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Low TSH and Normal T3 & T4, but Hypothyroid Symptoms

by (5100) Updated May 27, 2013 at 11:12 PM Created May 25, 2011 at 7:26 PM

I seem to be having hypothyroid symptoms even though my blood work seems to be fine. Here're the results along w/some relevant metrics:

  • 10/01/09 TSH (0.81)
  • 10/27/09 TSH (0.75); T4 (1.25); Cortisol (14.3); Testosterone (307); Homocysteine (8.7)
  • 12/31/09 TSH (0.52); T3 (2.60); T4 (1.13); Cortisol (14.1) Testosterone (466); Free T Dir (14.7)
  • 04/26/10 TSH (1.47); T4 (1.25)
  • 09/09/10 TSH (0.70)
  • 12/10/10 TSH (0.60); T3 (3.00) T4 (1.66)

Obviously my TSH is low and below the functional range (1.8-3), so I don't seem to be hypo and in fact hyper. My T3 and T4 seem normal. However, here are my hypo-like symptoms:

  • Cold fingers & hands (but toes aren't cold)
  • Chronic constipation for 2Y: lack of colon moisture & Bristol Chart 1 stool (tried pre/probiotics, fermented food/beverages, soluble fiber supplements, as well as antioxidants and starch introduction a la PHD).
  • Dry, scaly, cracked feet: mounds of dead skin when going barefoot (hands aren't dry though)
  • Irregular, brittle, fungal & whitened-out toe nails
  • Low libido: testosterone (see above) seems low.
  • Skin rash / psoriasis, calf area. Not too itchy but been there for 2Y.
  • Forgetfulness and senior moments: nothing major but it's sometimes confounding when you can't remember the names of your coworkers.

However, no real

  • Fatigue, sluggishness or depression
  • Increased sensitivity to cold
  • Hoarse voice
  • Muscle weakness
  • Brittle hair
  • No real IBD/IBS or digestive issues other than constipation
  • No weakened immune system for chronic infections

I'm currently seeing an endo and rheumy for T2 diabetes and autoimmune issues: (i) Sjogren's (confirmed) and (ii) occasional gout-like joint attacks (not confirmed to be gout or rheumatoid arthritis, however). I've been eating low-carb/Paleo last 2 years. My BG control is ok (A1C: 5.4-5.7), as is my weight (5-10/157, 46Y male) and my autoimmune symptoms have improved since Paleoing. I do low carb (50-75g net carbs; 65% fat, 20% prot, 15% carbs) and am intermittently ketogenic. Never been tested for thyroid antibodies.

What do you think? Is this what Chris Kresser would call "hypothyroidism caused by pituitary dysfunction" or "thyroid resistance"? However, my cortisol and other measures (e.g., homocysteine) seem normal.

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7 Replies

602e5d4f4e8b31a301ea49f250f19dbe
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270 · May 25, 2011 at 8:45 PM

You should read Datis Kharrazian's "Why Do I Still Have Thyroid Symptom's When My Lab Tests Are Normal". Thyroid issues are amazingly complicated...he does a good job of breaking it down and explaining why it is so easy to have functional hypothyroidism when your lab values are in the normal range.

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20 · February 06, 2012 at 3:56 PM

I am at my wits end. I had a thyroidectomy and have been steadily increasing my levothroxine dose for about 7 months now and am taking a huge 350mcg. My levels TSH and T3 are in the normal range but I can not feel normal. I am moody, depressed, and feel hypo symptomatic. I want Armour or a T3 supplement but have issues as I live in the UK. I need to really convince a specialist before I can be prescribed Armour. 350 is so much. Does anyone have advice. I just want to feel normal and enjoy my life.

Cef9e473e0869fc2e68db69e43d996dc
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116 · May 26, 2011 at 1:54 AM

You mentioned PHD, but have you seen the latest blog post over at The Perfect Health Diet. It is a guest post from Mario discussing iodine, selenium, and the thyroid. Chris Kresser also added a few comments suggesting that he has changed his mind on iodine since his iodine series.

This has reignited my interest in iodine, so I've dusted off my Lugol's bottle and have begun taking a drop every other day. I have never been tested for hypothyroid but I have a few of the symptoms (then again who doesn't...the list includes just about anything and everything that can be wrong with you).

As for your hypo-symptoms I would continue to increase the safe carbs. I had a lot of the same problems when low carb which significantly improved when I increased carbs to over 200g per day.

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10 · June 27, 2012 at 8:21 PM

I too am in living hell. My TSH levels are low and getting lower, but my T4/T3 levels are at the high end of normal. I have been diagnosed and undiagnosed with having Hyperthyroidis/Graves Disease since 2008. Currently undiagnosed. I am suffering through EVERY sign/symptom: Chronic Insomnia, Fatgue, Extreme weight loss with increased appetite, nausea, vomiting, constipation/diahrea, extreme hot flashes/night sweats, fatigue and weakness, hair brittle and thinning (almost gone in places), palpitations, fainting, irritability. I also have several nodules on my thyroid. Only one doctor has performed the blood, ultrasound and uptake and he diagnosed me definitively. I moved and went to another clinic and this doctor undiagnosed me based on one blood test for my TSH and T4/T3 levels after having me stop Methimazole for only two weeks. I am now being ignored by my PCP doctor because I suggested I be further tested because if it isn't Hyperthyroidism/Graves disease, it could be other thyroid issues. I have gone from 145 lbs to less than 120 lbs in less than three months. I am 5'8" with a naturally thin frame and high metabolism. I now look like a drug addict. I am afraid that I could have Thyroid Storm and die home alone.

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0 · May 27, 2013 at 11:12 PM

Currently I have been experiencing these symptoms of the TSH being in the range of 1 to 2, but have symptoms of Hypothyroidism. It has taken me years to say that I take Potassium Iodine drops, selenium to convert T4 to T3 hormones, L-Tyrosine caplets to manufacture T4, and drink plenty of water to insure the chemical transformative process to happens properly. Not related to the thyroid I take Potassium to alleviate muscle cramps, Low Sodium V-8 is a good source of potassium; and then I also take Biocitrate Magnesium helps me to get rid of muscle twitching of the eyelids. For Brain functioning I take B-complex vitamins, with a Biotin caplet booster helped to restore my mental connotative abilities, and now I take this combination once a week because it around this time my hair starts to fall out.

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0 · February 16, 2013 at 7:29 PM

I have removed brain tumor( maningioma) two months & two weeks ago. I have very serious necasea & vomiting, Abdominal pain too. My blood test of TSH is 0.259, T4=1.01,T3=0.758. Please what could be the solution.

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0 · October 18, 2012 at 2:52 PM

You have Sjorgens. Chances are, therefore, high for having Hashimotos or Graves. Your docs surely have checked your antibodies. Even without one of the above, your system might still be attacking your thyroid. Autoimmune disease often live together or overlap.

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