# TSH very low, but FT3 and FT4 under range...what does this mean?



## JSprenkle (Feb 20, 2011)

I have been seeing a holistic doctor for my thyroid treatment while still seeing my family doctor for all other care. At my last visit, my thyroid doc switched me from Synthroid to Naturethroid. My family doctor was worried that my thyroid doc was over-medicating me based on my suppressed TSH from my labs in July (this was before I switched to Nathurethroid):
TSH 0.08 mcIU/mL (range 0.30 - 5.00)
Free T4 1.1 ng/dL (range 0.6 - 1.6)
Free T3 3.1 pg/mL (range 2.5 - 3.9)

I just had new labs and my FT4 and FT3 have dropped below range while the TSH is barely above the low end of the range:
TSH 0.39 mcIU/mL (range 0.30 - 5.00)
Free T4 0.5 ng/dL (range 0.6 - 1.6)
Free T3 2.4 pg/mL (range 2.5 - 3.9)

My brain fog and muscle pain have improved greatly, but my energy is still very low. I see my thyroid doc this week and want to prepare for the visit. Do you think a dose increase is needed with my frees being low? Also, does it hurt anything to have my TSH suppressed? I don't know how to explain suppressed TSH to my family doctor.

I got my labs 24 hours after taking my last Naturethroid tablet. Did I wait too long? Would this have made the levels of my frees seem low when they're not?

Thanks for any help!


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## Lovlkn (Dec 20, 2009)

> I got my labs 24 hours after taking my last Naturethroid tablet. Did I wait too long? Would this have made the levels of my frees seem low when they're not?


Possibly - but you have more going on than that.

You were hypo based on your Frees for both lab's -

How long has your TSH been suppressed? This could be happening for a number of reasons. I would start with the TSI and TPO antibodies tests along with a sonogram of your thyroid to rule out nodules. It could possibly involve your pituitary.

I'm glad you are feeling better - but your labs are still pretty screwy.

Have you ever had TSI and TPO antibodies tests?


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## JSprenkle (Feb 20, 2011)

Lovlkn, thanks for your reply. My TPO antibodies have been tested many times and are always normal. Years ago on a TSI test, the range was <140 and mine was at 121. In the last year, the TSI came back at 30% of baseline. Don't know why that would change so much. I've never had any sonograms of my thyroid. How do nodules affect levels? My pituitary was only tested when I was first diagnosed hypo and that came back normal (that was in 2008). I think I need an increase in Naturethroid, but anticipate a drop in TSH which my family doctor will question.


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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)

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

You are undermedicated on the NatureThyroid. What is your current dose? And for how long? FT3 is the criteria to use for dosing any med w/T3 in it.

You will feel better as your FREE T3 rises and this should be accomplished by getting the FREE T3 lab every 6 to 8 weeks and increasing by 1/4 grain by your doctor until you feel great. For most of us it is when the FT3 is at about 75% of the range provided by your lab.

At your last lab, you are not even mid-range which is 3.2; you are indeed below the range.

Hope this has been helpful to you!

info above.


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## Lovlkn (Dec 20, 2009)

As long as you have TSI showing up - you will be on a dosing roller coaster.

How often do you get tested for Free's?


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## JSprenkle (Feb 20, 2011)

Thanks Andros and Lovlkn! I was switched from 150 Synthroid to 2 grains Naturethroid about 8 weeks ago. My doc wanted to give the switch in meds a chance to level out before having labs done. Fortunately, he tests my frees, TSH, reverse T3, and TPO & Thyroglobulin antibodies each time. When I was on Synthroid, my reverse T3 was high and that has come down on the Naturethroid. I see him Thursday and think I will ask him about the TSI tests I had done in the past to see if they factor in anywhere.

Any suggestions for pituitary tests to ask for? Also, how could thyroid nodules be making my labs screwy? My younger sister was diagnosed hypo about 1 year ago and she has nodules that they are watching to see if they grow in size.

Thanks again!


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## Lovlkn (Dec 20, 2009)

Any TSI is TSI so being below their range does not mean you do not have it.



> Fortunately, he tests my frees, TSH, reverse T3, and TPO & Thyroglobulin antibodies each time.


Can you please post a few TPO antibodies results with ranges please?

Anytime the doctors office tells you your labs are "normal" they mean "in range". Just because you are "in range" does not mean you are in "your range".

What we shoot for on this board is 3/4 range for FT-4 and FT-3.


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## JSprenkle (Feb 20, 2011)

Thyroperoxidase Ab (ref range <=34):

10/1/14 - <10 IU/mL
5/10/14 - 11 IU/mL
8/14/13 - 13 IU/mL

After my visit in July (no antibody labs), my doc put me on selenium, saying it should help keep the antibodies down.

I was seeing a different doctor when I had the higher TSI levels years ago, so I should probably ask my current doctor what he thinks. Also, I used to have an elevated ANA titer (not super high), and the old doc never explained that either.


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