please let me know.  I'll be contacting our local compounding lab to see if they can tell me the names of any local docs who have prescribed NDT.
thanks for everyone's help and encouragement!  Erin1010

[FTB4]

Sorry about tha experience with a big Ego, I have been on Armour for almost two years now and I am a rookie compared to other members here.
Please do you self a favor, after you get the remaining test results, dump him. Experimental My butt!, What does socialist medicine in Europe know, they base everything on TSH, you cannot even be treated by an MD for thyroid unless your over 5.5 or 6.0.  We have many thyroid sufferers on this forum that are in Canada and the UK, and they all are in needless pain and suffer symptoms, just because of MD's like the one you just visited, these md's still think the world is flat! although we still have MD's here that are old time too, it is a struggle for all of us, but more so in the UK and Canada. Do you live in the US? If so you can try posting to "Barb" or "Gimel"   they have assisted others in locating good thyroid doctors here in the US. Maybe they can help you. Don't let this guy spook you.
Take Care  FTB4

[Erin1010]

Well, no luck with the endocrinologist today.  He was thoroughly opposed to treating my symptoms as evidence of hypothyroid.  He will also "never" use dessicated thyroid on any patient.  I got the exact response that the online community has prepared me for, however, I still feel so disappointed and discouraged.  I left with his suggestion that "something is definitely wrong, but I don't know what."  Also, he suggested the possibility of Addison's Disease which he pointed out is serious and can be fatal, so now I'm stressing about that.  He sent me away with an article written in the European Thyroid Journal which explains that the use of thyroid meds combining T3 and T4 are to be considered "experimental" and are to only be given to patients with a long history of using T4 only meds and experiencing continued hypo symptoms.  These people are few and far between according to the article.  
He ordered a morning cortosol test and depending what turns up there, along with the results a renin test and aldosterone test that I am currently waiting for, he may see me again....
Did I find a real dud of an endocrinologist, or is this to be expected?  I know my body and I've done tonnes of research.  In addition, my mother is hypo and on synthroid and has been for decades, although it has not helped her as she continues to have hypo symptoms and has developed fibromyalgia. too.  How to find a good progressive doctor!  Any ideas?   Erin1010

[Erin1010]

thank you for your help.  I really appreciate the links!  :)

[Erin1010]

thank you for your help.

[gimel]

Good info from FTB.  Keep in mind that TSH is a pituitary hormone that is affected by so many variables that it is totally inadequate as the primary diagnostic for thyroid issues.  At best it is an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T3 and Free T4.  Many doctors will tell you that TSH is the most sensitive test for thyroid issues, but TSH cannot be shown to correlate well with either Free T3 or Free T4, much less with symptoms, which are the most important concern.  

Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown Free T3 to correlate best with hypo symptoms, while Free T4 and TSH did not correlate at all.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not just TSH results.  

You can get some good info from this letter written by a good thyroid doctor for hypo patients that he sometimes consults with from a distance, after initial tests and evaluation.  The letter is then sent to the participating PCP of the patient to help guide treatment.  Note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

My suggestion would be to take a copy of this link showing 26 typical hypo symptoms with you, marked up with those which you have.  I would also take a copy of the letter linked above.  Then tell the doctor you would like to be treated clinically, as described in the letter.  If the doctor disagrees, then you will ultimately need to find a good thyroid doctor that will do so.

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html


I would also make sure they test you for Free T3 and Free T4 each time you go for tests.  Also you should request to be tested for Vitamin D, B12, and ferritin.

[FTB4]

Most Hypothyroid sufferers feel the best when the TSH is Supressed under 1.0, The T3 at about 3/4's up in its range and T4 (Free) about 1/2 way up in its range, You Free T4 and T3 look fine although for some reason your TSH remains higher than it should be for the Free Levels shown, your MD could or should treat you by Symptoms more than lab results, he should increase your meds a little at a time while keeping an eye on The Free T3 and Free T4 levels, The TSH is a Pituitary hormone that is sent to the thyroid to Stimulate it to produce more T4. Good luck on your appointment and I hope he is experienced in thyroid and not just diabetes.Regards  FTB4