# Free T4 staying low as Free T3 increases and TSH decreases



## oakleaf (Feb 6, 2017)

Hi,

I am wondering about my lab results. I started Levothyroxine in October. My T4 is staying low, my TSH decreased, and my T3 is going up. But I still have symptoms, fatigue, aches and pains, weight gain and other smaller symptoms. I have arrhythmia that may be associated with hypothyroidism according to my cardiologist.

Throughout my dosage, I felt some of my symptoms lessen as I hit 50ug levothyroxine, less crashing fatique, less faintness, and less arrhythmia. For two weeks on 50 ug I felt almost completely normal, with no aches, arrhythmia, fatique. But after those glorious 2 weeks my symptoms started coming back (ache, fatigue, arrhythmia) while still on the 50ug dose

I asked my Dr. to up to 62.5 ug levothyroxine, but this dosage has not helped, and I am feeling aches, fatigue and arrhythmia again. I feel that I should be better, my Dr. probably won't increase my levo. dosage with the TSH being under 1.

My Vitamin D is low at about 20 ng/mL, but when I try to raise it past 1000 IU my arrhythmia seems to bother me more, but this could just be my imagination as well, I need to track this.

*Why would my Free T4 stay at the very bottom of the range, even though my Free T3 has increased up to 82% of range along with the levothyroxine dosage?* Should I ignore the low Free T4 and just use the Free T3 to regulate dosage? What are the optimum levels for Free T3?

Any suggestions about where to go from here would be appreciated.

Here are my lab results, most recent first:

1/27/2017 have been on 62.5 ug levothyroxine for 6 weeks:
*TSH 0.56 ulU/ml* (0.27-4.20 uIU/mL in range)
*T4 Free 0.9 ng/dL *(0.9-1.8 ng/dL in range,* 0% of range*)
*T3 Free 3.6 pg/mL* (2.4-4.2 pg/mL in range, *82% of range*)
T3 Uptake 31.80% (21.6-34.1 % in range) (I didn't ask for t3 uptake, that was my Dr's request).

11/30/2016 have been on 50ug levothyroxine for 6 weeks:
*TSH 1.24 uIU/mL* (0.27-4.20 uIU/mL in range)
*T4 Free 0.9 ng/dL* (0.9-1.8 ng/dL in range, *0% of range*)
*T3 Free 3.1 pg/mL* (2.4-4.2 pg/mL in range, *39% of range*)

9/29/16 had been on 25 ug levothyroxine for ~6 weeks
*TSH 2.52 uIU/mL* (0.27-4.20 uIU/mL in range)
*T4 Free 0.9 ng/dL* (0.9-1.8 ng/dL in range, *0% of range*)
*T3 Free 2.9 pg/mL* (2.4-4.2 pg/mL in range, *28% of range*)
T3 Uptake 31.6 % (21.6-34.1 % in range)

8/10/16 not yet taking levothyroxine
*TSH 5.02 uIU/mL* (0.27-4.20 uIU/mL* HIGH*)
*Free T4 0.8 ng/dL* (0.9-1.8 ng/dL low -11% of range (*LOW*)
Free T3 (not tested)
T3 Uptake 30.4 % (21.6-34.1 % in range)

Regarding parathyroid:
4/13/16 calcium 9.6 mg/dL (range 8.5-10.5 mg/dL)
8/10/16 PTH 20 pg/mL (range 15-65 pg/mL)

Regarding antibodies:

1/27/17: Thyroglobulin Ab 83.6 IU/mL (0.0-4.0 IU/mL range)

9/30/16: Thyroglobulin Ab 102.9 IU/mL (0.0-4.0 IU/mL)

8/10/16 Thyroid Peroxidase Ab <60 IU/mL (standard range: <60 IU/mL)

Thank you!


----------



## joplin1975 (Jul 21, 2011)

I'm wondering if you have had a thyroid ultrasound?


----------



## oakleaf (Feb 6, 2017)

joplin1975 said:


> I'm wondering if you have had a thyroid ultrasound?


Hi,

I have a family history of Hashimoto's; what information would an ultrasound reveal? Two sisters with Hashi's, a grandmother with goiter & thyroid removed, mother with parahyperthyroid and probably hashimoto's. I can ask my endo for one, I will be seeing one for the first time next month. Thank you!


----------



## jenny v (May 6, 2012)

An ultrasound can determine if you've got any nodules or if your thyroid is swollen or not. It's good to have at least one for a baseline measurement, esp. if you have a history of thyroid problems.


----------



## joplin1975 (Jul 21, 2011)

Yes. And sometimes nodules can really throw off your lab results. More importantly, your elevated TgAB numbers and low TPO really demands an ultrasound.


----------

