# low ft4 with normal everything else



## bemis23

Not sure what to do with my labs. My FT4 keeps testing at about .8 but everything else is in the normal range. My TSH is in the lower end of normal. I also show up for anemia, and the doctors are so stuck on anemia that they at times disregard my thyroid. Thought it was Hashimotos but I'm negative for those antibodies. I've had same problems with 3 of my 4 pregnancies- I get hyperthyroid symptoms for first month or so postpartm, then go hypo for a year, then supposedly it evens out.....I know it improves, but I don't think it ever is where it should be- I never feel great and continue to struggle with fatigue, weight gain (or inability to lose weight), and mild depression and emotional issues. The doc isn't too concerned with my thyroid though and just thinks it is where it should be and that I just naturally run low, but that's fine for my body. Um, what do I do?


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## Lovlkn

If you have them please post dates, lab's and ranges along with what medications you are on, if any.

Your FT-4 would be in low range for most lab's. A low FT-4 indicates an under active thyroid. You have symptoms of under active thyroid.

Save yourself the headache and order your own tests and take them to the doctor is both FT-4 and FT-3 are in low range.

www.healthcheckusa.com has a test package for around $85 that has a TSH, FT-4 and FT-3.


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## Andros

bemis23 said:


> Not sure what to do with my labs. My FT4 keeps testing at about .8 but everything else is in the normal range. My TSH is in the lower end of normal. I also show up for anemia, and the doctors are so stuck on anemia that they at times disregard my thyroid. Thought it was Hashimotos but I'm negative for those antibodies. I've had same problems with 3 of my 4 pregnancies- I get hyperthyroid symptoms for first month or so postpartm, then go hypo for a year, then supposedly it evens out.....I know it improves, but I don't think it ever is where it should be- I never feel great and continue to struggle with fatigue, weight gain (or inability to lose weight), and mild depression and emotional issues. The doc isn't too concerned with my thyroid though and just thinks it is where it should be and that I just naturally run low, but that's fine for my body. Um, what do I do?


We do need lab results and ranges on the same page so we can have a look.

There could be many things going on here. What antibodies' tests did you have?

Any of these?

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), 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/


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## bemis23

I do not have the actual report of the lab results yet. I called the clinic to see if results were in because it had been a while, and she gave me the info on the phone. Hopefully they will be mailed this week and then I can post more detail.


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## Andros

bemis23 said:


> I do not have the actual report of the lab results yet. I called the clinic to see if results were in because it had been a while, and she gave me the info on the phone. Hopefully they will be mailed this week and then I can post more detail.


That will be excellent and most helpful to us so we may help you! Good deal!!!


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## bemis23

here are my labs:
tsh 1.510 range .540-5.7
ft4 .82 range.93-1.7
ft3 2.97 range 2.57-4.43
acth 21
cortisol 10
thyroperoxidase Ab, S <.3 range <9.0

this means nothing to me. I have had my ft4 tested 4 times in the past 3 yrs. It likes the low .8 area consistently. I also KNOW I have been hyper, then hypo for my last 3 postpatums. I fear my ft4 will stay just a little low and this will be as good as I get to feel, which is much better than 4 months postpartum, but still not amazing. Dr says to not medicate, just keep checking every 3/6 months since hypo runs in family (my dad and half of his siblings out of 10 kids).


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## Lovlkn

bemis23 said:


> here are my labs:
> tsh 1.510 range .540-5.7
> ft4 .82 range.93-1.7
> ft3 2.97 range 2.57-4.43
> acth 21
> cortisol 10
> thyroperoxidase Ab, S <.3 range <9.0
> 
> this means nothing to me. I have had my ft4 tested 4 times in the past 3 yrs. It likes the low .8 area consistently. I also KNOW I have been hyper, then hypo for my last 3 postpatums. I fear my ft4 will stay just a little low and this will be as good as I get to feel, which is much better than 4 months postpartum, but still not amazing. Dr says to not medicate, just keep checking every 3/6 months since hypo runs in family (my dad and half of his siblings out of 10 kids).


I'd like to see some lab history. You are terribly hypo right now and presenting symptoms - what reason is your doctor giving you to not medicate?


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## bemis23

the dr says that since my other numbers (besides ft4) are in the normal range, that i'm ok for now. he wants to watch my tsh specifically. in fact, he said that i don't need the other numbers tested every 3-6 months, just tsh. what about this lab work convinces you i'm so hypo? i'm really confused right now. i feel better than i have in months. that being said, i still don't feel as good as i would like. and is it normal to have terrible anger issues if you are hypo? for 8 months i was unable to cry, but the anger, and the quick mood changes.......unbearable. ugh. i have all these symptoms that fit hypo, but then the dr tells me i'm still ok, and then i think maybe it is all in my head.


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## bemis23

[quote name='bemis23']here are my labs:
tsh 1.510 range .540-5.7
ft4 .82 range.93-1.7
ft3 2.97 range 2.57-4.43
acth 21
cortisol 10
thyroperoxidase Ab, S <.3 range <9.0

i also have labs from july 2012, but only tsh and ft4:
tsh 1.250 range.50-5.700
ft4 .80 range .9301.70
i'm also anemic....hgb was 10.8 range 11.7-15.8, and hct 32.9 range 33.2-48.0

my iron levels are good though. i have heard anemia can result from underactive thyroid, wondering that's why i'm low?

i also had my ft4 tested in march 2009 and it was at about .82........


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## jenny v

Ugh, you are way hypo. Your FT4 isn't even in range and your FT3 is almost out of range, too. Although your TSH is okay-ish, your Frees are not good and you should be on some kind of thyroid replacement medication. Is your doctor an endocrinologist?


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## Andros

bemis23 said:


> the dr says that since my other numbers (besides ft4) are in the normal range, that i'm ok for now. he wants to watch my tsh specifically. in fact, he said that i don't need the other numbers tested every 3-6 months, just tsh. what about this lab work convinces you i'm so hypo? i'm really confused right now. i feel better than i have in months. that being said, i still don't feel as good as i would like. and is it normal to have terrible anger issues if you are hypo? for 8 months i was unable to cry, but the anger, and the quick mood changes.......unbearable. ugh. i have all these symptoms that fit hypo, but then the dr tells me i'm still ok, and then i think maybe it is all in my head.


LHM (Lord have mercy!) Both your Frees are in the basement. I don't see how you are able to function at all!

Please find another doctor STAT. This is ridiculous!

Because you do not have TPO does not mean you do not have Hashimoto's. BUT........................that is not the most important thing at issue here.

You need to demand an ultra-sound and also these tests except for TPO which you already had.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), 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/

Your labs are peculiar and they suggest that adrenal fatigue and/or pituitary be ruled in or out.

http://www.drrind.com/therapies/thyroid-scale-matrix

This is not in your head! You really need a better doctor; that's no joke!


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## bemis23

yes i went to an endo. he was pretty unimpressed with my numbers, and just wants the tsh checked every 3 months or so. since that is in range, he thinks the rest is ok. i'm ready to just give up and be fat, unmotivated, depressed, and fingernailess (oh they break so easy, i have 8 sore broken nails right now). ugh. how do i convince them in need meds when my numbers are all in range or close to it?


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## bemis23

you know, that makes me feel so much better to hear you are surprised i can function at all, because most days are SUCH a STRUGGLE, and i guess i just figured i've become really lazy. hearing that gives me hope that maybe it really is my thyroid still affecting me! but why is my endo so against giving me something??? he just says i'm close enough to being in range and if he gives me meds it could do more harm than good- basically put me into hyper or something, from what i could understand.


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## bemis23

oh i forgot to mention. the endo said he wanted to test my adrenal function. it all was normal i guess.....the lab for that is posted already but i don't know which numbers exactly show that. one of the links you gave me was very helpful and it does almost look like i could have estrogen dominance or adrenal issues.....especially when i nearly miscarried with my last pregnancy and they suspect i might need progesterone shots if i have more children. thanks for that link. i think i will call my GP and talk to her and see if she will refer me to a different endo.


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## Andros

bemis23 said:


> you know, that makes me feel so much better to hear you are surprised i can function at all, because most days are SUCH a STRUGGLE, and i guess i just figured i've become really lazy. hearing that gives me hope that maybe it really is my thyroid still affecting me! but why is my endo so against giving me something??? he just says i'm close enough to being in range and if he gives me meds it could do more harm than good- basically put me into hyper or something, from what i could understand.


Honey bunny; get another doctor. Quickly.

You are not lazy; you are ill.


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## bemis23

ok i emailed my regular doctor about the lab work and getting a second opinion on all this from a new endo. he is extremely difficult to get into, and so i haven't seen him yet this year on any of this thyroid stuff. he responded to me by saying that i have post partum thyroidtoxicosis. he made an appt for me on nov 5th to discuss it.
to my understanding, postpartum thyroidtoxicosis would put me at hyper??? which i KNOW i am not. and wouldn't my labs look very different if that's what I had? i'm weary of so many diagnoses, or lack of them. wondering if i might have a hormonal imbalance that is causing this. anyway, i guess that is the next step, seeing if i have postpartum thyroitoxicosis, and seeing if i can get dr to test me for hormonal imbalances, and perhaps a new endo! what tests specifically should i ask him to run on me? i think TSI was mentioned. what else do i need to have done?


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## bemis23

ok i met with my primary physician. he reviewed my history, and wants to start me on a dose of levythyroxine. i am not sure that he is convinced i should be on it, he thought my numbers might still improve if i gave them more time (personally, i think this is as good as my life gets......based on my history of the past postpartum periods), but is willing to put me on a small dose. interesting. the endo looked at my lab numbers and told me my tsh was normal, so i didn't need anything. my GP here also looked at the numbers, but focused on the relationship of FT3 to FT4 and how that was off. so that's why i get meds.
interesting enough, the nurse I had also is being treated for hypothyroidism. and was so understanding about the symptoms i have. and my body temp sits inthe 96 degree area! i've known it was under, but to have a nurse know WHY it was under was nice.


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## Andros

bemis23 said:


> ok i met with my primary physician. he reviewed my history, and wants to start me on a dose of levythyroxine. i am not sure that he is convinced i should be on it, he thought my numbers might still improve if i gave them more time (personally, i think this is as good as my life gets......based on my history of the past postpartum periods), but is willing to put me on a small dose. interesting. the endo looked at my lab numbers and told me my tsh was normal, so i didn't need anything. my GP here also looked at the numbers, but focused on the relationship of FT3 to FT4 and how that was off. so that's why i get meds.
> interesting enough, the nurse I had also is being treated for hypothyroidism. and was so understanding about the symptoms i have. and my body temp sits inthe 96 degree area! i've known it was under, but to have a nurse know WHY it was under was nice.


What is your starting dose? You will have to get labs about every 8 weeks for further titration until you feel well.

Glad this one doc has looked at the FREES rather than the TSH.

Please read this so you can advocate for yourself.

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
FREE T3 explained by Woliner
http://thyroid.about.com/cs/testsforthyroid/a/freet3.htm


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## bemis23

my starting dose is 50 mcg of levothyroxin. dr told me to take it at night. first night i got kind of giddy, then felt sick, and had headaches. then i switched to morning. SO TIRED.....laying on the floor, dozing on and off. that lasted 2 days. now i'm back to more normal, not so tired. does this all make sense for someone starting meds? also, i know this dr is watching my frees more closely, but one thing i'm not so sure of is what i have. he said i have (let's see if i can name it right) postpartum toxicosis or something. i don't think he is right. the endo thought there was something else going on, and my thyroid was responding to that. this dr thought it was most likely just my thyroid, and not a different hormonal imbalance. although i disagree with the endo on not needing meds because my tsh was in range, i wonder if he was right on it being something else that my thyroid is responding to.....basing this off my lab numbers, which just don't make sense to me! (why would tsh be normal, when ft4 is below range???). anyway, so much i don't understand, and i just want to know what i have.....i want to be able to put a NAME to this! and know that i'm treating it properly.
also wondering, what do i expect the first few weeks of this dosage? what should i be looking for to know if this is working or not? i feel lost- got this dosage, and now what?


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## Andros

bemis23 said:


> my starting dose is 50 mcg of levothyroxin. dr told me to take it at night. first night i got kind of giddy, then felt sick, and had headaches. then i switched to morning. SO TIRED.....laying on the floor, dozing on and off. that lasted 2 days. now i'm back to more normal, not so tired. does this all make sense for someone starting meds? also, i know this dr is watching my frees more closely, but one thing i'm not so sure of is what i have. he said i have (let's see if i can name it right) postpartum toxicosis or something. i don't think he is right. the endo thought there was something else going on, and my thyroid was responding to that. this dr thought it was most likely just my thyroid, and not a different hormonal imbalance. although i disagree with the endo on not needing meds because my tsh was in range, i wonder if he was right on it being something else that my thyroid is responding to.....basing this off my lab numbers, which just don't make sense to me! (why would tsh be normal, when ft4 is below range???). anyway, so much i don't understand, and i just want to know what i have.....i want to be able to put a NAME to this! and know that i'm treating it properly.
> also wondering, what do i expect the first few weeks of this dosage? what should i be looking for to know if this is working or not? i feel lost- got this dosage, and now what?


I hope you read the links I provided. It takes 8 weeks for T4 to build up in your system. You will slowly start to feel better.


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## bemis23

I did read the links, thanks. It was helpful, but a bit like wading through mud! This is all so new to me. What exactly is titration? Is that the adjustment period to having all this T4 in me? I have no idea what to expect I guess. I have days where I feel like crap, then I will have a day or part of a day where I feel so normal, the cravings go away, I have energy, my skin isn't so dry, I am not so angry......and then it goes away. That's hard, the hope I feel when I feel well, and then crashing down. So 8 weeks.......


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## javynliz

I know how that feels... Feeling good one day and hopeful...then crap. Hugs


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## Lovlkn

Request your Vit D levels be checked and also your Ferritin levels. Both of those can mimic hypo symptoms of fatigue and lack of energy if low


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## bemis23

javynliz said:


> I know how that feels... Feeling good one day and hopeful...then crap. Hugs


is that pretty typical then, when you start a thyroid med? i just need to wait it out 6 weeks, and then see how I'm doing? just want to know what to expect at this point in time....


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## jenny v

bemis, titration is bascially slowly bumping up your dosage until you reach a euthyroid state (i.e., the level where your levels look good and you feel good). It can take a while and take some tinkering with the dosage levels to get there.

I'm on Synthroid and I've found that it typically takes me about 4-6 weeks for the medication to build up in my system enough to feel any difference. It's an up and down period for a while until it steadies out.


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## javynliz

Bemis23,
I don't know if that is typical for everyone. I do know that I seem to be on a roller coaster ride from day to day. Hopefully, you can get the answers you need. I am still searching for them myself. I am new to all of this as well. There are a lot of very knowledgeable people on here that I'm sure can give you more information than me. I just wanted to offer my support. I know how it feels to be confused about what is normal and what is not. The past 2 1/2 years for me have been very confusing. HUGS


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## bemis23

well i got new labs. tsh is 0.240 range 0.540 - 5.700, which is down from what it was.
ft4 is .98 range .93-1.70........which is up from .8

5 weeks on levo. why do i still feel like crap? my vit d and ferritin are normal. they didn't test my ft3 i guess......


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## Andros

bemis23 said:


> well i got new labs. tsh is 0.240 range 0.540 - 5.700, which is down from what it was.
> ft4 is .98 range .93-1.70........which is up from .8
> 
> 5 weeks on levo. why do i still feel like crap? my vit d and ferritin are normal. they didn't test my ft3 i guess......


How much Levothyroxine are you taking? And you have only been on it for 5 weeks; is that correct?

What was the number on your ferritin test; do you know?


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## bemis23

Yes I took Levothyroxine for 5 weeks......50 mcgs. I did switch to NP thyroid though- and I've been on this one for about 5 days. I do much better with NP. No more hyper symptoms, and I don't feel as hypo anymore, although I suspect I will need my dose increased. My ferritin is 27.3 with standard range being 8-120. I do take a high quality Vitamin D supplement, although I don't know what my levels are. I'm hoping the major hypo symptoms don't return- I did feel good on Levo at first. Hopefully the NP won't be that way.


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## javynliz

to me your ferritin is suboptimal. Doc didn't think so?


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## bemis23

my dr never said a word about my ferritin results. what can i do to increase my levels?


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## Andros

bemis23 said:


> Yes I took Levothyroxine for 5 weeks......50 mcgs. I did switch to NP thyroid though- and I've been on this one for about 5 days. I do much better with NP. No more hyper symptoms, and I don't feel as hypo anymore, although I suspect I will need my dose increased. My ferritin is 27.3 with standard range being 8-120. I do take a high quality Vitamin D supplement, although I don't know what my levels are. I'm hoping the major hypo symptoms don't return- I did feel good on Levo at first. Hopefully the NP won't be that way.


Hope you are working on that ferritin as it should be 50 to 100 and the closer to 100, the better.

Hope you do exceedingly well on the NP. If titrated properly, you should.

Wonder if this would be of interest to you?

Vitamin D
http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php


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## bemis23

interesting article. could very well apply to me. i know that my high cholesteral, depression, anxiety, and low hemoglobin were thyroid related, whereas the doctors tried to separate them from my thyroid. this could very well be with my vit d as well, although i'm not sure how to judge if it is or not. 
i'm not sure how to approach my doctor about having both tests for autoimmune. i feel kind of dumb and pushy to keep "suggesting" all these things. the NP is working out much better than levo was. no hyper symptoms with NP, whereas it was pretty bad with levo. 
my newest thing is my throat. it feels kind of weird inside on the right side. like when i swallow there is something stuck in it. doesn't really hurt, although it can hurt a little when is swallow food. i think i've maybe had this feeling before, but now i'm wondering, could it be thyroid related? also, my voice sounds a little weird- a little low, or hoarse, but not too bad, not the way it was when i was WAY hypo.


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