Am I hypothyroid. Appreciate your opinion.

Hi all, I'm 26 year old healthy male and currently not under thyroid hormone treatment. I would like to ask your opinion about my blood test results:

1st test on April 12, 2017

TSH: 0.66 uIU/mL (lab range: 0.3-5.10)

FT4: 12.9 pmol/L (lab range: 11.5-22.7)

FT3: 5.6 pmol/L (lab range: 3.5-6.5)

2nd test on July 6, 2017 (same lab as 1st test)

TSH: 0.66 uIU/mL (lab range: 0.3-5.10)

FT4: 12.5 pmol/L (lab range: 11.5-22.7)

FT3: 5.5 pmol/L (lab range: 3.5-6.5)

3rd test on July 20, 2017 (different lab, now I went to endo)

TSH: 0.66 uIU/mL (lab range: 0.35-4.55)

FT4: 11.9 pmol/L (lab range: 11.5-22.7)

FT3: 5.1 pmol/L (lab range: 3.5-6.0)

Why I have very low FT4 with normal FT3? However I notice both my FT4 and FT3 are declining but my TSH remain the same.

My other hormones, LH, FSH, HGH, cortisol, prolactin, estradiol are normal. But my total Testosterone is in the middle range and my free Testosterone almost hit the low border. Can it be due to hypothyroidsm?

I have constipation for years, started to feel very tired since last year and last week started to have sleep apnea (whenever I would fall asleep, I felt my breathing stopped). I loss weight and muscle. Feeling cold sometimes, have high cholestrol, frequent urination and blurred vision. Whenever I'm working in my office, I feel very anxious which I believe due to my low Test. Last night I took my first basal temp, it was 36.1C.

My endo said my thyroid is within the range and normal. I have another appointment with him next week and want to ask his opinion about my Testosterone level (I did the test in another lab) and would like him to test my RT3, TPO, DHEA and SHBG. Appreciate your kind opinion. Thank you.

[jimh111]

Your thyroid results look fine, the slight changes are within the tolerances of the assays. Has your vitamin B12 level been checked? This could be B12 deficiency.

[Hidden in reply to jimh111]

No, I haven't check my B12 yet. Looking at the results, is it normal for TSH value remain constant? I believe as my FT4 is decreasing, my TSH would increase to balance back the level. And based on my reading, the optimum level for FT4 should be in the upper range. How can I increase my FT4? Thanks.

[greygoose in reply to Hidden]

It's not your FT4 that's important, it's your FT3. And, for someone not on thyroid hormone replacement (being on THR changes the rules of the game), your FT3 is good.

Your TSH hasn't changed because the changes in your FT3 are minimal, and the TSH doesn't react that fast. And, your pituitary is still satisfied that you have enough T3 in your system, so it doesn't need to poke the thyroid any harder.

I agree with jim, you need to get your B12 tested.

[greygoose in reply to greygoose]

Oh, forgot to say, if I were you, I wouldn't waste my money on an rT3 test at this point. Unless you are starving or have a virus, that isn't likely to be high at the moment.

But, TPO and Tg antibodies would be a very good idea.

[Hidden in reply to greygoose]

Thanks greygoose, I will get my B12, TPO and Tg antibodies check. Is it possible that this is due to secondary hypo where 0.66 TSH is the highest level my pituitary can provide to my thyroid? And the reason why my FT3 still high is because I still have some reserve FT4. Looking at the trend where my FT4 and FT3 are decreasing but TSH remain the same, I'm afraid I'm slowly becoming hypo because TSH supply is lower the FT4 and FT3 demand.

[greygoose in reply to Hidden]

Of course it's possible, but it doesn't show up yet. I don't think you'd find a doctor willing to take a gamble on that at the moment. You really do not want to take thyroid hormone if you don't need it. And, at the moment, you don't need it because your FT3 is good.

But, just one question : on your last set of labs, in a different lab. The TSH and FT3 ranges are different, but not the FT4 range. Are you sure that's right? Can you check on that, please?

[Hidden in reply to greygoose]

Hi greygoose, yes the ranges are correct.

My last result showed that my LH, FSH, ACTH, prolactin and cortisol are normal, but my HGH is actually slightly above the level, 12.2 mIU/L (lab range <9.0). So I took another test last week (i don't remember what the name of the test is but I had to drink glucose syrup and had my blood taken every 30 minutes for 2 hours). I will have the result next week. When I checked online however, 12.2 is still within normal range for other labs. I really hope everything is okay. But at the same time I want to know what cause me all the symptoms I'm having right now, especially depression/anxiety.

[greygoose in reply to Hidden]

OK, so it sounds as if there's nothing wrong with your pituitary, then - unless it's TSH specific hypopituitaryism (spelling?). Are they testing your hypothalamus? I have no idea how you test that, I'm afraid.

[Hidden in reply to greygoose]

It will depend on the result of my HGH test. If my endo suspects something is wrong with my pituitary, then I need to do MRI scan.

[greygoose in reply to Hidden]

OK

[jimh111 in reply to Hidden]

It's quite a fluke that your TSH has been the same for all three tests although the third test has a different reference interval. Although your fT4 is lowish your fT3 is highish thus balancing out. On average, the healthy population will have fT3 and fT4 in the middle of their reference intervals. Your fT3 / fT4 balance is unusual but I wouldn't worry about it, many patients have the opposite balance which seems to cause problems. You can boost your fT4 level by taking levothyroxne but this will lead to a reduction in your fT3 as the TSH falls and your thyroid becomes understimulated. I wouldn't take thyroid hormone at the moment until you have at least ruled out vitamin B12 deficiency. Some patients are hypothyroid with normal thyroid hormone levels but before trailling thyroid hormone you should rule out other possible causes. B12 deficiency is a good posibility and so it should be ruled out by measuring your B12 levels. (Do not supplement B12 until you have had a blood test for B12).

[Hidden in reply to jimh111]

Thanks jimh111, I will get my B12 check. Is it possible that this is due to secondary hypo where 0.66 TSH is the highest level my pituitary can provide to my thyroid? And the reason why my FT3 is still high because I still have some reserve FT4. Looking at the trend where my FT4 and FT3 are decreasing but constant TSH, I'm afraid I'm slowly becoming hypo because TSH supply is lower the FT4 and FT3 demand.

[Hidden in reply to jimh111]

One more I would like to ask, I have read about supply and demand theory where if our T4 level is too low for us, our body will start over converting it into T3. This over conversion is to make as much T3 hormone available for our body to use, as it can, because it thinks it doesn't have enough, based on a low T4:

medhelp.org/posts/Thyroid-D...

What do you think about this theory? Thanks.

[jimh111 in reply to Hidden]

In healthy subjects fT3 and fT4 tend to seasaw a bit. It seems this is to keep a stable supply of thyroid hormone as many tissues can convert T4 to T3, so they are able to use both T3 and T4. In particular the pituitary responds to both T3 and T4 and TSH seems to promote T4 to T3 conversion.

The pituitary can underperform during periods of starvation, illness or depression. This seems to be a survival mechanism. Your hormone levels don't look low. It could still be hypothyroidism as some patients are hypo with normal hormone levels. The only way to find out is a trial of hormone, but other causes should be eliminated first.

[Hidden in reply to jimh111]

Thanks jimh111 for your opinion. Really appreciate it.

[SlowDragon Administrator]

Check vitamin D, folate, B12 and ferritin

These can give symptoms if low, either in own right or can affect thyroid

Also if these are low consider gluten intolerance or silent coeliac

Both thyroid antibodies need testing too

[Hidden in reply to SlowDragon]

Thank you, I will get those tested. Are my results ok?

[humanbean]

If your Free T4 and Free T3 keep on declining and if your TSH doesn't rise then I would suggest you ask your endo for testing for :

secondary hypothyroidism - a problem with the pituitary gland, or

tertiary hypothyroidism - a problem with the hypothalamus.

Secondary and tertiary hypothyroidism are known collectively as central hypothyroidism. With this condition the body doesn't produce enough TSH, so the thyroid doesn't respond adequately, even if it is perfectly healthy.

Since your Free T3 is currently not too bad I would say it was too early to raise the subject with your endo.

[Hidden in reply to humanbean]

Thank you. That's what I thought actually. I think that is the maximum TSH my pitutary can provide. And my reserve FT4 and FT3 are declining bacause my TSH unable to provide more to meet the demand. I will discuss this further with my endo.

[ElleBee71]

Hi mhhk

Your results aren't conclusive. You have low tsh, low t4 and high in range t3.

There's a couple of possibilities. This may be your normal. Your t3 (which is the active thyroid hormone) is actually quite good. But, you also may be developing hypothyroidism with that low in range t4. This might be caused by a pituitary gland problem. Normally when you're t4 is low the pituitary gland send tsh to the thyroid gland to tell it to produce more thyroid hormone.

Take a look at this webpage and talk to your endocrinologist. Pituitary issues apparently also affect other glands/hormones so could be cause of your other issues and low testosterone.

Good luck!

endocrineweb.com/conditions...

[Hidden in reply to ElleBee71]

Thank you. I will discuss this more with my endo. Considering all the symptoms that I'm having right now, I'm afraid there's something wrong with my pituitary.

[Angel_of_the_North]

Have you ever had sex hormones tested? Ever had to get up to pee at nght or had leakage from your nipples? Have you ever had whiplash or a head injury? It could possibly be a pituitary problem although I'd expect free t3 to be lower. Low TSH with low T4 can mean secondary hypothyroidism, but GPs aren't trained to find it or deal with it.

[Hidden in reply to Angel_of_the_North]

Hi Angel, my LH, FSH and prolactin are normal, but my GH is slightly above the level, 12.2 mIU/L (lab range <9.0). So I took another test last week to check whether I have something wrong with my pituitary (i don't remember what the name of the test is but I had to drink glucose syrup and had my blood taken every 30 minutes for 2 hours). I will have the result next week. When I checked online, 12.2 is still within the range for other labs. So, I am not sure. I don't have any head surgery before. Thanks.

[Phoenix605]

Do you exercise? My FT4 drops like that when I am doing regular moderate gym sessions or decent length walks. TSH and FT3 doesnt move much but FT4 tanks. This is because when exercising your body is busy converting FT4 to maintain the FT3 levels it needs. TSH is not rising because the pituitary recognises that you are still producing adequate FT4 to maintain FT3 at a good level.

[Hidden in reply to Phoenix605]

Hi Phoenix, I rarely exercise. Maybe once or twice a week of regular jogging. Sometime not at all because I will feel tired when I arrived home from work.

I have read in article below that in hypo situation (lack of T4), our body will convert extra T4 to T3 in an effort to maintain thyroid function as best possible:

forefronthealth.com/hypothy...

[SpicyLotus]

I think you need to go to a Sleeping Dissorders specialist, because your constipation and gastrointestinal dissorders are probably a consequence of the sleep apnea. Air flow is being obstructed somewhere (and you need to find out where and what is causing it), because if you don't breathe properly you are not getting enough oxygen to your brain. Your TSH levels are more on the hyper than the hypo side, so the tiredness again, is probably another consequence of your sleep apnea. Go get checked asap, because without oxygen flowing in correctly, your entire system will get messed up, and it will eventually make you hypothyroid as your body will have to work harder to regulate your bodily functions.

[Hidden in reply to SpicyLotus]

Hi SpicyLotus, my sleep apnea only happen recently. But I have constipation for years already. I will discuss about it with my endo. Thanks.

[SpicyLotus in reply to Hidden]

When you go to your ends, make sure he/she tests you for Hashimoto's. In Hashi, your immune confuses your thyroid for an intruder, and so it attacks it, leading you to being hypothyroid.

[SpicyLotus in reply to SpicyLotus]

Endo, not ends