# Normal TSH and FT3 but Low FT4. Help me Please!



## Bane808 (Aug 23, 2015)

Hi all,

I'm new on here and looking for answers. Hopefully some of you may be able to help 

I'm a 25 year old male. Was otherwise healthy until I took a 3 month cycle of prohormones (steroids) at 18 years old. After this I saw a rapid decline in health- depression, anxiety, fatigue, and low libido. These symptoms have persisted for 7+ years. I went to an endocrinologist in 2009 for this problem, but he opted not to put me on testosterone replacement therapy because my testosterone levels while very low for my age never fell below the normal range (total testosterone was around 350) and all other hormones were okay, I believe TSH was 2.4 and Free T4 was 1.4.

For several years after the initial cycle my quality of life was okay. I would have general malaise and fatigue at times, I had mild to moderate depression periodically, anxiety levels were much higher, and my libido never recovered. However, I could still function, workout, and overall still succeed in school and work.

Fast forward, at 22 years old I started experiencing neurological symptoms. First it began as muscle cramping in calves, then over several months progressed into body-wide muscle twitching. I started having bad insomnia, extreme muscle pain/stiffness aggravated by exercise, peripheral neuropathy (intermittently), intolerance to cold, severe depression and anxiety, and digestive issues like constipation and bloating/gas. I had a hard time exercising because I was super stiff and achy and extremely fatigued all the time.

I've had the neurological/muscular problems now for 3+ years. I have to take Elavil to fall asleep. And I'm always waking up feeling unrefreshed.

My PCP would pull my TSH levels over the years and they always came back normal between 1.2-1.4 uIU/mL. I asked him recently to pull free T4 and free T3 and these were the results...

TSH: 1.37 uIU/mL 
Free T4: 0.75 ng/dL (range 0.8-2.2) Low 
Free T3: 2.99 pg/mL (range 1.5-4.2)

According to the Stop the Thyroid Maddness site, "If you have low FT4 and a mid-range or slightly higher FT3, it usually means the T4 is converting like mad to give you the T3 you do have, which means hypo".

I think it's important to point out that I've been on testosterone replacement therapy now for 6 months, I now have an extremely good testosterone level. I also found out I have severe sleep apnea and have been treating that diligently for the last 6 months with my Bipap machine. Despite both of these things, I'm still very fatigued, still getting periodic mood swings and depression, digestive problems are sticking around, and muscle twitching and stiffness still remains.

Anyone have any input- am I hypothyroid? Could this be the cause of some of my problems? I tried recently the test recommended on the STTM website, to check for adrenal fatigue- the pupil test- where you shine a light at the side of your eyes in a dark room and watch for your pupils to constrict- mine fluctuate like crazy. I also tried the HCL test to see if I have low stomach acid, I've made it up to 4 600mg pills without any symptoms- a probable indication of low stomach acid.

I have an appt. with an endocrinologist here soon. What should I tell him in regards to my bloodwork, I feel like he's going to tell me I'm fine. :/ I've had way too many docs do that to me over the years despite clear symptoms.

(I've tried supplementing with everything- magnesium, COQ-10, Vit B12, Iron and have ruled out Lymes, auto-immune disorders, neurological disorders like ALS and MS, I also was tested for Celiacs and had the IgA and IgG tests come back negative).

Thanks


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## Octavia (Aug 1, 2011)

You need to get that Free T4 much higher.

The problem is that many doctors try to treat patients based only on their TSH levels, and unfortunately, yours is pretty good. But that Free T4 level indicates that you need T4 replacement, which would be Synthroid (or something similar/generic).

If your endo focuses on your TSH and tells you you're fine, steer him/her toward that Free T4 level, which is not in range.


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## Bane808 (Aug 23, 2015)

Octavia said:


> You need to get that Free T4 much higher.
> 
> The problem is that many doctors try to treat patients based only on their TSH levels, and unfortunately, yours is pretty good. But that Free T4 level indicates that you need T4 replacement, which would be Synthroid (or something similar/generic).
> 
> If your endo focuses on your TSH and tells you you're fine, steer him/her toward that Free T4 level, which is not in range.


Thanks Octavia. Would there be any benefit of taking natural desiccated thyroid versus the Synthroid?


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## Octavia (Aug 1, 2011)

I don't know a ton about natural desiccated thyroid, but my first instinct is to steer you toward Synthroid or an equivalent simply because what you need is replacement T4. And my understanding (which could be incorrect...others, please pipe in here) is that the desiccated thyroid has heavier concentrations of T3.


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## Bane808 (Aug 23, 2015)

Okay. I was on the STTM site and I kept seeing "Use Nat. Desiccated Thyroid! Not Synthetic T4." So somehow I had it in my head only Nat. Desiccated Thyroid would be an optimal choice for me- looks like I need to do some more research on synthetic T4.


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## Octavia (Aug 1, 2011)

Synthetic works for many, many, many people, and it's the first choice for most doctors. BUT there are some people who do much better on the desiccated drugs (and they sometimes have a hard time finding a doctor who will prescribe desiccated, unfortunately).


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## joplin1975 (Jul 21, 2011)

Yes. I think STTM is a great resource but my pet peeve is the idea that NDT is the ONLY right choice. That's not true and I think it misleads people. I happen to be an odd one in that my body seems to hyper convert t4 to t3. NDT would be a terrible option for me.


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## Globo (6 mo ago)

Bane808 said:


> Hi all,
> 
> I'm new on here and looking for answers. Hopefully some of you may be able to help
> 
> ...


Hi! I know it's an old post, I'm 22 and I'm in the same situation as you with blood tests pretty much the same as yours. have you started taking thyroid medications? how are you now?


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