Thyroid Labs: Normal fT3 and TSH, Low-ish fT4, Feeling Hypo

I’ve been on T replacement for 5.5 years. Have felt like I’ve had low thyroid symptoms for a few years now. Weight gain, fatigue, dry skin on my body, oily skin on my face (may be T related), thinning of the outer edges of my eyebrows, bloating/puffiness. My free T4 hasn’t changed in 3 years according to old bloodwork and my free T3 is within 0.05 pg/mL of where it was 3 years ago. That time interval was within when I felt kinda hypo.

I got thyroid labs done and am waiting on updated Testosterone, Free T, and estradiol numbers. I’m a little concerned by the Free T4 number below as it’s on the lower end of the scale, while my Free T3 and TSH look just fine. I have an appointment with an endocrinologist next week and am curious if a) these numbers look at all unusual to you guys who know this stuff b) point to anything specific I should ask the endo about.

February 2018 Labs (Current)
TSH 1.310 mcIU/mL Reference: 0.358 - 3.800 mcIU/mL
Free T4 (EIA) 0.89 ng/dL Reference: 0.76 - 1.46 ng/dL
Free T3 3.44 pg/mL Reference: 2.18 - 3.98 pg/mL
Anti -Thyroglobulin <15 U/mL <61 U/mL
Thyroid Peroxidase Ab <28.0 U/mL <60.1 U/mL

For completeness, here’s some old thyroid data to show what things looked like over time.

Old Data
July 2015 Labs
TSH 1.110 mcIU/mL 0.358 - 3.800 mcIU/mL
Free T4 (EIA) 0.88 ng/dL 0.40 - 1.80 ng/dL
Free T3 3.49 pg/mL 2.18 - 3.98 pg/mL

April 2012 Labs
Free T3 3.18 pg/mL 2.18-3.98
T4 Free (Thyroxine) 0.91 ng/dL 0.76-1.46
T3, Reverse 179 pg/mL 90-350

December 2011 Labs
TSH, 3rd Gen 1.46 mcIU/mL 0.358-3.8

You’re converting fT4->fT3 efficiently and your fT3 levels are great. Your thyroid needs further investigation though, thyroid seems to be having issues.

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T4 might be suggesting that you are not getting enough iodine. Using iodized salt?

Please eval overall thyroid function via oral body temperatures - see below.

If body temperatures are low, you are hypo and normal metabolic activities are impaired.

Your outer eyebrows and dry skin are definite symptoms and you might also be feeling cold easier, lethargic, lower libido, lack of clarity of thought or generalized hair thinning.

Your fT3 is a bit above mid-range allowing that rT3 might be interfering with fT3. And if body temperatures are low, rT3 suspected elevated now and should be tested. Then also see references to rT3, stress, adrenal fatigue and Wilson’s book in that sticky.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Can you say more about what this means and what data points you saw that made you think this? Appreciate your help.

I have definitely been feeling cold more often. I went through a phase about a year ago where I was overheated all the time but the last few months I’ve been much colder. I will look into the sticky and will get a thermometer to log morning temps.

Never mind I thought your Thyroid Peroxidase was <28.0 U/mL **>**60.1 U/mL, misread is all. Sorry for the confusion. I have similar results, lower fT4 and higher fT3 and since fT3 is the active thyroid hormone it matters a lot more.

Ok-- so do you do anything for that low fT4? I’m not sure if it’s worth the endo appointment if things are generally good.

Checking your body temperatures using a glass thermometer will show whether you’re hypo or not. Your need to be 97.7 upon waking and 98.6 mid afternoon between 12-2pm. Your question about low fT4 is difficult to answer as everyone is different. I would like to see SHBG tested, if high could bind up all free T and make you feel hypogonadal regardless of T levels.

Ok-- glass not digital? I’m on my way to the store for dinner stuff and will get a thermometer.

No to digital, 1 degree is the difference being fine and being not alright.

I got my rT3 level. Doesn’t seem like an issue.

T3,Reverse 11.2 ng/dL 9.0 - 27.0 ng/dL

I got new labs on Free/Total T and E2, and I think that’s the cause of my issues. I’m above the range on all of them, so it’s time to back down my dose and see where I end up. I’ll make a separate thread tracking that issue and keep all my posts to it.

You need a testosterone panel, I suspect elevated E2. Oily skin, bloating and weight gain usually happen with high E2 which blocks testosterone at receptor site making one feel low T again.

I have one that I just got results for. I’m high on everything. As I mentioned, I will start a fresh thread that will be my log going forward.

It would be best if you didn’t create a new thread, you will force people to go on an easter egg hunt for info that most will just drop your case and lose interest.

For good context keep everything here.