# Struggling with diagnosis



## jmam1983 (Sep 18, 2014)

Hi all!

I'm still a newbie around here and am still struggling to get a clear diagnosis. So a few months ago I had a bunch of serious symptoms including muscle weakness and joint pain, and after theorizing it might be hypothyroidism, my GP tested me. She saw the results as being normal, but I saw an endocrinologist anyway after hearing that sometimes TSH levels are not the end-all-be-all and that the "normal" range is not so normal. So this is where I tested in July:

Tsh

Test

Low

Normal

High

Reference Range

Units

Tsh

3.570

0.450-4.500

uIU/mL

Triiodothyronine (T3)

Test

Low

Normal

High

Reference Range

Units

Triiodothyronine (T3)

140

71-180

ng/dL

Sedimentation Rate-Westergren

Test

Low

Normal

High

Reference Range

Units

Sedimentation Rate-Westergren

4

0-32

mm/hr

Thyroxine (T4)

Test

Low

Normal

High

Reference Range

Units

Thyroxine (T4)

8.5

4.5-12.0

ug/dL

Then I saw the endocrinologist who said that based on the above info, she wanted me to try a really low dosage of synthroid. She also tested my blood again to be sure before I started the medication, and those results are here, from September 2nd:

Vitamin D, 25-Hydroxy

Test

Low

Normal

High

Reference Range

Units

Vitamin D, 25-Hydroxy

50.0

30.0-100.0

ng/mL

Thyroxine (T4) Free, Direct, S

Test

Low

Normal

High

Reference Range

Units

T4,Free(Direct)

0.97

0.82-1.77

ng/dL

Tsh

Test

Low

Normal

High

Reference Range

Units

Tsh

2.790

0.450-4.500

uIU/mL

Thyroid Peroxidase (Tpo) Ab

Test

Low

Normal

High

Reference Range

Units

Thyroid Peroxidase (Tpo) Ab

15

0-34

IU/mL

Triiodothyronine (T3)

Test

Low

Normal

High

Reference Range

Units

Triiodothyronine (T3)

127

71-180

ng/dL

She admitted that my second test showed that I was in a healthy range even by limited endo standards but that I might need to be closer to a TSH of 1 and so we'd try a small dose of the meds. Then I saw her again this week after getting my blood test done last week. She's now not convinced my thyroid is the problem since my TSH is at the exact same level as it was prior to medication, but has decided to up my dosage to see if that does anything. She said if things don't change in 6 weeks when I get my blood tested again it may mean my thyroid is healthy and that 2.7 is my natural state so she'll advise that I discontinue the medication and proceed towards "testing" and treatment for fibromyalgia, which is what my new GP thinks I have (obviously you can't be tested for fibro but tested for all the other possibilities). The problem is that I *do* feel better in many ways now that I'm on thyroid medication. Friends and family are noticing a difference in my disposition and energy levels. All but the joint pain has resolved itself. So I feel sort of... lost. Anyway, would love to know what you guys think of my test results based on your various experiences. Here are my results from October 16th:

Triiodothyronine (T3)

Test

Low

Normal

High

Reference Range

Units

Triiodothyronine (T3)

147

71-180

ng/dL

Tsh

Test

Low

Normal

High

Reference Range

Units

Tsh

2.760

0.450-4.500

uIU/mL

Thyroxine (T4) Free, Direct, S

Test

Low

Normal

High

Reference Range

Units

T4,Free(Direct)

0.94

0.82-1.77

ng/dL


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## Lovlkn (Dec 20, 2009)

Your FT-4 is low . Goal is 3/4 range for FT-4 and total 3. Your thyroid is underperforming and causing your issues.

Your D is also low. Did the endo suggest supplementing? Prescription D treatment is 50K IU for 12 weeks - retest then likely supplementation of several 1000 IU daily to keep in high range. I take 5K IU daily to keep myself in high range, am in the sun as much as possible, live in the South and still need that much to maintain.

You are going down a rabbit hole for fibro, it's your thyroid numbers. TSH lags up to 6 weeks and a screening test - not for dosing purpose.

FT-4 and FT-3 is better than FT-4 and Total 3 for telling your exact free thyroid hormone in your system. Talk to your endo - insist they run those free tests. Read your Synthroid insert or do a search on the web for it and it will confirm what I am saying. I have been to 3 different endo's and they all try to dose by TSH which is WRONG. I now see a DO who doses me by my Free's and I happen to run 0 or close to 0 TSH with 1/2 to 3/4 range Free's.

Good luck and keep pushing for the real reason - your thyroid.

Another test that if low causes muscle pain is low Ferritin ( iron).


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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)

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583
(Copy and paste into your browser)

I am not exactly clear on when did you start the thyroxine replacement and how much is the dose you are on.

Presence of TPO "does" suggest thyroid disease. It is probably a very good idea to request and ultra-sound and more tests which I will list above.

Welcome!


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## jmam1983 (Sep 18, 2014)

Lovlkn said:


> Your FT-4 is low . Goal is 3/4 range for FT-4 and total 3. Your thyroid is underperforming and causing your issues.
> 
> Your D is also low. Did the endo suggest supplementing? Prescription D treatment is 50K IU for 12 weeks - retest then likely supplementation of several 1000 IU daily to keep in high range. I take 5K IU daily to keep myself in high range, am in the sun as much as possible, live in the South and still need that much to maintain.
> 
> ...


I do supplement my D - I'd been off it for a while but I take 5000 IU a day most days. I'm consistently pretty low on that as skin cancer runs in my family and I'm very careful about my exposure. Why is the reference range for free T4 so different from the ideal? I do like my endo and the first time I went in I felt like she really spent a lot of time with me trying to figure out what was going on, so I'm hopeful I can keep working with her. I definitely do NOT want the fibro diagnosis - I have a couple friends with it and I know that frankly hypothyroidism is easier to deal with.



Andros said:


> 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.........
> ...


I started on 25 mcg the first week of September and this week (on 10/21) I went up to 50 mcg. Thank you for the test recommendations!


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## Lovlkn (Dec 20, 2009)

> I do supplement my D - I'd been off it for a while but I take 5000 IU a day most days. I'm consistently pretty low on that as skin cancer runs in my family and I'm very careful about my exposure. Why is the reference range for free T4 so different from the ideal?


If you supplement - and this Vit D test was taken with consistent Vit D intake - you might need to increase. Why would you stop taking if you know you run low?? You do not need to be in the sun - you just need to be consistent on Vit D intake and test regularly - like every 6 months once you get into the groove of taking it daily.

As far as ranges and "ideal" , ranges are made up taking a cross section of the population, some have thyroid disease some do not. When we speak about being in 3/4 range it is the range where most of us, who have thyroid disease, whether hyper or hypo, feel our best. Just because you are "in range" you are not necessarily in "your range". I for one feel better being slightly below 3/4 of range.


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## ifthespiritmovesme (Jan 8, 2014)

Fibromyalgia is not a diagnosis I would accept. I've had it for years, and it's not fibromyalgia - it's my thyroid......


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