# Low TSH, low T4, T3



## GoHard (Jul 14, 2015)

Hi everybody.

I am 24 y.o., female.

Height 172 cm, weight about 47-49 (always have been in this range).

I have been experienced fatigue since this late spring. Somnolence too. General blood tests are normal, biochemistry too.

Blood pressure is slightly low, but I feel myself quit normal in this range (89-105/45-65) and don't perceive it as low. Although heart rate is slow - about 50-66 pounds per minute. For me this heart rate is considered as low, as I always lived with mild tachycardia (blood pressure the same).

I constantly feel exhaustion. Drink a lot of tea to alleviate fatigue but with no result.

I periodically do blood tests, including hormone levels tests.

Here is summarized dynamics of thyroid and pituitary hormones since 2013 (see attachement please).

Note, I felt myself good until spring 2015.

Normal range: TSH 0.270 - 4.20

free T3 3.10 - 6.8

general T3 1.3 - 3.1

free T4 12 - 22

general T4 66-181

Thyroid ultrasound investigation (10 07 15)

Contours smooth, capsule is well defined, elastisity preserved, echostructure is slightly inhomogenous, echodensity is homogenous.

Isthmus 0.2 cm

Right lobe 4.7x1.0x1.5 cm. In the upper segment anechogenic element (colloid cyst) 0.4x0.3 cm. Vol. 3.4 cm3;

Left lobe. In the middle segment two anechogenic elements (colloid cysts) - 0.4x0.2 cm, 0.3x0.2 cm. Vol. 3.0 cm3

General volume 6.4 cm3

Conclusion: Hypoplasy and colloid cysts on thyroid.

Doctor said there is nothing to treat. Consume iodine-rich food. (I already take prophylactically KI!!) However, questions are: why at low T3 and T4 TSH levels are also low? Is it a kind of sick euthyroid syndrome or secodary hypothyroiditis?

Cause TSH levels are quite same inspite of normal or low levels of effector thyroid hormones?

Any advise is highly appreciated.

P.S. Sorry for possible mistakes, i am non-native speaker.


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## Lovlkn (Dec 20, 2009)

Ignore TSH -

Free T-4 and Free T-3 will tell you what thyroid hormone is in your blood at time of draw.

Most likely because you have cysts - you seem to be experiencing low thyroid. Both your FT-4 and FT-3 have been below low range since 04/12/14.

Have they checked your antibodies? TPO and TSI? Thyroglobulin would also be a good test to have run.

Low TSH could be from stimulating antibodies.


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## GoHard (Jul 14, 2015)

Thank you very much for your reply!

Unfortunately, endo only looked at TSH and concluded that if TSH is normal, nothing to do. No additional analysis recommendation, no suggestions about a possible role of agonizing Abs.

Is this condition treated as hypothyroidism?


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## Andros (Aug 26, 2009)

SUGGESTED TESTS
TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin and Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/
(Copy and paste into your browser)

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

Hi and welcome!

Lovlkn is right; you need more testing. Clearly you do have a thyroid issue for if you did not, your ultra-sound would have been unremarkable.

Some tests listed above and the FREES are essential.


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## GoHard (Jul 14, 2015)

Hello!

New analysis results (04 aug 2015)

T4 free 10.2 (12-22)

T3 free 3.3 (3.1-6.8)

TSH 0.568 (0.27-4.2)

Abs against thyroglobulin 11.07 (<115)

Abs against thyroid peroxidase 5 (<34)

Unfortunately, at present I found no TSH receptor Abs assay available.

Please, any comments!


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## graves84 (Oct 7, 2013)

Your t3 and t4 shows you near hypo. How do you feel? Are you taking meds right now?


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## GoHard (Jul 14, 2015)

Some days I feel extremely exhausted (with no obvious reason). Also, eventually, I took a test for anti-TSH receptor antibodies and they are in normal range (0.3, negative result <1.75)

I decided to take the very low dose thyroxin (1/8 of 25 mg pill) but I experienced tachycardia, even at this dose. However, a desire and drive to do smth appreared.

I don't know what to do. Try to continue at even lower dose or...?


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