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- Thu Aug 28, 2003 3:25 pm
I have at least 75% of the symptoms for hyperthyroidism, was treated for the disorder during my last pregnacy, currently have irregular periods and unexplained weight gain. My doctor performed the usual tests with the following results: TSH is 2.73 (mind you that standard levels of normal was changed to .3 to 3 early this year) and T4 is 1.3 (normal is 4.5 to 12.5) and T3 is 80 (normal is 80 to 220). Now according to the website thyroid.about.com if TSH is high and T4 is low and T3 is below 80, you are most likely hypothyroidic. Yet my doctor just informed me that I'm "normal" and do not need medication. Is this true or should I seek a second opinion? What specialist should I seek?
| Dr. Shank
- Fri Feb 03, 2006 9:24 pm
Was your total T4, or your free T4 (FT4) 1.3? If your free T4 was 1.3, you are most likely normal, but if your total T4 was 1.3, you are definitely in the hypothyroid range. Since T3 is maintained normal long after T4 becomes low, I suspect that you are right, and that you probably have hypothyroidism. (If the reference range you gave for T4 was the one the lab gave with the results, the test was for total T4.)
Your irregular menstrual periods and your large change (either up or down) are consistent with hypothyroidism. You did not say what other symptoms you have, but a review of them should have been included in your evaluation, along with a targeted physical examination. Laboratory testing is only part of the evaluation, and TSH is only part of the laboratory testing. Non endocrinologists are taught to look at the TSH and to ignore everything else. As you noted, the official position of the American Association of Clinical Endocrinologists and the American Thyroid Association is that a TSH between 0.3 and 3 is normal. Frankly, I find that in nearly all cases in which the TSH is above 2 (outside of non thyroidal illnesses), the patient is clinically hypothyroid and feels and functions better with higher thyroid hormone levels. In fact, I believe that most cases in which the TSH is consistently above 1.5 can be proven to be clinically hypothyroid.
I am concerned that your TSH was not much higher, given your low thyroid hormone levels. This can be seen in non thyroidal illness, very low levels of the thyroid binding proteins, and a combination of thyroid gland failure (very common) with pituitary failure (uncommon).
I would not put much faith in the opinion of anyone who was still measuring total T4 or total T3, and I would have serious doubts about the understanding of anyone who would obtain any measure of T3 to evaluate possible HYPOthyroidism (except as a last resort, by someone who had a sophisticated knowledge of the effects of non thyroidal illness on the metabolism of thyroid hormones, and such a person would definitely not be using measures of "total" thyroid hormones).
Since you were also treated for hypothyroidism during pregancy, it seems unlikely that your laboratory abnormalities are due to temporary hypothyroidism (such as "post partum thyroiditis" or "subacute thyroiditis") or to distortions from non thyroidal illnesses.
I am an endocrinologist with advanced certifications in thyroid and a Ph.D. in Physiology and Biophysics for my work pertaining to the thyroid. While it would be unreasonable to expect most other physicians to understand thyroid as well as I do, it is not unreasonable to expect them to go beyond what I call the "cereal box version" of such a common problem. Unfortunately, most physicians learned that TSH is the "single best test" of thyroid function, but missed the fact that TSH is lousey as a single test.
Yes, by all means, get a second opinion from someone who really knows thyroid. Endocrinologists are the experts in glands and hormones, including thyroid. You can locate an endocrinologist near you at http://www.aace.com
Let us know how how thngs turn out.
I hope that this has been helpful to you.