# Officially hypo, now what?



## greatdanes (Sep 25, 2010)

Kinda perturbed right now. When I went in last thur I saw with my very own eyes that only the FT3 AND FT4 were ordered. When I Called for the results, the asst said they only tested for the FT4 and the tsh. My tsh is the highest I've EVER seen it, and my ft4 the lowest I've ever seen it, so I know my FT3 is low as well. I have a feeling he will say that since he doesn't know what my ft3 is, he won't treat. I don't have the ref ranges b/c I got the results over the phone, but all of us here should know by now what the ref range is, lol.

FT4 .64 ref range usually(0.7-2.19) 
tsh-3.04 .(45-4.68)

So while my tsh is ''in range''(not for me) you can clearly see that my FT4 is hypo.

What do you think my endo will do? I've never been hypo before so don't know what normal protocol is.

Miraculously, I'm not tired or gaining a whole bunch of weight. I've gained about 3 punds in a month, but i had lost up 12-15 pounds when hyper so i figure it's just slowly coming back on.

My only complaint is joint and back pain, some days worse than others but bearable. My apt is thurs, and I really hope he gives me something, I don't want to keep plummeting


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## GD Women (Mar 5, 2007)

I don't remember if you are already treated, if so ignore the below. If you are not being treated then please heed the below and bring it up to your doctor. Better yet google the subject, run it off and take it to your doctors. Doctors are so sensitive you have to handle them with kit gloves and make them think it was their idea in the first place. this is tricky and I can't give you examples. You are all on your own when handing an sensitive and egotistic doctor.

First:
T3 test is usually ordered in cases of an overactive gland. Otherwise it's usually not done routinely because it adds little information compared to the combo of a TSH, T4 and Free T4 that you get when you get a thyroid panel.

In other words a free T3 would then be performed if the free T4 is normal and the TSH is less than 0.45.
http://www.aacc.org/events/expert_access/2005/thyroid/Pages/qanda.aspx

Second: 
Your levels look like Central hypothyroidism. TSH cannot be used to diagnose central hypothyroidism because current TSH assays measure biologically inactive TSH isoforms. When the serum FT4 is low and yet the serum TSH is only minimally elevated (<10 mIU/L), a diagnosis of central hypothyroidism should be considered. TRH-stimulation testing may be useful for specifically diagnosing central hypothyroidism.
When using FT4 as the therapeutic treatment for central hypothyroidism, the daily dose of L-T4 should be withheld on the day of the FT4 measurement.
Guideline 27. Clinical Utility of TSH Assays (Functional Sensitivity < 0.02 mIU/L) http://www.medscape.com/viewarticle/452667_5

Hope this helps.


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## greatdanes (Sep 25, 2010)

Thanks I'll look into that. 6 weeks ago tsh was undetectable, t3/t4 were both high. Started low dose Atd,2-3 weeks later t3/4 were in range but low end and tsh was.0004. 3 weeks later are the numbers in my first post. I figure the hAshi antibodies are taking over and the tsh will continue to rise the way it has been. Which is why I hope they can get me started on thyroid meds.


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## GD Women (Mar 5, 2007)

Well then its probably not central hypothyroidism. The ATDs are no doubt the reason. Although you could have shifted into central hypo. You seem to have conflicting Labs/levels. Even when I went hypo with TSH 7.58 FT-4 didn't stray to the hypo side. Although I think I have just a conflicting Labs/levels as you - not like yours but never the less conflicting.

Any way good luck with your appointment thurs.


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