# TSH within normal range but changed, not feeling great



## Rosario (Nov 3, 2013)

Hello. I had a partial thyroidectomy in the beginning of December. Before that all tests done came back normal but I had large nodules that had to go. Now about 6 weeks out from surgery I am feeling tingling in my extremities, sensitivity to the cold and hot flashes. My new blood tests came back and my TSH increased but is still within normal range. Free T4 is normal too but cannot compare to previous because the lab ranges are very different. Had other tests done this time but it was the first time so nothing to compare against. Should I give this time and ask to be retested? If so, how many weeks? I feel like I am going hypo. What do you think? Thank you!

Here are the labs.

On 1/8- post surgery

http://s1291.photobucket.com/user/rosariopix/media/week5postlabs_zpsb82420fa.jpg.html?filters[user]=138371692&filters[recent]=1&sort=1&o=0

On 10/23 - before surgery

http://s1291.photobucket.com/user/rosariopix/media/33158297-a2c3-4ef4-a119-148632a054a8_zps5bc795f6.jpg.html?filters[user]=138371692&filters[recent]=1&sort=1&o=2

http://s1291.photobucket.com/user/rosariopix/media/PastedGraphic-2_zpsee8f2f3e.jpg.html?filters[user]=138371692&filters[recent]=1&sort=1&o=1


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## jenny v (May 6, 2012)

Sorry, I may be missing it, but I didn't see a Free T4 result listed on your labs. Your TSH is slightly elevated (most of us like ours around 1.0), but without Free T3 and Free T4, it's hard to tell if you're hypo. I'm guessing you're headed that way, but you really need to have the Frees tested. Will your doc do that?


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## Rosario (Nov 3, 2013)

Thank you for the reply. I assumed that the T4 listed was free. I'm still learning how to read these reports. Just called and asked for free 3 and free t4. Getting it done Monday. Anything I should get tested? Thank you so much.


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## Andros (Aug 26, 2009)

Your Total 3 is very low. This does not bode well because Total 3 is bound, unbound and rT3 (reverse) hormone. This way, we cannot tell what portion is your FREE T3 (unbound active hormone available for cellular uptake.)

Maybe you can "insist" on the FREE T3 test? Most of us feel best w/TSH @ 1.0 or less and FREE T3 at about 75% of the range given by your lab.

To sum it up, humble opinion is that you are undermedicated at this time.


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## jenny v (May 6, 2012)

Could I ask why you had the partial thyroidectomy? Was it cancer? Were you ever tested for thyroid antibodies before surgery (like TPO Ab, TSI, Trab)? If you've got Hashi's, the rest of your thyroid might be giving up the ghost and shutting down, so you'll need to supplement with more medication.

Let us know what the Free T3 and Free T4 tests turn up!


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## Rosario (Nov 3, 2013)

Thank you both for your replies. Andros, I did ask for free T3 and free T4 from my internist and she said yes. I get it done Monday.

Jenny, I had a partial because I had masses on my left side that were pushing on my throat. The largest was 2.5cm and the biopsy came back inconclusive so I went ahead and had it done. The pathology said benign and did not say anything about evidence of hashi. I asked my surgeon and she said there was no evidence but would order antibodies. The blood tests on 1/8 said no antibodies. I am not sure why they were not tested before surgery. By the time I realized that I should have them done, I had too little time before the surgery.


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## Prudence (Oct 30, 2012)

Ahh, I see a Free T4 on your lab before surgery (the third link you posted). That seems a tad low in range before you even had the surgery, but not anything major-. hopefully the Free's you'll get tested Monday will shed some more info. Your total T3 is pretty low, and usally that reflects your FT3 is also low, but the FT3 is really a better indicator. But yeah, to be honest? You probably are going hypo. Are you on any sort of thyroid replacement right now, or are they waiting?


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## Rosario (Nov 3, 2013)

thanks for the reply Prudence. I feel like I am going hypo. That's why I started asking questions and asking to see the results. I am not on any meds. I had my follow up and the surgeon ordered the tests you see. She did not include the antibodies until I asked her to. A week later, I get my results via a phone call from the office staff. She said all normal and that was it. I didn't feel normal so I posted here to see what everyone thought. When I called my internist to ask for the frees, the doctor did not hesitate. She said yes. The idea that I have to research myself and request these tests is baffling to me. If I had not found this website, I would be sitting in my home with all sorts of problems waiting for them to get worse. Thank you and thanks to everyone who supports this site.


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## Rosario (Nov 3, 2013)

Here are my new free t3 and t4 results. While they are closer to the bottom than the upper range, I am still normal.

Free T3 - 2.6 range 2.3-4.2

Free T4 - .99 range .73-1.95

I have 3 options.

-Wait and give it longer. I am only 6 weeks out from surgery and if I am in fact going hypo, my next labs will be out of range.

-Call my internist which seems to be going by the normal designation of my labs and ask her if I can go on meds and see what she says.

-Call my internist and tell her the theory of feeling better at TSH of 1 and upper range of FT3/FT4 and ask her for a referral to an endocronogist and don't bother with her suggestions on meds. I have PPO insurance and don't need a referral from my insurance's perspective but the endo I would like to see requires one. I could see someone else if this is my best bet and my dr. says no.

What do you think? Thank you!


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## jenny v (May 6, 2012)

I'm having trouble getting your file to open, would it be possible for you to post the numbers and ranges of your labs?


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## Rosario (Nov 3, 2013)

I just edited my previous post with the results and ranges. thanks


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## jenny v (May 6, 2012)

Thanks!

Oy, you are headed towards (if not already at) hypo with those numbers. Both FT3 and FT4 are in the very bottom of the ranges so I'm not surprised you aren't feeling great. Ideally, you want both at the midpoint of the ranges, at the very least. I would ask your doc to start you on something now, since you have symptoms, rather than wait until you totally drop out of the ranges and feel worse.


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## Rosario (Nov 3, 2013)

should I ask my internist or go straight to an endo? I ask because the internist simply looks at my labs, says normal range and moves on. It says something about her approach even if she puts me on something.


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## jenny v (May 6, 2012)

You don't necessarily need an endo, you just need someone who is well versed in thyroid dosing, which it sounds like your internist isn't. The endo that you want to see requires a referral, right? You might do well to get one now since they typically can have long waiting lists to get an appointment.


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## Rosario (Nov 3, 2013)

Thanks jenny v. That is what I'm thinking about my internist too. I did not go over my symptoms recently with her since it was my surgeon who ordered my initial post op labs but I did send her the results and asked her for the ft3 and ft4. I expected her to not just say normal results. Perhaps they all say that initially until you press with symptoms. I have only communicated via staff so far. She returned my call from today asking for meds but I didn't see it until her office was closed. I'll see what she says tomorrow morning and ask for a referral if she says I'm fine. Thanks so much for the advice.


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## Rosario (Nov 3, 2013)

update. internist's office person called today. she said the dr. said everything is normal and where it should be. called surgeon since she has access to all my documents to see if she agrees. if she calls back with the same normal verdict, do you think an endo will concur since I am in the norm all around? Don't want to waste my time and I have a feeling this will continue moving in the direction it appears to be going in and i won't be normal soon.


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## Rosario (Nov 3, 2013)

Did not hear back from surgeon. She is suppose to address my question on Monday. I am almost sure she will say everything is fine and that I should wait. She is the one who only tested only my tsh and said normal and nothing more. What would you do next? Will most endos look at my results and say that they are off or do most use the references and that's it? I read that most people feel best at TSH of 1 and 75% of range for the frees but do doctors say this and treat to these levels or is this what patients feel best at?


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## Rosario (Nov 3, 2013)

Finally an update. Saw a endocrinologist and had my levels tested again. I posted them below. Free T3s are at the mid point now and so are Free T4s. Should feel great but still feel the same. Endo said to consider other causes. He talked about TSH and that he uses that and something about Frees not being a great indicator. No idea the rational he gave because I was worried about something else. He did a scan and found another 2CM nodule on my left thyroid bed-yes the side I had operated on in December 2013. He said he did not believe it just popped up that quickly but cannot imagine how the surgeon left it behind. ?? After I left the office it dawned on me that previous reports stated that the nodules were embedded in the gland. Wrote the surgeon and her reply was that it could be material she left in there to stop the bleeding and that my body would eventually absorb it. Do they make material that is meant to stay inside after surgery? Needless to say this visit left me with more questions than answers. Pretty disappointment. Any advice on either my levels or this new nodule/material on my left thyroid bed? Thank you.

April 2014

TSH 3.4 (range .40-4.50)

Free T3 3.1 (range 2.0-4.4)

Free T4 1.22 (range .80-1.80)

January 2014

TSH 2.13 (range .45-4.50)

Free T3 2.6 (range 2.3-4.2)

Free T4 .99 (range .73-1.95)

October 2013

TSH 1.4 (range .5-4.7)

Free T4 1.19 (range .73-1.95)

Sept 2012

TSH 1.70 (range .40-4.50)


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