# low free t4, normal TSH



## pokute (Jul 9, 2015)

Hi. I'm new to the board and have a question about my thyroid lab results. I went to the doctor recently due to extreme tiredness since last year. I got a thyroid panel done with the following results.

Free T4- 0.66 (0.79 - 2.35)

TSH- 2.51 (0.49 - 5 not sure of exact range for this one)

My doctor first told me it was subclinical hyperthyroidism. When I pointed out it was low and not high, she admitted her mistake and that it was subclinical hypothyroidism. She said it's not the cause of my symptoms (tiredness all day long, really dry skin, freezing cold all the time, constipation, numb and tingling hands and feet), because the TSH is within range.

All the other labs so far besides thyroid have been normal.

Should I get a second opinion, or is it unlikely that this needs to be looked into more?


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## joplin1975 (Jul 21, 2011)

Get a second opinion. That TSH is a shade too high and your free t4 is much much much too low. You should have your free t3 tested as well as your antibodies. You should also have a thyroid ultrasound.


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## Octavia (Aug 1, 2011)

Ditto what joplin said. I have nothing to add.


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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.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
(Copy and paste into your browser)

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

You might need to firstly find a new doctor who understands the thyroid. Goodness!

You definitely need the FREE T3 test for starters and also some antibody tests.

I will list info for you..........

And welcome!


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## Pharm.D (Jul 10, 2015)

People can have low free T4 and normal TSH when they have central hypothyroidism. That means your pituitary isn't releasing enough TSH to keep your T4 to optimal levels. With a low free T4 your TSH should be much higher if your pituitary gland was functioning properly. If it was me I would want to get a free T3.

Symptoms of central hypothyroidism are usually less severe. Based on how severe your symptoms are it sounds like your fatigue might me adrenal related. In other words you probably have no cortiosl in your body. This can happen due to long periods of stress. So in summary.....

Get a free T3

Get a four point saliva cortisol test

Start levothyroixine for hypothyroidism


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