Why would the Free T3 & T4 be "in Range" but the TSH is high.

[Kitten-whiskers]

Sorry to ask a silly question - my brain is very muddled to day

Thank you x

[LouiseRoberts]

Sorry to be a pain - but can you supply the results and the reference ranges - thanks! x

[Kitten-whiskers in reply to LouiseRoberts]

Sorry everyone, I do not have them. I am getting my Info from a copy of the letter from the Endo to my GP.. My last TSH was 10.85 (back in Nov I think) and she said "suprisingly the FT3 & FT4 were in range". If one is out of range, shouldn't they all be

Best wishes

[LouiseRoberts in reply to Kitten-whiskers]

Please post them once you have them! x

[humanbean]

This is me wearing my cynical hat so don't take this post seriously...

Let's imagine the free T4 range is 9.2 - 17.6 (I just made up the numbers). And imagine your result for free T4 was 9.0. This is obviously below the range.

All that is required to make your result be "in range" is for the lab to change the reference range to 8.9 - 15.8 and hey presto! Your result is now in range - a miracle of modern science - you are cured!

As far as I can tell none of the labs use any particularly sophisticated ways of determining the correct reference range. I am convinced they just use the samples they get sent to determine the ranges i.e. they use the blood samples of people who are probably already sick to determine who is well and who is ill.

[LouiseRoberts in reply to humanbean]

Actually - they test a random cross-section of the population.... still get the same problem though.... as this will include people who are symptomatic but not diagnosed..... or those with odd results and no symptoms....

Need to also bear in mind that some people believe that there is an environmental aspect... so if they are all from the same area.....!

L

x

[humanbean in reply to LouiseRoberts]

I've heard this before - about a random cross-section of the population being used for creating reference ranges. But in my entire life I have never known anyone to ever be asked if they would give a blood sample to be used in creating reference ranges for tests.

There must be healthy people in the UK who don't go to the doctor for years at a time. Do they get letters occasionally asking them to give blood for reference range testing?

Do any of the blood samples that get used for the reference ranges come from people who get interviewed about their health to be sure that only healthy people are included?

I really want to be convinced that the reference ranges are created from people who are healthy, but I know it won't happen.

[LouiseRoberts in reply to humanbean]

There's no doubt that the ranges need investigation! x

[Kitten-whiskers in reply to humanbean]

Hello Humanbean,

Thank you for your reply. I am very poorly and seem to be getting worse.

I am without a doubt Hypo along with Adrenal Fatigue & leaky gut but the real problem for me is taking the medication, it makes me feel awful. The docs & Endo do not understand this

[jimh111]

TSH rises as fT3 and fT4 decline. The rise in TSH is much greater than the fall in the fT3, fT4. However, the reference interval for TSH is also proportionally much larger. If your thyroid gland is suffering minor failure the pituitary pumps out more TSH in order to restore the fT3, fT4 levels. Thus, someone could have a TSH of 10.85 and be perfectly well, more often they will be unwell because although their fT3 and fT4 may remain within their reference intervals they may be lower than they used to be.

High TSH with fT3 and fT4 within the reference intervals is referred to as 'subclinical hypothyroidism' by most endocrinologists. The general view they hold is that if the TSH is between 5 and 10 no action should be taken. If it is over 10 or the fT3 or fT4 are below the lower limit of their reference interval they consider treatment. This is very frustrating for patients:-

1. It is only subclinical IF the patient has no signs or symptoms of hypothyroidism. It is unscientific to use a blood test to define if a disorder has clinical effects. If the patient has symptoms of hypothyroidism it is clinical.

2. Everyone is different. Some people will be fine with a TSH of 10, others will be very ill with a TSH only as high as 3.0.

If you have signs and symptoms of hypothyroidism I'd strongly urge you to insist your doctor gives you a trial of thyroid hormone supplementation. Your response to the hormone is the only definitive way to know if it is hypothyroidism.

[Kitten-whiskers in reply to jimh111]

Hello Jimh111

Thank you for all that great info - very impressive . I have been give thyroid medication back in 2011 but it causes lots of problems, it's been so bad that I have stopped taking it completely. I was hoping an endo was going to help me but it doesn't look like it, they all seem so cold and unhelpful

[Femme1]

There is also the issue of intra cellular activity. Perhaps the levels of ft3 and ft4 are perfectly fine 'in your blood' but this is of little help if they cannot enter your cells where they become active and make you feel well. Maybe adrenals are a little tired, maybe ferritin is low, these things can stop us actually absorbing the thyroid hormones we do make. I'm not saying this is your problem, just that it in some people it could explain the difference in levels and your high TSH. Also, as mentioned previously, 'in range' ft3 and ft4, might be right at the bottom of the healthy range and thus make you feel rubbish, but warrant an 'ok' in terms of lab results. I would be more inclined to go by how you feel. I was kept I'll for years with only just in range blood tests, and a tsh that never raised above 2.59 . We're all different I suppose. Best advice Dr Skinner gave me was to listen to my body.

[Kitten-whiskers in reply to Femme1]

Hello Femme1,

You are spot on, I really have trouble taking any form of thyroid medication. I do have poorly adrenals & leaky gut (I am doing everything I can to correct this) Fantastic advice from Dr Skinner - I do listen to my body but not sure what else to do. I need the medication but I can't take it.

[galathea]

Your free t4 And free t3 can be in range with a high tsh, If the thyroid is failing and needs to be driven very hard to make sufficient amounts of hormone.

You need to watch those frees because if they start to drop it could well mean that the thyroid cannot make any more hormones no matter how much it is flogged.

Suggest you get your antibodies measured to determine if you have hashimotos, which is the most common reason for failing thyroids

Xx

G

[Kitten-whiskers in reply to galathea]

Hello Galathea,

Thank you for your advice, I am not sure why they never seem to test the Antibodies, i will ask the endo to test that when I next go back end of September

Best wishes

[Burrfoot1980]

when I was diagnosed my TSH was through the roof and my T4 etcs was really low, once I was supplemented with levothyroxine my TSH came down and my T4 etc came up. Maybe I am being thick but if your thyroid is OK and producing in range but your pituitary gland is still working overtime maybe there is a problem somewhere. like Femme1 suggests there could be issues with your cells not absorbing the hormones thus pituitary gland is still over working because it thinks it needs to make more of it. As femme1 suggests listen to your body if you feel unwell go back to Dr/GP/Endo and push for investigation

[Kitten-whiskers in reply to Burrfoot1980]

Hello Burrfoot1980

The cells certainly don't absorb very well, I have all sorts of problems taking the Thyroid medication, so now I barely take any because I am frightened of whats going to happen.

The Docs/Endo are really not interested in helping, I have changed surgeries , seen different endo's and none have been interested, It is quite simply take a pill and you will be well, that doesn't work for me.

Best wishes

[Burrfoot1980 in reply to Kitten-whiskers]

Hi kitten-whiskers, I understand where your coming from. The drs and endos have a Duty of care and should abide by it. I am shocked at the treatment you have received and recommended complaining to the CQC or the GMC. Has anyone offered you any alternative medication like armour? Although medication has helped me to feel almost right I attribute most of feeling better due to changing my lifestyle. I now make sure I exercise at least 2-3 times a week, I limit goitrogenic foods and have removed fluoride from my diet and I supplement my nutritional needs with juice plus.

[Kitten-whiskers in reply to Burrfoot1980]

Hello Burrfoot,

The docs have made it clear they won't prescribe Natural Thyroid or Hydrocortisone. I am so glad to hear you are nearly well. I have purchased natural thyroid online (nutri thyroid and westhyroid pure) but they done the same thing. I do take lots of supplements, and I do exclude fluoride and will be (hopefully next week) starting my exclusion diet (avoiding gluten, wheat, dairy etc) for 30 days then introducing it again to see which foods are causing the problem. I do exercise when I can (always walking & yoga)

I did see a different endo last week (this is after making a nuisance of myself) and her plan was to force the medication in (by giving me betablockers to mask some of the symptoms) and get the thyroid up to a normal level - I think if I do that I will end up in hospital or worse........ That shows that she didn't really listen to what I was saying

[Burrfoot1980 in reply to Kitten-whiskers]

Again I reiterate how shocked I am at your treatment, meds should be a last resort. I think,it's a really good idea to try cut things out then gradually reintroduce them. I tried a period wheat free, dairy and caffeine free but nothing really affected my symptoms however my body did feel better for getting rid of all the toxins ans now I oonly have bread or daily now and again and I home cook most foods now to avoid unwanted chemicals. Do you, suffer with facial flushes?

[Kitten-whiskers in reply to Burrfoot1980]

I do get flushes in my face, my back and my bottom - that symptom seems to be caused by Thryoid meds. Do you take Thyroid medication or have you completely nearly got well without meds? this is what I am hoping to do. I will be starting cooking all my own foods and baking my own bread as well, it is shocking what goes into our foods today. Sadly I am not a great cook - but have my sprecial free from cookbook at the ready.

[Burrfoot1980 in reply to Kitten-whiskers]

I get flushes in the face and my endo is currently screening me for an adrenal problem he thinks I may have some sort of inflammation possibly caused by the meds. I started on 50 and quickly went to 100 then jumped to 150 for quite a while but since seeing the endo he has reduced me back to 100 And I feel the same as when on the 150 but with less flushing. To be honest though I really do think it's the eating natural/healthy that has made the most difference. I hope it all works.out for.you. If you get the chance check out juice plus its what I use to kind of fill the gap, the group I'm in (its all on facebook) are really supportive and there are hundreds of easy recipes using natural ingredients whilst avoiding wheats and glutens and dairies apart from little organic butter now and.again. Really hope.it works out for you. All the best

[Kitten-whiskers in reply to Burrfoot1980]

Thank you Burrfoot, It sounds like you have a much better endo than the two I've seen. I will definitely check out juice plus & will without a doubt be cooking, anything to help get better. Thank you for your advice

Best wishes