Am I hypo??

[thyroidconfused]

I'm 35F with new onset of constipation and I can't lose my 20lb baby weight!!! I'm tired all the time but I was blaming that on my kids. I have low T4 total (3.8), low free T4 (0.7), and low Free T4 index (1.1) but my TSH is totally normal at 1.32. What the heck is going on???. My T3 total is 84 which is normal as well. I had a normal thyroid ultrasound and neg thyroid antibodies. My Vitamin D is 28 which is also low so I am supplementing now.

[greygoose]

Hi thyroidconfused, welcome to the forum.

- First of all, we need the ranges for those results. Ranges vary from lab to lab, so we need those that came with your results.

- Secondly, What time of day did you have the blood draw for those tests? TSH varies throughout the day, and is highest before 9 am.

- Total T4, Total T3 and T4 index are of no use for diagnosis. What we need to see are Free T4, Free T3, TSH and antibodies.

- There are two antibodies for Hashi's: TPO ab and Tg ab. Did you have them both tested?

- Did you have heavy blood-loss during any of your pregnancies?

If you can answer those questions, we'll have a better chance of seeing what's going on.

[thyroidconfused in reply to greygoose]

Thanks for your response!!

From my lab:

Free T4 range: 0.8-1.8; mine was 0.7

Free T3 range: 2.3-4.2; mine was 2.9

TSH range: 0.4-4.5; mine was 1.32. My understanding is that it should be in the upper 3s or higher to correlate with sub clinical hypothyroidism. And that a TSH in the 1s is good. So this is what doesn’t make sense to me. My blood was drawn at 8 am.

I had both antibodies tested and they were both negative

I don’t believe I had any heavy blood loss, at least not that I was told

[greygoose in reply to thyroidconfused]

My understanding is that it should be in the upper 3s or higher to correlate with sub clinical hypothyroidism.

Technically, yes. But, that is assuming that your pituitary is working correctly. And, not all pituitaries do work correctly. And when the pituitary isn't capabable, for whatever reason, of producing adequate TSH, you will get what is calle Secondary hypo. Or, it could be that the hypothalamus is at fault, not signalling the pituitary to make more TSH. We call that Tertiary Hypo. And when in doubt as to which one is malfunctioning, we call it Central Hypo. But very few doctors have ever even heard of Central Hypo, let alone be able to recognise it when they see it.

But, you didn't answer the question about blood-loss during the birth of your babies. Or have you perhaps had a bad knock on the heard recently?

[thyroidconfused in reply to greygoose]

No bad knock on my head! 😂 My response was the last line above - I was never flat out informed that I had heavy blood loss during childbirth. Never had to have a blood transfusion or was told to take iron or anything like that. Was discharged after the standard 2 night stay. So I am guessing the answer is no, but who knows with healthcare these days.

[greygoose in reply to thyroidconfused]

Who knows indeed! Sorry, somehow managed to miss that last line of your reply.

Well, those aren't the only causes of Central Hypo. It could still be the problem. It's just that those are the two causes a doctor might just know about.

So, was this your first thyroid blood test? Or do you have other results much the same?

[thyroidconfused in reply to greygoose]

I had blood tests in July that were exactly the same except for low Free T3 and total T3. My GP put me on liothyronine 5mcg and synthroid 25mcg but I couldn't get over the normal TSH and I stopped them after 3 weeks. The constipation was just resolving when I stopped them. But i wanted to see a specialist to get an answer to the TSH question. All the specialist did was repeat labs and tell me to go on synthroid again. no further workup. You have honestly asked more questions than either of them did. Sounds like I need a new doctor. I just want to understand what is going on and not blindly take pills.

[greygoose in reply to thyroidconfused]

Well, to be brutally honest, you were very lucky to find two doctors that would prescribe for you - and one of them prescribe T3! - with such a low TSH! Usually, doctors go by the TSH only, and seeing yours would have told you there's nothing wrong with your thyroid - even when there obviously is a problem of some sort.

And, all in all, seems pretty obvious to me that the problem lies with your pituitary (or hypothalamus) rather than your thyroid itself. And, there's not a thing you can do about that, except take thyroid hormone replacement (levo, T3, NDT).

But, if you want further proof, ask for a scan of your pituitary (it might be mis-shapen or compressed or something) and for other pituitary hormones to be tested. There are quite a few of them, and they could all be low if your pituitary is mal-functioning: ATCH, HGH, etc. Have you ever had your cortisol tested? There is only one test for the hypothalamus and that is very rarely done because it's not a simple blood test like the others.

With thyroid problems it's not always possible to to understand what exactly is going on. Very few doctors ever understand, or care, and are very unwilling to persue the matter - as you've found out. And, whilst you're trying to find out, you're just delaying the inevitable, and increasing the risk of low thyroid hormone levels further damaging your heart and other organs. Your whole body needs thyroid hormone, every single cell. And, if there's not enough to go round, damage can be done anywhere and everywhere. So, the sooner you get on thyroid hormone replacement, the better.

Forget the TSH. You can live without it but you can live without T3. The total reliance that doctors have on TSH is assuming that everyone has a perfect pituitary/hypothalamus, which just isn't the case. It is actually the least important of the three numbers, FT3 being the most important. So, don't ever allow any doctor to dose you by the TSH. Always insist on having the FT3 tested.

[thyroidconfused in reply to greygoose]

Thank you so much for this explanation. I think this is what I needed to hear. I appreciate it.

[greygoose in reply to thyroidconfused]

You're very welcome.