Normal TSH but low T3 and T4

[VixUK]

Hi all,

A friend of mine has been suffering a lot of depression, fatigue, lethargy etc... so I encouraged her to get her thyroid checked out. She has family history of underactive thyroid.

Her results are slightly puzzling to me.

TSH 1.59 (0.27-4.20)

T3 0.94 (0.8-2.00)

Free T3 2.78 (2.00 - 4.4)

T4 5.26 (5.1 - 14.1)

Free T4 0.98 (0.93 - 1.70)

She hasn't seen a doctor yet but can anyone give me some feedback on what this could indicate?

[shaws Administrator]

This link may be helpful:

thyroiduk.org.uk/tuk/testin...

[VixUK in reply to shaws]

Thanks! Very interesting.

[Clutter]

VixUK,

TSH is low-normal but FT4 is very low and FT3 is low. Results rule out primary hypothyroidism but I think it's possible that there may be secondary/central hypothyroidism or isolated TSH deficiency because I would expect to see higher TSH with such low FT4.

I recommend your friend discusses this with her GP but she should prepare herself to be told everything is fine because GPs are not good a diagnosing central hypothyroidism. If her GP suspects central hypothyroidism your friend should be referred to endocrinology for investigation and management. cks.nice.org.uk/hypothyroid...

I certainly recommend your friend checks her thyroid levels again in 3-6 months to see whether FT4 has dropped.

[VixUK in reply to Clutter]

Thanks! We don't actually live in the UK so we can go straight to an endocrinologist. However, in my experience, that's not much better. All doctors here see themselves as gods who should never question their opinion.

I manage my own hypothyroid with minimal interference from the doctor.

We can buy all mediation over the counter here without a prescription, so much easier than when I was in the UK and was being told everything was fine.

However, I don't want to advise anyone else to do that without consulting a doctor first. I hope she can find a good one.

[Clutter in reply to VixUK]

VixUK,

If your friend has central hypothyroidism it is necessary to check pituitary function in case sex and growth hormones are also deficient.

patient.co.uk/doctor/pituit...

Treatment for central hypothyroidism is Levothyroxine replacement the same as for primary hypothyroidism.

[SlowDragon Administrator]

Perhaps check her thyroid antibodies and also vitamin D, folate, ferritin and B12