Thyroid help needed please. Consistent low T4 with normal TSH...

[LacksDaisies]

Brief history
41 yo female with depression. Was on 20mg but getting worse so increased to 40mg which hasn't helped. As had other niggling symtoms which could be thyroid related (chronic fatigue, weight gain, painful joints esp hands and feet, hair problems, the worsening depression) doc ordered FTT which showed possible thyroid problems and asked me to have further blood tests

Repeat test has come back, and although I don't know the exact numbers, the summary is "consistently low T4 with normal TSH"

Am booked in to discuss with the GP on Monday, and have tried to find out information but it would appear that thyroid results are a bit of a minefield and have left me more than a little confused. From what I understand the normal TSH could be a red herring as the brain overcompensates for an underactive thyroid by producing more TSH and that "normal" is a pretty broad brush anyway. I also found one snippet of info that said that fluoxetine may cause abnormal levels, and am worried that this will be dismissed due to the ADs even though there are lots of other symptoms.

any advice from those in the know would be greatly appreciated, especially things I should be asking my GP.

Poorly DS2 so have to post and run but will be back later.

TIA

LD - I am about to send you a PM.

Leoni wrote > "T3 has a half life of 2.5 days. It turns up in the bloodstream very quickly, and works quickly. It is highly reliable, in contrast to the above poster's quite misinformed [in places] post. It is just as reliable to measure T3 as it is to measure T4 - who told you it isnt?

I have been taking Armour thyroid/ natural thyroid for 9 years instead of thyroxine. I know plenty about it. I take it twice a day - oooh, majour inconvenience there [sarcasm]."

I'll refrain from insults and sarcasm, but the research I read (whose whereabouts I've fogotten - crap memory another symptom of HypoT) stated that (iirc) that they had many problems regulating the amount of T3 in the body and that the levels varied significantly over the period of a day - which was not what was desired. The test is accurate at a point in time, but that doesn't give a reliable picture of what happens over 24hours. They tried administering T3 'many' times per day and that this also didn't result in reliably stable T3 levels over 24 hours. They also found that for a given input level of T3 the (inbody) T3 measurements were not consistent.

I assumed that when they used the word 'many' to refer to the number of times T3 was being administered that it was referring to perhaps 4-8 doses per day (as 2 doesn't seem to qualify).

However I'd be very interested to hear about the treatment recommended above - any particular reason why you have to keep the source of it private? - I thought that these forums were places we could help heach in public.

Good endocrinologist and there is a charity called the British Thyroid Foundation - just google them - that has lots and lots of info.

like me apparently (shit warmed up that is!)

just back from the GP and the results are in. As I had an inkling, he had asked for T3 and antibodies to be done and the lab ignored the request and did a repeat free T4, TSH and total T4. I asked him why and he said that they are expensive tests and labs don't like doing them unless they are absolutely necessary

TSH is 1.4, FT4 is 9.5 and total T4 is 84. Blood was taken at 11.30. The first sample was taken at about 2.30 and the TSH was 0.88.

Doc seemed to think that the low FT4 is probably a red herring and that it may have something to do with illness or medication (perhaps the fluoxetine). He dismissed the feeling of me having something stuck in my throat, and said that many of the other symptoms could be down to the depression.

However, he was happy to refer me to an endocrinologist since we have private health insurance!

So, next step to call the endo and see what happens from there.

he did palpate my throat and hmmm'd a lot and said he couldn't feel a goitre. It felt damn uncomfortable though and feels horrible now, like I need to be constantly clearing my throat. first noticed it 2-3 weeks ago, so well before I knew there were blood issues so I don't think it's psychosim psycosim my imagination (in fact I only realised where my thyroid was a few days ago!)

I'm a bit disappointed in my GP actually, as he is usually pretty good and has more of a holistic approach than most GPs I've encountered over the years.

he did use inverted commas round "best" though when he wrote down that "TSH is the best way if judging thyroid status" as tbhough he didn't quite believe it himself.

I'll carry on down the route proscribed for me for the time being Leonie, but thanks for all your information and help . I'll keep you posted of my progress and may get in touch via pm for details of your Dr S if I exhaust all avenues here!

i know i a ressurrecting an old thread but just wondered how your eyes were lacksdaisies

I had to have my Armour raised from 90 to 120 mg because of the new formulation but did well with it. Then last year I used compounded. Gained a bunch of weight and became hypo during my yearly checkup. Now I'm back with Armour - 120 mg plus 15mg for the past week and I can feel my energy getting back.