Are a Low Level TSH and Low Free T4 a concern?

[stacylo]

I went to my gynecologist because I am 47 and thought I may be having perimenopause issues: 30 lb weight gain, skin issues, very tired, can't sleep, moodiness, excessive sweating, etc. She said it is NOT menopause or hormone related. I asked her if it could be thyroid and she said that it was a possibility. So she ran a CBC, TSH and Free T4. My MCHC (for anemia) was just under at 32.3 (range 33.0 to 36.4), my TSH was .751 (range .45 to 5.00) and my Free T4 was .75 (range .71-1.85). I am not sure what the issue is but she thinks that things are fine. I DO NOT feel normal. I feel terrible constantly. No energy, drained. Watch food intake, eat less now than before but wear 3 clothes sizes more....I know something is off.....somewhere.

[gimel]

I agree with what flyingfool suggested.  Also, your TSH being in the lower part of its range along with your low Free T4 is suggestive of central hypothyroidism.  With central hypothyroidism, there is a dysfunction in the hypothalamus/pituitary system that results in TSH levels that are too low to adequately stimulate the thyroid gland to produce thyroid hormone.    In view of that possibility I would also suggest testing for cortisol.  

An evaluation for multiple symptoms should always be the primary diagnostic for hypothyroidism, along with tests for Free T4 and Free T3 (which was not tested for you).  Treatment should be based on adjusting FT4 and FT3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important.  

So the most important step for you  now is to find a good thyroid doctor that is willing to treat clinically, as described, and be willing to prescribe T3 type meds if needed.   Based on all our experience that does not necessarily mean an Endo.     If you would like we can try to help locate a good thyroid doctor in your general area.   If interested, how far are you willing to travel to find a good thyroid doctor, and what insurance do you have?   If you prefer, just click on my name and send me a message with this info.

[stacylo]

Thank you. I put a note on you page. Wasn't sure how to send a message....Thank you!

[gimel]

Click on your name and there on your personal page you will see messages.  Click on that and you can access a PM I just sent.

[flyingfool]

many people do not feel well with a Free T4 level below 50% of the range.  You are at about ZERO percent of the range.

You are in "no man's land".  That is where you feel like crap but your numbers are within range so the Doctors do nothing for you and you continue to feel like crap.

Maybe you can work with your Dr to ask for a clinical trial of a starter dose of T4 medication.  Tell him your goal would be to work up with dosage changes to 50% of the range.  To assure him or her that you are not trying to do something crazy.  You are simply literally trying to get to the exact MIDDLE of the so called "normal" range.

Also you should really get your free T3 levels checked. That is the active form of thyroid and the only form used by your body at the cellular level.

Most all of your symptoms are consistent with low thyroid.

You should also check your iron, ferritin, Vitamin D3 and B12 levels.

Ideally you want your B12 to be in the very upper part of the range, above 700 or higher.  You want D3 to be at least 50, and Ferritin to be about 100.  Often times folks who are low thyroid are also deficient in one or more of these other areas.  Being low in those also cause fatigue.

You are also borderline being anemic and that doesn't help fatigue either.

[stacylo]

What about my TSH being at the lower end of the range too? according to their range (.45 t0 5.00)? What affect would that have? Now I am only having these tests done by a gynecologist so I am sure she is going to say...."you are fine" since they are all in range and not below like you said....Maybe I AT LEAST should go to the family Dr? Or an endocrinologist?