# Followup labs- lowTSH and Low FT4



## GeekGirlNB (Nov 7, 2010)

Got my followup labs, and I'm a it confused.

10/15 lab
TSH: .04 lab range: .35-4.0
Free T4: 1.12 lab range .81-1.54

11/28 lab
T3	** **137	***58 - 159
TSH	0.16	0.35 - 4.00
T4 FREE	0.88	0.81 - 1.54

At last appointment-10/15- dr ordered new labs for 11/28 and lowered my Synthroid by 10-15 mg and lowered my Cytomel by 2.5 mg. So, I'm on 10mg of Cytomel and .112 of Synthroid, all generic.

And, I'm sure you've all noticed, he didn't order the free T3 like I asked, just the T3. Grrr

I think I'm confused about why the FT4 and TSH are both low. Maybe I'm backward about this, it is early lol. But if TSH is going up, shouldn't T4 go up, too?

And, frustratingly enough, since my med change, I've had afternoon headaches, irritability and hives. Now, it could bethe thyroid med change, or it could be the wellbutrin sr I added a little after that. Wellbutrin was fine for 4 weeks and the side effects hit me in the last 2.
Help?


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## GeekGirlNB (Nov 7, 2010)

Another poster's issue that I just read made some sense to me.

The headaches since I was at the beginning of puberty. The eye blurriness and "floaters" that happen at whatever TSH and T4 level, Eye swelling to the point where the top of my eye lid now overlaps the lower part, The fatigue, dry skin, weight gain,and cold extremities even when the levels are on the hyper side or "normal", And the dr. Who told me I had an abnormal heart rhythm. Plus the fact that I've been telling my doctors for years now that I need my hormones tested because they aren't right...

This is a pituarity issue, I think.

In addition to the symptoms above, I am always tired, always cold in my hands and feet and sometimes nose, occasional tingling or loss of feeling for no particular reason. I am on wellbutrin and it's supposed to help me lose weight and have a higher sex drive, none of which is happening. In fact TMI, I've lost the ability to orgasm, which should not happen on wellbutrin.

I know something is wrong with my hormones, and no matter how optimum my thyroid levels are, even when they look amazing, and they have, I never feel good and depression never lifts. I feel like an old lady, and I'm 30. My muscles and joints hurt, I get winded walking up 1 flight of stairs. I can't lose weight.

So when I googled 'low TSH and low T4', the first thing that popped up was central hypothyroidism, and it looked right.

I don't know, just a thought. I'm so frustrated with this. Had thyroid issues Diagnosed at 11 years old, and have been depressed, having migraines and slowly gaining weight ever since, no matter what my thyroid levels are. So sick of this!


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## Phayah (Nov 4, 2011)

My recent labs were somewhat similar (low normal TSH, abnormally low Free T4, high normal total T3) and I'm also really confused. I haven't been diagnosed with anything yet. All I know is, I have a "non-suspicious" nodule and they are doing a biopsy Friday because of the size. My symptom list is way out there, from head to toe. Oh, and my docs never order the tests I request. They order what they want to order.

I also have skin problems. I'm not sure what it is. Perhaps eczema/psoriasis in random places and a rash across my upper back/shoulders (maybe hives). My doc gave me an over the counter cream for it and told to come back in 3 weeks if it doesn't go away. My face/scalp will NOT stop peeling. I bought T-Gel for my hair and some exfoliating gel for my face which is awesome by the way. I have to use it way more than it recommends though. How can anyone have that much skin?! I've had chronic migraines for 17 years. Irritable, absolutely... among many other things.

I don't take any ADs but I have tried many different ones over the years. I do take Adderall however these problems started after I had been taking it for months. Adderall is somewhat similar to Wellbutrin as they both effect dopamine. I can't take Wellbutrin because I won't be able to sleep.

As far as ADs go, I've always heard that side effects go away over time. There are many possibilities though. You can develop allergies to just about anything or meds can cause an imbalance.


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## Phayah (Nov 4, 2011)

GeekGirlNB said:


> Another poster's issue that I just read made some sense to me.
> 
> The headaches since I was at the beginning of puberty. The eye blurriness and "floaters" that happen at whatever TSH and T4 level, Eye swelling to the point where the top of my eye lid now overlaps the lower part, The fatigue, dry skin, weight gain,and cold extremities even when the levels are on the hyper side or "normal", And the dr. Who told me I had an abnormal heart rhythm. Plus the fact that I've been telling my doctors for years now that I need my hormones tested because they aren't right...
> 
> ...


This is what I'm worried about. I have just about all of those symptoms too. Parasthesia, cold feet/hands, eye problems, crippling fatigue, weight gain/loss, heart rate high/low, BP high/low, muscles/joints, lack of physical stamina. As for the orgasm, I have tricks for that. PM me if you haven't tried it all yet (lol).

I have a couple of other symptoms I haven't quite figured out. Tinnitus or sensitive hearing/pain in ears. The docs say they look fine. The inside of my nose gets red/raw. My lymph nodes swell intermittently. The rest of my symptoms (not listed) seem to easily fit into an endocrine issue.


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## GeekGirlNB (Nov 7, 2010)

Yeah, the whole thing is confusing me, too. I can't seem to find a good dr. They all just do what they want and won't listen!

Re: your face and the new exfoliating gel.. Can I ask what it is? The only reason I ask is that I'm a licensed Esthetician and using an exfoliation product more than recommended can actually be making your skin problem worse. When you exfoliate it signals your body to make new skin cells. If your skin is really dry and flaky, then you should probably be using a really good, non clogging moisturizer and using the exfoliating product 1-2x per week until the skin normalizes. Also, make sure whatever cleanser you are using is cream based. Even the gel exfoliator could be drying you out because gel products usually are moredrying than cream based products.

Anyway... Off soap box, lol. 

I think I need to email a few of the endos in my insurance and tell them exactly what I am looking for. I don't want to waste anymore time with crappy dr.s who don't know what to do with thyroid patients.

I can't even begin to calculate how ,uch money I've wasted on this and on dr. Appointments that were useless.


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## lainey (Aug 26, 2010)

GeekGirlNB:

You can't google "low T4 and TSH" with your results because of the medication you are taking. Central hypothyroidism doesn't really apply in your case because taking T4/T3 meds in combination is going to produce the lab results that you have.



> But if TSH is going up, shouldn't T4 go up, too?


Adding T3 medications to T4 only meds will suppress the fT4 results and the TSH. Even though you lowered the dosage of both meds, your numbers will still reflect the presence of T3 medication (cytomel).

Have you ever had a full set of thyroid antibodies run--TPO, TSI, etc? Often when people have both the blocking and stimulating antibodies, they struggle with symptom and medication adjustments as you have.


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## GeekGirlNB (Nov 7, 2010)

lainey said:


> GeekGirlNB:
> You can't google "low T4 and TSH" with your results because of the medication you are taking. Central hypothyroidism doesn't really apply in your case because taking T4/T3 meds in combination is going to produce the lab results that you have.
> Xxsnipxx
> Adding T3 medications to T4 only meds will suppress the fT4 results and the TSH. Even though you lowered the dosage of both meds, your numbers will still reflect the presence of T3 medication (cytomel).
> ...


Huh, ok, I didn't realize the t3 would confuse my labs. How, then do I get an accurate reading? And, how then do I adjust medication and deal with the crazy symptoms?

I had This antibody test in October:
TPO AB	792.4	<5.6 IU/mL

That is the only antibody test I've had in years. Like I said, my dr.s haven't been real helpful in the testing and the one I have now wants 'adjust and monitor based on TSH' which I told him I would not do...because it's dumb, lol.


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## Phayah (Nov 4, 2011)

Awesome, maybe you can give me some advice. The gel is "Frutique" and says "papaya enzyme exfoliating gel". I just started using it. The first day was awesome but the peelies were back the next day. I used it again a couple of days later with the same results. I'm not sure what to do now. It seems like I cannot wear makeup at all anymore because it just makes me look worse with peeling skin.

I'm not really consistent with cleansers. I have some Olay Foaming Face Wash (sensitive skin) that I use but I also use unscented castile soap in the shower. My moisterizer is Olay Regenerist but I think I need something heavy duty for night time. I also have to worry about chin acne though.

Asking about docs and telling them what you want seems like a really good idea. I recently did that when looking for a psychologist and I absolutely love her. I will be doing the same when I look for a new dentist here. I wish I had those options for doctors but my insurance is Tricare and everything has to go through a doctor on base.


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## GeekGirlNB (Nov 7, 2010)

Phayah said:


> Awesome, maybe you can give me some advice. The gel is "Frutique" and says "papaya enzyme exfoliating gel". I just started using it. The first day was awesome but the peelies were back the next day. I used it again a couple of days later with the same results. I'm not sure what to do now. It seems like I cannot wear makeup at all anymore because it just makes me look worse with peeling skin.
> 
> I'm not really consistent with cleansers. I have some Olay Foaming Face Wash (sensitive skin) that I use but I also use unscented castile soap in the shower. My moisterizer is Olay Regenerist but I think I need something heavy duty for night time. I also have to worry about chin acne though.


Ok, that info is helpful.

The papaya gel: papaya is a good exfoliator, mild, though. And in gel form it will dry you out more than anything.

Same with the Olay foaming face wash. Nothing wrong with Olay, but any foaming or gel face products are more for people with oily skin. Both of those products, the cleanser and exfoliant, are drying you out most likely.

And soap should never touch your face, or body for that matter, lol. Soap is very, very drying. Your skins ph is made to be more in the acidic range and soap (and the cleanser you're using) are very alkaline on the ph scale, the opposite of what you want.

Chin acne is usually due to hormones, and really common in people with endocrine issues, too. I suffer from acne and I am doing all the right things for my skin! Sucks to have acne and be an esthetician, lol.

Ahh, if you lived anywhere nearby, I would totally want to treat your skin issues and give you great professional products! LOL

But, my recommendations would be to ditch the soap altogether. It does nothing for your skin except strip all natural oils and dry you out. It basically unbalances your skin wherever you use it. It's made to feel silky smooth and nice, but it dries out shortly after that.

Switch to creamy cleansers and get an exfoliation product that is creamy as well and only use it 2-3 x per week. Papaya, pumpkin, passion fruit, etc are good enzyme exfoliators, just make sure the base is creamy. Or if you want something even better that is a mild to moderate chemical exfoliant, use glycolic acid or a glycolic/lactic acid mix. Nothing that foams or is gel-like for your skin. Also wash your face in the morning at before bed with the good cleanser.

If you have an ULTA store near you, they have a lot to choose from. Tell them what you're looking for and they're somewhat knowledgeable.

You'll probably find that the moisturizer you have will be adequate once you switch to the right facial products.

If you want to look into a fabulous professional line, that is reasonably priced, I will PM you a link.

And, back on topic, I just emailed my PC dr. And requested a referral to an endo. I have Kaiser and they are surprisingly well organized and prompt, but I still need a referral.


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## Lovlkn (Dec 20, 2009)

GeekGirlNB said:


> Got my followup labs, and I'm a it confused.
> 
> 10/15 lab
> TSH: .04 lab range: .35-4.0
> ...


What was your original DX? Did you have a thyroidectomy?

Stimulating antibodies can keep TSH suppressed. A TBII test would confirm if you have stimulating antibodies although you will likely have to beg for that test.

Your doctor needs to dose your replacement on FT-4 and FT-3.

I fought my endo and then 2 GP's for years before finding one to dose me on my FT-4 and FT-3 and feel fantastic now. Before I was suffering alot of hypo symptoms.


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## GeekGirlNB (Nov 7, 2010)

Original diagnoses about 19 years ago (I was 11 or 12) was Hashimotos Thyroiditis with Goiter. No thyroidectomy. Never had a scan and had antibody test once, as far as I can remember. Didn't pay much attention until I was in my 20s.

I had this antibody test in October: TPO AB 792.4 <5.6 IU/mL.

I just got the call from my PCP that I have a referral to the endo! Now, I gotta call and find a good, reasonable, and up to date one!

Wish me luck!


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