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Possible to be hypothyroid but have normal tests?

Discussion in 'Thyroid Dysfunction' started by Ocean, Mar 16, 2012.

  1. Ocean

    Ocean Senior Member

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    I have seen an endocrinologist and my thyroid tests he did were normal. I do have a lot of symptoms of hypothyroid but I imagine these can also be attributed to other causes. Still, I wondered if it's possible I do have this but the standard tests don't reflect it?
     
  2. Sushi

    Sushi Moderator and Senior Member Albuquerque

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    What tests did he/she do? There are a number of significant thyroid tests that are not routinely done.

    Sushi
     
  3. Ocean

    Ocean Senior Member

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    Sushi, I'll have to dig up my copies of the lab tests and see, I don't know offhand. My papers are a mess, so hopefully I can find it!
     
  4. SickOfSickness

    SickOfSickness Senior Member

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    YES.

    I would not rely on ANY tests and would go by symptoms. What's the harm in trying a little bit of natural thyroid and seeing if you improve or not? This book is also about thyroid being at the root of many major health problems: "Solved: The Riddle of Illness". I am starting natural thyroid. I'm just mad at myself for not continuing it when I first tried it. At the time I was taking too many other supplements and got confused.
     
  5. Ema

    Ema Senior Member

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    Back in the day, doctors relied on symptoms over lab tests and there were many fewer cases of untreated hypothyroidism. Now they call it fibromyalgia and treat with antidepressants or other expensive meds, rather than treat the root cause. The TSH is a terrible test of actual thyroid function (it is a pituitary hormone) but yet that is the one that is most commonly used by ignorant doctors.

    Make sure you get FT3, FT4, and RT3 tested to properly rule out hypothyroidism, including subclinical hypothyroidism. I would also test for thyroid antibodies at the same time. In my opinion, FT4 should be approx 1.4, FT3 needs to be at the top of the range, and the ratio between FT3 and RT3 should be greater than 20 (according to Dr Holtorf in CA). Otherwise, a trial of NTH or T3 could be in order and might help symptoms a lot!

    Stop the Thyroid Madness (website) is a great resource for those struggling with hypothyroidism symptoms as well.

    Just remember that it is important to make sure the adrenals are strong and healthy before embarking on thyroid treatment or one may get intolerance symptoms that can be mistaken for hyperthyroidism by those who don't understand. Proper iron levels are also a prerequisite for utilizing thyroid hormone properly so it is important to get evaluated as well.
     
  6. justy

    justy Senior Member

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    As everyone else says above it is a resounding yes. It depends on where within ther normal range you labs are. My T4 was ususally low normal (it kept going down over a 5 year period starting at 16 and endidn up down at 12.5) my tsh had been 3.5 and at the lower end 1.5 (it tended to fluctuate) basically some people do better when their t4 is at the higher end of the range - perhaps 18-21. whils it can bebest to have a low TSH say under 1.
    I tried a trial of thyroxine ;last year for 3 months. My levels hardly budged and i didnt feel any better, but then i got hyperthyroid symptoms. without my levels being high as you would expect for hyper. With the agreement of my doctor i stopped it and we agreed that it could have been an adrenal problem - which i am now working on with herbs - or toxic heavy metals. A lot of PWME cant seem to toleratre throxine and she explained these where the reasons why usually.
    Some try a natural like armour thyroid - but as i am a vegetarian they are not suitable for me. Some advocate T3 alone or with T4 but be careful - there is a woman posting on this forum who had a heart attack due to incorrect T3 treatment.
    Like all things in this blasted illness it appears to be complicated.
    Take care, Justy.x
     
  7. rlc

    rlc Senior Member

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    Hi Ocean, research has been done by groups like the American association of clinical endocrinologists that has shown that the reference range for TSH is completely wrong and a lot higher than it should be, in the past it was always believed that if TSH is above 5 then the patient has hypothyroidism. They are now saying that any TSH result above 2.5 may mean that the patient has hypothyroidism. They estimate that millions of people are not getting their thyroid problems diagnosed because of this.

    Unfortunately although the research has been done all the labs in the world are still using the old reference range and people are still having their true diagnosis missed in very large numbers.

    So everyone needs to double check what their TSH is and dont let them tell you its fine just because TSH isnt over 5, and make sure that Thyroid antibodies and T3, T4, and RT3 have been done.

    The problem with the TSH reference range is explained in this article http://thyroid.about.com/od/gettestedanddiagnosed/a/tshtestwars.htm

    There is a article on this page http://www.bmj.com/content/337/bmj.a801?tab=responses by Dr Mirza called Unveiling the mysteries of the Thyroid, in which he explains that patient who have a TSH between 2.5 and 5 should not be given standard amounts of Thyroid medication because it will suppress the thyroid and make the patient worse. He explains how to treat it properly with lower doses in this article.

    All the best
     
  8. rlc

    rlc Senior Member

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    Hi Justy, the reaction to taking thyroid medication that you had sounds a lot like what Dr Mirza is saying, that doses that are too high in people who dont have complete thyroid failure will make the patient very sick. So it might be worth checking what doses you were given. Because the thyroid medication might be very good for you but at a lot lower doses.

    Dr Mirza says in Unveiling the mysteries of the Thyroid found on this page http://www.bmj.com/content/337/bmj.a801?tab=responses

    3. The authors recommend a full-dose levothyroxine replacement for
    almost every one without coronary artery disease. This relies on the
    assumption that by the time a person develops hypothyroidism, the whole
    thyroid gland has failed. In our clinical experience, most people with
    thyroid failure present with partial thyroid failure and they lose thyroid
    function slowly over months or even years. Prescribing 100 mcg of
    levothyroxine to a person with a TSH of 10 for example is a recipe for
    suppressed TSH and symptoms of palpitations, tremors, anxiety, and other
    symptoms of overtreated thyroid failure. Hashimoto's thyroiditis, which is
    the precursor for thyroid failure, does not evolve into hypothyroidism
    over night. Since the hypothyroidism is evolving, the treatment should
    also be titrated gradually. This is even more cost effective, since it
    saves many unnecessary phone calls, visits (including visits to the
    Emergency department), and blood tests.

    In our experience, a levothyroxine dose of 12.5 mcg a day would reduce TSH
    by 2 digits. This simple math will allow you to have a rough estimate of
    levothyroxine dose. The goal is to reach a TSH of 1-1.5 mU/L.

    All the best
     
  9. August59

    August59 Daughters High School Graduation

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    Are your adrenals being checked as well? If they are and testing is abnormal then the adrenals are suppose to always be treated first or at least at the same time.
     
  10. Ema

    Ema Senior Member

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    The goal is to feel well and be rid of hypothyroid symptoms, not to chase a magical lab number that may or may not accurately reflect thyroid status at the cellular level.

    For many, levo will not work at all due to conversion problems. Most people find that a combination of T4/T3 (such as found in natural thyroid products like Erfa or Naturethroid) or T3 only work much better at alleviating symptoms.

    Yes, titrating up the thyroid dose is important as is making sure to have good adrenal function prior to commencing thyroid treatment. The symptoms described sound more like thyroid intolerance due to weak adrenals or low iron status than a true hyperthyroid reaction. And a suppressed TSH does not automatically cause symptoms.
     
  11. Ocean

    Ocean Senior Member

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    Thanks everyone for the replies. Once I locate my lab results I will post which tests I had done here. I read about a thyroid test that tests the tissue or something, they put it on your arm I think? Does anyone know about that? I am getting my cortisol tests, thank you for the warnings not to start any thyroid treatment until I get that figured out.
     
  12. Athene

    Athene ihateticks.me

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    I have been reading about thyroid a lot lately and I got tested yesterday.

    Apparently ten percent of people with CFS end up with thyroid deficiency eventaully.

    The typical profile according to my doc is LOW TSH, low T3 snd low T4. He says this means the thyroid itself is OK, the problem is a lack of hypothalamus and pituitary stimulation on the one hand, and also the failure of the organs generally to convert T4 into a usable version of T3 onthe other hand. T4 is converted to T3 by many interanal organs, but when they lack the right nutrients, or are infected which I think ours are, they make a mirror image of T3 called rT3 or reverse T3. This blocks the receptor sites and shows up as normal T3 in blood tests, but is actually stopping the real T3 from doing its job - this situation is called thyroid resistance.

    The big question is, should you supplement in this situtation or not? Supplementing can actually make an OK thyroid gland adjust by making less thyroid - probably not good since it was not the thyroid gland with the problem in the first place, but all it collaborating organs going wrong.

    The main nutrient that you need to convert T4 to T3 is selenium. My sister who has severe hypothyroid (she has a tumor) is prescribed this along with her T4 supplement and she says it is essential for her and makes a huge difference.

    I found a very good website that explains a lot of this issue (link to first page, click through links at bottom to see all five page to get all the info)
    http://chriskresser.com/low-t3-syndrome-i-its-not-about-the-thyroid
     
  13. ukme

    ukme Senior Member

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    How much selenium Athene? I've tried everything bar thyroid meds and nothing works!
     
  14. SickOfSickness

    SickOfSickness Senior Member

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  15. justy

    justy Senior Member

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    I have found that my symptoms are slightly better if i take selenium regularly. I take 100-200mcg a day. It si very dangerous to take too much selenium - over this amount is not ok.
    Justy
     
  16. Ema

    Ema Senior Member

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    Low TSH can also be a result of iron deficiency as it was in my case. Anemia is also common in chronic illness and infection as iron is a favorite food for pathogens so the body tries to starve the pathogens (and the body too unfortunately).

    I agree with most of what you have written about RT3 and thyroid hormone resistance but RT3 does not show up on a blood test as FT3.

    Selenium can be useful if you are low but it can also seem to facilitate conversion of T4 to RT3 (instead of T3) if that is the predominant pathway as it is for many of us. I would not assume that selenium will improve conversion if you are a poor converter already. It may just make you a better converter to RT3!

    There is a LOT of contention over these points though and what exactly is going on with thyroid resistance and the best way to treat it. There are some that contend that T4 is still important and that there is no evidence that RT3 actually does block T3 in the thyroid receptors. There are other groups that insist that T3 only is the only treatment for an RT3 problem. I would look at www.thyroid-rt3.com for a discussion on T3 resistance and www.tiredthyroid.com for an alternative viewpoint on whether or not RT3 blocks the receptors.

    My opinion is that treating thyroid dysfunction that is due to an autoimmune disease like Hashi's is different from treating one that is a result of chronic illness. I would think it should be possible to correct the upline problems and theoretically not need thyroid hormone at some point in the future. But I'm not convinced that taking thyroid hormone will cause harm. Thyroid hormone is necessary for every cell in the body and not correcting hypothyroid levels doesn't seem to be a viable option either. I do think that T4 alone hardly ever works in these cases.
     
  17. Ocean

    Ocean Senior Member

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    So would it be safe to take selenium in amounts less than 200/day even if I haven't tested as being hypothyroid?
     
  18. Mya Symons

    Mya Symons Mya Symons

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    My mom (when she was alive), my sister and I all have Hashimoto's disease. When we got older, we all had the hypo-active thyroid symptoms long before our TSH test measured abnormal. Yes, I think it is possible to be hypothyroid and have normal tests at first. The problem is finding a doctor who actually knows and understands this can happen. They are few and far between. You could try Mary Shomon's thyroid website. She has a listing of thyroid friendly doctors. http://thyroid.about.com/
     
    Athene likes this.
  19. Mya Symons

    Mya Symons Mya Symons

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    I tried not taking my thyroid hormone for awhile because I did not feel like it was helping at all. At first I felt a lot better and it was great. But, after awhile my osteoarthritis was much much worse. It was kind of like having to choose between the FMS pain and the osteoarthritis pain. Since the osteoarthritis was causing damage, I decided to take it again. If your thyroid levels are low (such as from Hashimotos disease), I wouldn't do what I did. Instead I am going to keep trying to get to a doctor who will add some natural thyroid meds or some T3. When I get money:(
     
  20. Athene

    Athene ihateticks.me

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    My sister's doctor told her to take 100mcg a day of selenium.
    I take 200mcg a day because that is the dosage of the tablets I have, it says one a day on the pack.

    Selenium comes in different organic forms that have very variable absorbability (44 to 70 percent), so the amount you actually get depends on the quality of what you are taking. Its better to get top quality and take a lower dose.

    My nutrition encyclopedia says the safe supplementary rate is 200 to 800mcg a day.
    Ocean, I am sure it would be safe for you to supplement selenium. My book says 40 percent of the population is slightly to badly deficient in it. And as I say, it does lots of things, not only relating to the thyroid gland.

    Selenium recycles antioxidants including vits A adn C and contributes to enzyme systems and various other things which I think mean PWCs may need quite a lot of it. If you take too much of it, it is detoxed by methionine so presumably that would place a burden on the methylation cycle (??)

    Thanks everyone for the really useful info and links. This is turning into an extremely useful thread.

    Well I got my thyroid results. T4 is below normal, T3 is lowish but in normal range, TSH is middle of the range. What does that mean?
    I have all the symptoms of hypothyroid, but they could all be blamed on CFS really so I don't know what to think. I saw my GP who has ordered an ultrasound of my thyroid gland but has already said he thinks there is nothing wrong with it, and would therefore not want to prescribe me thyroid - unless my specialist in Lyme disease and CFS says otherwise. He says you can make a normal gland atrophy if you take thyroid when the real cause of lowish hormone levels is NOT a defective thyroid gland.
    I asked him if he thought this situation could be in activity of the pituitary gland(not sdtimulating as much TSH as needed), and he said no, he thinks that is impossible.
     

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