# Help—Severe Symptoms; mixed labs



## cody (May 27, 2014)

Here's the story: 22 year old female, very overweight, diagnosed with depression, anxiety, currently suffering from extremely low energy, weight gain, etc. I've been bounced around a bit between physicians, psychiatrists, and back to physicians. Eventually someone thought to order a test of thyroid function. The results were:

T4 (Free): 11.4 pmol/L (lab normal range 12.8 - 20.4)

TSH: 4.9 mU/L (lab normal range 0.4 - 3.8)

T3 (Free): 5.4 pmol/L (lab normal range 4 - 6.8)

Creatinine (serum): 54 umol/L (lab normal range 45 - 90)

TPOAb/TSIAb: Negative

I was also verbally told than my iron was fine, and although my ferritin was low, it was still just within normal levels.

In short, it would seem my TSH is high, my T4 is low, my T3 is normal, and I'm testing negative for Hashimoto's.

My physician consulted an endocrinologist, and reached the conclusion that my results meant I was fine; especially that as long as the T3 didn't drop any lower it would not be appropriate for me to got on hypothyroid medication of any sort, and that my best bet was to continue seeking help through the mental health system.

The thing is, my symptoms are severe, and seem very much in line with hypothyroidism. Notably, the depression, low energy and weight gain, but also hypersomnia (ie, sleeping 12+ hours a day, wake exhausted, nap frequently, too tired to leave the house most days), severe brain fog, joint pain, muscle pain, dry skin, thinning eyebrows, vision problems, anxiety, and on and on, etc. I'm on Effexor for my depression, but it's not really working, and nobody seems to have any clue what's causing all my other symptoms. I don't see how my psychiatrist can help me fix this (in fact, he's the one that ordered the thyroid blood work because he had no other ideas).

I guess my question is...is what I'm hearing from my doctor plausible? I had thought that a high TSH and low T4 was pretty clear evidence of hypo, but what I'm hearing from my doctor is that they aren't that far outside of normal levels, so if my T3 is normal, nothing else really matters. Has anyone else had lab results like mine (high TSH, low T4, normal T3)? Did you get prescribed meds? Did they help? I don't want to hold out false hope, but I really thought Synthroid or whatever was going to finally give me life back. If I talk to another doctor, am I likely to hear anything different?

*TL;DR: Have lots of hypo symptoms, high TSH, low T4, normal T3. Doctor reckons it's just depression. What now?*


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## joplin1975 (Jul 21, 2011)

Cody,

Have you had, just for giggles, an ultrasound of your thyroid?

Also, have you had things like ferritin and vit d tested?

Your free t3 is just at midpoint...I think, given your symptoms, a trial dose of synthroid might be a good idea. But, I'm sure the real experts will be around shortly.


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## Andros (Aug 26, 2009)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
(Copy and paste into your browser

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)

No way; your FREE T4 should not be in the basement nor should your TSH be that high. And believe it or not, FREE T3 could stand to be a little higher.

Under the circumstances, it would be a very good idea to get an ultra-sound of your thyroid. And incidentally, if anyone can fix you, it would be your psychiatrist who is firstly and above all medically trained.

Info enclosed above!


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## cody (May 27, 2014)

joplin1975 said:


> Have you had, just for giggles, an ultrasound of your thyroid?
> 
> Also, have you had things like ferritin and vit d tested?
> 
> Your free t3 is just at midpoint...I think, given your symptoms, a trial dose of synthroid might be a good idea. But, I'm sure the real experts will be around shortly.


No ultrasound. Ferritin was tested, but I didn't get a copy of that lab result. I was verbally told that it was low, but just within normal range. I think the doctor said it was "50", but I don't know the units or normal range. No test for vitamin D.



Andros said:


> No way; your FREE T4 should not be in the basement nor should your TSH be that high. And believe it or not, FREE T3 could stand to be a little higher.
> 
> Under the circumstances, it would be a very good idea to get an ultra-sound of your thyroid. And incidentally, if anyone can fix you, it would be your psychiatrist who is firstly and above all medically trained.


I'll see about getting an ultrasound. As for my psychiatrist...I've been bounced around a lot.

My doctor thought I might have bipolar and referred me to the psych; the psych thought it wasn't that but had no real clue what it might be. He's the one who finally ordered the initial tests; unfortunately his response on seeing them was "I have no idea how to read these but it looks bad; go talk to your doctor. I don't think I can help you until your thyroid is fixed". But my doctor said, basically "these don't look so bad; your thyroid is fine; go back to your psych".

So...yeah, the psych is medically trained, and I'm trying to get another appointment with him (might be a couple weeks) but he's already told me he knows nothing about thyroid issues, and that he doesn't think he can help me until the thyroid is fixed. Good to know your limitations, I guess? And my doctor doesn't think my thyroid needs/can be fixed, so...not sure where that leaves me. No one really seems to think they can fix my symptoms, which are honestly severe and getting worse.

I'll try and wrangle an ultrasound. Beyond that, any more ideas?

It's good to hear that my T4 and TSH are indeed wrong, but...how wrong are they? Is it a clear "holy shit, those are wrong; find a doctor who knows what he's talking about and will get you on meds", or is it a more of a "eh, that's a bit weird; talk to your doctor about getting more tests, but if he thinks meds are not appropriate for you then he's probably right"? Money is very tight for me, and my insurance will not cover me going to a specialist without a referral from my doctor, which he won't give. I can try changing doctors or just paying out of pocket, but I don't want to be stupid either. On the other hand...it's hard to exaggerate the impact this is having on me.


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