# Causes of low free T3 and normal TSH



## dee0515 (Jul 22, 2014)

Hi everyone. I'm a 28 y/o female. For the last 1.5-2 years, I've been complaining to my PCP about excessive fatigue, weight gain (about 15-20 lbs in the last 2 years, despite strict dieting), and some depression. I thought exercising more would help my energy levels, but it's like I don't even have the energy to exercise. My doctor has checked my TSH several times. It was always below 2,so I was put on an antidepressant. It didn't help. I'm not taking it anymore. This last time, she checked my T3 and Free T3. Both were low.

My TSH was 1.614 [.358 - 3.740]
My T3, total was 64. [76. - 181]
My Free T3 was 152. [210 - 440]

T4 was not tested. She has referred me to an endocrinologist. Unfortunately, the waiting lists are months long. The one she wanted me to see has no openings until the end of January 2015!!

Anyways, does this explain why I feel so terrible? Also, what are some potential reasons for low T3 when the TSH levels are normal? If anyone could offer some advice or encouragement, I would greatly appreciate it.


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## joplin1975 (Jul 21, 2011)

If you have an autoimmune issue, you'll have antibodies which can skew the results...in particular TSH. So it "looks" normal, but you still are symptomatic. It's one of the many reasons that testing only TSH is not advisable.

Yes, low t3 would be a reason you feel terrible. It would be interesting to see your free t4 number, but your t3 is the "active" hormone used for basic metabolism so if you are low in that, yup, you'll feel crummy.


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## Lovlkn (Dec 20, 2009)

If it were me I would request Free T-4 as well as some antibodies tests - TPO and TSI.

Yes, a low FT-3 will make you feel horrible


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## dee0515 (Jul 22, 2014)

Thank you both very much for your replies. I will see about getting my free T4 tested, but my hunch is that my PCP will want me to wait until I see the endocrinologist. I would not be surprised if it was something autoimmune. My mother has autoimmune issues (lupus).

I am so frustrated and baffled by everything at this point. I also have PCOS, and am seeing a reproductive endocrinologist for that. It seems that both the PCOS and thyroid issue may be interfering with my fertility; however, the RE says that the regular endo will be more knowledgeable about the thyroid. I just wish I could get some answers, and start feeling better. I don't think other people my age feel this way.


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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.

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)

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583
(Copy and paste into your browser)

rT3
http://thyroid-rt3.com/whatis.htm
(Copy and paste into your browser)

Welcome to the board!

This absolutely explains feeling terrible. I am surprised you are able to type your post! OMG! I don't think I have ever seen a FREE T3 that low. This is your active hormone available for cellular uptake. FT3 is your energy source.

Anyway; may I suggest an ultra-sound of your thyroid if you have not had one yet? And a lab test for rT3 (reverse T3) also?

Some info above!


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## dee0515 (Jul 22, 2014)

Andros,

Thank you very much!

Yes, I've been poking around the internet and have come across those sites you suggested. I appreciate it very much! To me, having more knowledge is always better.

I will suggest the additional testing when (and IF!!!) they ever can get me in to see an endocrinologist. It seems that my PCP office is having trouble finding an endocrinologist in my area that has openings. This is incredibly frustrating!

I am extremely tired. For some reason, I am able to make myself do the things that I have to do (work, etc.). If I don't HAVE to do anything, chances are, I won't. This is not laziness. I WANT to have more energy and do things. But the energy is incredibly lacking. It seems like a major ordeal to fold the laundry at times. Will my energy levels improve once my thyroid is corrected? Will it make it easier to lose weight?

Do you know what causes low T3? And can I ask, what would a thyroid ultrasound be confirming/ruling out?

I am also wondering if perhaps a low T3 could lead to m/c and infertility issues.

I am SO relieved to have found this place!
Sorry for all the questions!


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## Andros (Aug 26, 2009)

Insufficient Free T3 can be life-threatening. A person (and animal) cannot survive w/o it. Ultra-sound is needed to be sure you don't have cancer of the thyroid gland.

Then there are autoimmune situations where auto-antibodies and antibodies to those are very active, thus skewing numbers such as the TSH (keeping it low in this case) where ordinarily w/low T3, the TSH would be sky-high.

There a lot of other reasons such as insufficient peripheral deoiodination, damaged receptor sites and even the liver where much but not all of the conversion of T4 to T3 takes place.


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## dee0515 (Jul 22, 2014)

Thanks for your quick response. That makes sense. It sounds like numerous things could be the cause. Hopefully not cancer but best to rule it out.

Autoimmune wouldn't surprise me, because I think that is genetic.

When you say "life threatening," should I be seen by a doctor like tomorrow? Would another specialist besides an endocrinologist perhaps treat this? Maybe this is a bigger deal than I thought! Yikes!


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## dee0515 (Jul 22, 2014)

They finally got my an appointment for August 11. Will have to cross my fingers that everything stays alright until then.


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## joplin1975 (Jul 21, 2011)

You should be a-ok until then. Yes, low free t3 can be life threatening, but in a long term sense. I had pretty much undetectable levels of free t3 for about six months and I'm still here to talk about it.  It's not pleasant, but unless you experience some extreme symptoms, you should be fine.


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## dee0515 (Jul 22, 2014)

Andros & Joplin-

Thank you so much! This seems a little overwhelming at first. I appreciate the help!


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## dee0515 (Jul 22, 2014)

Hello everyone,

I had some more testing done at the endocrinologist. Here are the results:

Serum Testosterone H 70 ng/dL (8-48) -- says he is not worried about b/c free testosterone is normal

Free Testosterone 1.3 pg/mL (0-2.2)

Thyroid Peroxidase (TPO) Ab 11 IU/ml (0-34)

Free T3 2.4 pg/mL (2.0 - 4.4)

Cortisol 13.8 ug/dL H 2.3 - 11.9

Antithyroglobulin Ab <1.0 (0 - 0.9)

He said the next step is to do a dexamethasone test to further evaluate the high cortisol. If that's normal, he said he will put me on thyroid medications, even though my thyroid levels were in normal range at the most recent testing. Does this seem reasonable to you all? Anyone know anything about high cortisol?


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## Hayatiggs (Aug 19, 2014)

Dee, I can't be of any help as I am at the endo-waiting stage at the moment. I was just reading your earlier posts and it sounds exactly like what I have and have had going on for years, and I'm only 32. My endo appt isn't until Sept. 23. I can't wait. I had to schedule myself because my regular doctor (whom I will be leaving after this) first tried to tell me my problems (extreme fatigue, weight gain, limb numbness, blurry vision, depression, worsening heart murmurs) were ADD. When I told him I knew that wasn't what it was, he prescribed me sleeping pills and said that should make me feel much better. I hope you have some answers soon!


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## Andros (Aug 26, 2009)

It can be life-threatening if the extremely low FREE T3 persists over time. It can cause organ failure. And definitely brain cell function.


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## Andros (Aug 26, 2009)

So, what do you think accounts for the turn around on your FREE T3? Previously, it was below the range and now it is still low but within the range. (ranges are different because of two different labs, I suspect)


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## dee0515 (Jul 22, 2014)

Andros- 
I have no idea why my free t3 went from being below range to now being in range. I'm pretty lost about what's going on to be honest with you. Meanwhile, still feeling pretty crummy


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