Unfortunately a misdiagnosis can happen in the management of hypothyroidism and other thyroid disorders. If you go to a doctor with hypothyroid symptoms, you may be given replacement hormones without first determining what’s causing your thyroid issues.
Or, if you have hypothyroid symptoms but your lab tests are normal, your doctor may not realize you’re experiencing thyroid issues in the first place. You may even receive treatment or medication to deal with the symptoms you’re experiencing—like an antidepressant to address depressive symptoms—but you won’t receive anything that will help your thyroid disorder.
The problem with this approach is that thyroid physiology is complex.
The production, conversion, and uptake of thyroid hormone in the body involves several steps. A malfunction in any of these steps can cause hypothyroid symptoms, but may not show up on standard lab tests.
All cases of hypothyroidism do not share the same cause—and, as you might guess, they require different treatments.
In this article, I’ll present five patterns of thyroid dysfunction that may not show up on standard lab tests. If you have one of these patterns, your thyroid isn’t functioning properly and you will have symptoms. But depending on the tests your doctor runs, you may not get a diagnosis of hypothyroidism; and, if that’s the case, you won’t receive the treatment you need.
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A standard thyroid panel usually includes TSH and T4 only (while some panels will also look at free T3, free T4, and check for thyroid antibodies). The ranges for these markers vary from lab to lab, which is one of two main problems with standard lab ranges. The other problem is that lab ranges are not based on research that tells us what a healthy range might be, but on a bell curve of values obtained from people who come to the labs for testing.
Now, follow me on this. Who goes to labs to get tested? Sick people. If a lab creates its “normal” range based on test results from sick people, is that really a normal range? Does that tell us anything about what the range should be for health? (For more on the problems with standard lab ranges, watch this great presentation by Dr. Bryan Walsh)
Are you experiencing hypothyroidism symptoms even though your lab work is normal? You may still have hypothyroidism, though it may not show up on standard labs. Check out this article for more. #functionalmedicine #chriskresser
The Five Thyroid Patterns
1. Hypothyroidism Caused by Pituitary Dysfunction
This pattern is caused by elevated cortisol, which is in turn caused by active infection, blood sugar imbalances, chronic stress, pregnancy, hypoglycemia, or insulin resistance. (1) These stressors fatigue the pituitary gland at the base of the brain so that it can no longer signal the thyroid to release enough thyroid hormone. There may be nothing wrong with the thyroid gland itself. The pituitary isn’t sending it the right messages.
With this pattern, you’ll have hypothyroid symptoms and a TSH below the functional range (1.8 – 3.0) but within the standard range (0.5 – 5.0). The T4 will be low in the functional range (and possibly the lab range too).
2. Under-Conversion of T4 to T3
T4 is the inactive form of thyroid hormone. It must be converted to T3 before the body can use it. More than 90 percent of thyroid hormone produced is T4.
This common pattern is caused by inflammation and elevated cortisol levels. T4 to T3 conversion happens in cell membranes. Inflammatory cytokines damage cell membranes and impair the body’s ability to convert T4 to T3. (2) High cortisol also suppresses the conversion of T4 to T3. (3)
With this pattern you’ll have hypothyroid symptoms, but your TSH and T4 will be normal. If you have your T3 tested, which it rarely is in conventional settings, it will be low.
3. Hypothyroidism Caused by Elevated TBG
Thyroid binding globulin (TBG) is the protein that transports thyroid hormone through the blood. When thyroid hormone is bound to TBG, it is inactive and unavailable to the tissues. When TBG levels are high, levels of unbound (free) thyroid hormone will be low, leading to hypothyroid symptoms. (4)
With this pattern, TSH and T4 will be normal. If tested, T3 will be low, and T3 uptake and TBG will be high.
Elevated TBG is caused by high estrogen levels, which are often often associated with birth control pills or estrogen replacement (i.e. Premarin or estrogen creams). To treat this pattern, excess estrogen must be cleared from the body.
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4. Hypothyroidism Caused by Decreased TBG
This is the mirror image of the pattern above. When TBG levels are low, levels of free thyroid hormone will be high. You might think this would cause hyperthyroid symptoms. But too much free thyroid hormone in the bloodstream causes the cells to develop resistance to it. So, even though there’s more than enough thyroid hormone, the cells can’t use it and you’ll have hypothyroid—not hyperthyroid—symptoms.
With this pattern, TSH and T4 will be normal. If tested, T3 will be high, and T3 uptake and TBG will be low.
Decreased TBG is caused by high testosterone levels. (5) In women, it is commonly associated with PCOS and insulin resistance. Reversing insulin resistance and restoring blood sugar balance is the key to treating this pattern.
5. Thyroid Resistance
In this pattern, both the thyroid and pituitary glands are functioning normally, but the hormones aren’t getting into the cells where they’re needed. This causes hypothyroid symptoms.
Note that all lab test markers will be normal in this pattern, because we don’t have a way to test the function of cellular receptors directly.
Thyroid resistance is usually caused by chronic stress and high cortisol levels. It can also be caused by high homocysteine and genetic factors. (6)
Thyroid Treatment Depends on the Right Diagnosis
The five patterns above are only a partial list. Several others also cause hypothyroid symptoms and don’t show up on standard lab tests. If you have hypothyroid symptoms, but your lab tests are normal, it’s likely you have one of them.
Not only do these patterns fail to show up on standard lab work, they don’t respond well to conventional thyroid hormone replacement. If your body can’t convert T4 to T3, or you have too much thyroid binding protein, or your cells are resistant, it doesn’t matter how much T4 you take; you won’t be able to use it.
Unfortunately, if you have one of these patterns and tell your doctor your medication isn’t working, all too often the doctor’s response is to simply increase the dose. When that doesn’t work, the doctor increases it yet again.
As I said at the beginning of this article, the key to a successful treatment is an accurate diagnosis. Without understanding precisely what’s causing the problem, you may end up with a treatment that isn’t well-suited to your specific situation.
The good news is that, once the correct diagnosis is made, patients respond very well to treatment.
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So – you’ve described my plot. And yes my MD just continues to increase my dose despite no change in symptoms or lab work. But my question is – who can I go to to correctly diagnose and treat me???
I’m currently being seen by a very well reproduction endocrinologist at UT Medical School.
FRUSTRATED and confused in Houston –
H
i have had test done on T3 and T4. i know in my gut something is out of whack with my thyroid. i have tingling, pins and needles all over my body, i am 51 and female, i am tired when i wake up, i have gained 20 pounds in two years with no life style changes to account for it, yet my tests are “normal”. i am not floating in dough and am hoping to figure this out on my own because i am a substitute teacher and don’t make enough to go to endocrinologist. my mother had a goiter removed. i just want to feel better. Not everything is aging. if there is one thing i have learned from this, do not except all the changes as aging and dismiss your body trying to get your attention! that is my hope for all of you who read this.
My lab slip shows 7 different tests for thyroid. What are the recommended tests to run?
I love this article on thyroid disorders and have a question. Would the following lab results fit into one of these categories.
TSH: 1.8
T4: 2.4
T3 Uptake: >50
Free Thyroxine Index: >1.2
T4, Free(direct) 1.63
Reverse T3, Serum 12.8
T3: 75
Triiodothyronine, Free, Serum: 2.8
Hi there,
I was just wondering if you might be able to shed some light on my symptoms. I am 24 and have suffered with quite bad tiredness, aches, pains, and sore glands plus a ‘slow’ kind of feeling, on and off for a few years now. I am always intolerant to cold and always have cold hands and feet. Anyway all of this was always fairly tolerable. I managed to get through uni ok for example. After having my son last January, symptoms have got far worse. My legs feel super heavy and I seem to be always tired, weak all over and slow in myself no matter how much sleep I get. My ankles hurt and have tiny fluid cyst like things on both. Along with this I now also get short of breath just by climbing the stairs, have indigestion and acid reflux type symptoms too, have chronic tonsil stones and I sometimes feel dizzy upon standing. I’m not overweight and was always active before pregnancy. In the past year i’ve been to the emergency department over this and also seen my gps several times. All tests showed normal including the thyroid function tests they did. My blood pressure has always been on the lower side of normal.
The point is is that there is history of hypothyroidism in the maternal side of my family. (My mum developed it after having my sister and my grandparents on her side also have it).
I’m tired of hearing there is no physiological cause for this since I do not feel that simple bloodwork is exhaustive enough to conclude this. I’m not depressed and I also don’t believe it is the usual ‘new mum’ type of tiredness. Are there any better tests I can get to check for thyroid problems? Any advice or suggestions would be grateful.
So…..
how do you test for the 5 underlying thyroid problem you discuss in this article
Charlie
Eight years ago I was diagnosed with Restless Leg syndrome. I had insomnia for 3 months and had a hypothyroid diagnosis. Dr stated it wasn’t low enough to treat. I was given Mirapex for the Restless leg and had taken it for the past 8 years. Until last November. I had gained weight from 156 to 206 over those eight years. Under much stress ect. I crashed November 30th 2013. I can’t seem to find a Dr. who cares enough to even run blood work. I have to tell them what to do and I am no Dr. I no longer take any kind of medication and have experienced withdrawal from the Mirapex. I feel surges in my head in the location of the pituitary upon waking in the morning. My body twitches, arms and rt leg, Neck ect. I have changed my diet and lost 15 lbs. I have an enlarged node on the left side of my neck. Which Dr. says check it again next year and will not refer my to the endocrinologist. The twitching has decreased greatly but is still experienced each night and morning. I must return to work soon and I am concerned I will not be able to handle the stress without proper treatment. TSH 1.060 uIU/ml thyroxine t4 10.00 ug/dL t3 uptake 26 free Thyroxine index 2.6 I am 60 years old Female. Is this twitching still part of the Mirapex withdrawal or do I need to find a new DR? Still very tired. Thanks
Romilda,
It is a concern your Doc failed to listen to you enough, AND that he blew you off until next year to recheck that swollen gland? [maybe I misunderstood?]
People can order and get their own lab tests these days–insurance probably won’t cover it, but, SOMEtimes, that’s Worth it!
Places like:
http://www.directlabs.com
http://www.healthonelabs.com
http://www.accesalabs.com
And many more, on google search.
People order, the kit is sent to you, OR, can go to a lab-draw-point near you. Results are sent direct to you; I believe you pay directly for their services.
FIRST: one needs to learn what tests to order, before ordering willy-nilly.
Surge-feelings in head: me too–they don’t seem to happen as much when using a good Natural Desiccated Thyroid [NDT] at high enough dose.
Docs shined me on for years, only dosing the low 30 mg Armour–they err on the side of caution?
I kept feeling like I was losing ground.
So I tried doubling that dose for 2 weeks, and felt significantly better–EVERYTHING felt better [that’s saying a lot!].
Rather than have to argue my case as if it was a legal brief with HMO Docs, I found an outside clinic Doc who also does some alternative medicine.
She listened; paid attention. I did bring in a sheet of paper to add to my file, listing:
1. probable causes of my low thyroid; [family, exposures…]
2. symptoms I had without taking NDT; [litany!]
3. how I felt when taking double that does [60 mg. Armour]; 4. concerns Armour Company changed formulation–many people stopped getting relief of symptoms.
5. why I came there for this: because I was too tired of struggling to get help from HMO’s, etc., something was needed…I’d seen too many people on tiny doses, getting no relief, who’s Docs actually said “Don’t expect to get relief from your symptoms when you start taking thyroid”.
[[really!?]]
She immediately RX’d 60mg dose in WestThroid Pure [WP], enough to cover using that new kind until the next HMO Doc appointment for lab tests [annual labs for thyroid testing are mandatory, or the RX will not be refilled].
Getting that RX filled, was a whole ‘nuther circus–had to call a dozen+ pharmacies, 3 said they stock it, but really don’t–they stock the regular WestThroid, called “NatureThroid”, which they try to foist.
My HMO Pharmacy finally DID order it for me: I paid out-of-pocket close to same as it cost them to order it–though they billed it on the records as having about double that practitioner price .
Romilda, LOTS of things can cause muscle twitches, including low thyroid. Magnesium and/or potassium deficiency can also cause it, as could other things less likely. Some even get twitches and bad charlie horses from being Dehydrated.
One Solution: Drink more water–at least 6cups or more, depending on your weight… daily, with some fresh lemon or lime juice squeezed into it–that gives hydration, a little electrolytes, and it helps alkalinize the whole system as it needs–and it’s very cheap!
Detoxing from medications usually doesn’t take too terribly long–a couple weeks?? Average? “Hard drugs” can take longer.
PLEASE look for a different Doc.
IF your insurance only covers Docs/services they authorize, then to get coverage, you will need to try working within their “chain of command” rules, to get what you need.
That means asking questions of that insurance system, learning the rules, and finding other potential providers that are in the network. You can interview staff, and ask questions like “How does this Doc evaluate patients for low thyroid? Does this Doc listen to symptoms the patients report, as well as lab tests? Does this Doc have good knowledge of “sub-clinical low thyroid”? Etc. to help screen for one that might do better for you.
OR, pay for an alternative medicine Doc, out of pocket.
I did, and never regretted it—but you still have to quiz the Doc or their staff, about whether they have any experience in this–OR, if they would be willing to help be a “Medical Sleuth” for your needs. [[my outside Doc cost $150 for a new patient work-up; follow-up office visits cost $45–I think that is for at least 30 minutes+; labs are extra, or, she can order them, and I can get them done at the HMO labs]]
If I’d kept letting the HMO Docs keep me buffalo’d into accepting their “erring on the side of caution” any longer, I’d still be feeling bad, losing ground, related to low thyroid.
Now there’s at least one Doc on my side, and I’ll have several months of the higher dose evidence to present to the HMO Docs doing the labs—the proof is in the pudding!
THAT brings peace of mind!
About 10 years ago I was on a low dose thyroid medication and than my doctor went out of the country so I had to find a new doctor. My new doctor did thyroid test and they said I’m in normal range and they did not refill my thyroid medication. I have it checked every year and it still comes back normal. I have all the symptoms of hypothyroidism: I’m cold all the time, my BP is really low, I’m very healthy but yet I had an increase in my LDL cholesterol, and I’m tired and have no energy. I have another autoimmune disease called Interstitial Cystitis. Anyways, after my last lab results from my primary doctor I made an appointment to see an endocrinologist; hopefully I will get my answer. In the meantime I’m doing my own research. My primary physician only tested TSH and Free T4. They said my results came back in normal range but yet I have all the symptoms. My TSH read 2.495 and my Free T4 read 1.36.
Hi Chris. Great article. Are you familiar with the work of Dr. Alex Vasquez? He reports that thyroid receptor resistance can be inferred by testing for the total T3 to reverse T3 ratio. Optimal is 10-14, with lower values indicating thyroid receptor resistance. He suggests treating initially with T3 alone (no T4) and possibly pulsing every few months, with T3/T4 supplementation in between as appropriate. What are your thoughts on that?
Hi Chris,
I had some major concerns about my current health.
I am a 27 year old female, smoker (unfortunately), am 5’9” and weigh maybe 120lbs at best.
6 years ago, I know my weight was at 140lbs and that to be was perfect. So, I know I am underweight.
My symptoms tend to fluctuate between hyper and hypo. I did an intense research tonight, and I learned a couple of things. Firstly, I know that hyper/hypothyroidism cannot be caught using the basic simple tests that are used, also, that fasting and time of day can possibly affect the results. Also, I didn’t know that there was a possibility that I could have Hashimoto’s and Graves’? From the article I read, I don’t feel quite right, and sometimes it feels like a tug-of-war with energy, my weight loss, cold intolerance, heart palpitations and the pounding that is felt through the whole body, trouble concentrating and foggy memory. This has been going on most probably on and off for the past couple of years.
I was tested once, but I have the distinct impression that I have a thyroid problem and the tests came up negative despite the symptoms of both hypo and hyperthyroidism. Just read this just now, ”hyperthyroidism (Graves’ disease is a common type), in which the thyroid unleashes a flood of excess hormone. This can shock your body into sudden weight loss, rapid heartbeat, insomnia, or bouts of diarrhea. Sufferers can feel constantly wired, warm, and shaky, as if they’re hooked up to an IV filled with espresso.”
And a few hypothyroid symptoms are ”forgetfulness, fatigue, frequent chills, constipation”. It’s just a whole big combo of both hypo and hyper symptoms.
But is it possible it’s also a mal-absorption deal?
I would appreciate any advice.
It’s definitely a trip to the clinic on Monday.
Thank you
Also wanted to mention that currently I am not suffering from swollen lymph nodes, but I had a swollen lymph node on the right side of my neck, at the back of my neck, two inches from my ear. It stayed there for months, and disappeared.
Hello there…It’s a really good place to ask about my thyroid condition…I am form Pakistan…3 months ago in August i started to feel a bit tired but i didnt notice it and carried on my life but gradually gradually it started to get worse and after few weeks i was very tired and had sleepy brain all the time..whatever i eat whatever i do i will always drowsy and tired…I got my sugar,Thyroid and Cbc checked and as a result…i had TSH 6.9 and in cbc i had low platets 64000 and my sugar was ok with 86mg….the ENT Doctor gave thyroxine 50mcg and i have been using it for 1 and a half months now but i still feel tired and my brain is unfresh even i sleep all the night with peace…plz help me to get out of this condition…i want my brain freshness and agility back again 🙁 My parents think that i mostly stay at home all the time due to no job so i m taking stress on my mind and i am depressed…i try to keep my mind calm and do not think of it but my tiredness don’t leave me…I really want help from you people…i had vitamin d3 test also in which my vit d level was 28…i recently had a cb and thyroid test again and all came normal…Tsh T3 T4 were all normal and platelets now increased up to 115000….last year i had kidney stones issue which i dont have now…Now i am waiting for you people to help me out…Plz
Regards
Umair Ahmed Khan
I am curious about your number 1.:
Hypothyroidism caused by pituitary dysfunction
It is about the only place I”ve seen hypothyroid considered when TSH is low.
About me: turned 40 yrs Jan 2013. From 2004 when I stopped breastfeeding until approximately Jan 2013 I weighed between 128-132. I am 5’1″.
Since Jan 2013 to now Nov 2013 I have gained weight and now up to 143. Gain of 11 lbs. It might not seem like I lot, but remember I didn’t gain for 9 years. My exercise has always been on the lower side.
I also have been perimenopausal for the last 9 years or so and on bcps since the diagnosis. I did stop them in 2012 for some time, tried hormone replacement, then went back to bcps (Sprintec) in Sept 2012. This was the first time I discontinued bcps since 2004. I’m adding this b/c of course the perimen and/or the bcps might be the real issue, who knows.
I do have some autoimmune history – psoriasis, mono, some evidence of immune issues when trying to conceive.
Here are my last thyroid test results from august 2013:
T3 Uptake 26.3 22.5 – 37.0 %
Thyroxine 9.5 4.5 – 12.0 ug/dL
Free Thyroxine Index 2.5 1.01 – 4.44 Ratio
TSH 0.911 0.55 – 4.78 uIU/mL
Symptoms besides weight gain: constant fatigue, sleep a lot, stressed, extra facial hair (testosterone levels were normal), intermittent hair loss on head, dry hair, tire easily, low energy, anxiety and depression (on effexor 150 mg which helps but not completely).
As you can see, my TSH is on the lower side, as is the T3 Uptake. TSH has gone down about 50% in last 2 years. The test previous to that was in Dec 2011 and it was 1.4 at that time.
I’m not sure how I can be hypothyroid with a TSH of .9, but according to your number 1, it can.
So my question is, if you agree that this is worth pursuing, where do I go from here? An endocrinologist? What do I ask for? How do I figure out if this is the issue? What other symptoms would I have?
I really don’t feel like my life or eating habits have changed all that much to cause this weight gain. Yes I have been eating late at night more, but not a LOT more. I have cut back on what I eat during the day. My regular diet is pretty reasonable, I don’t pig out, don’t drink much soda, I eat a lot of fiber, etc. I have not started any new meds this year except for the Sprintec bcps last September (restarting them after 9 mos off of them but I was on hormone replacement some of that time). My day 3 fsh was 24 last September (perimenopausal). That’s all I can think of…
Two things that just occured to me: 1. My tsh says it is in uIU/mL but most of what I”m reading online says uIU/L…what’s the deal there?
ANd 2. other symptoms are really bad memory, especially recall memory, word finding, short term memory, difficulty concentrating, and also, well, saying the wrong word (like I call a doorknob a car). Of course these are all stress related as well.
Would I go to an endocrinologist to get cortisol levels tested? I really like my nurse practitioner, but I hate to ask her to order tests that she isn’t personally recommending. This is not exactly her speciality. Would getting cortisol levels tested help clear up the picture?
”bad memory, especially recall memory, word finding, short term memory, difficulty concentrating” that’s me most days.
I am so Ill, can anyone offer any advice please?
I have now completely stopped my Thyroid Medication (a total of 17 days so far) – I can not tolerate the terrible symptoms it causes, so would rather go without it – along with my underactive thyroid I also have Adrenal Issues & a Multinodular Goitre. I have tried building the Thyroid Medication up very slowly and it is not working – after nearly three years of trying I feel that it isn’t the only problem. I did wonder if Stomach Acid was a problem but don’t know where to go to find that out, or maybe Aldosterone is the missing link. I have used T3, Levothyroxine & Nutri Thyroid and all have had the same effect, out of all of them T3 was the one that done some good as well as causing terrible Symptons to. Does anyone know what is going on? I feel so bad and full of pain all the time.
Thank you
Debbie. I’d be curious to know what your cortisol levels are. I’m finding that it is very important in relation to not only your adrenals but thyroid function as well. I believe something is making your thyroid work way too hard. Have you had your iodine level checked?
Debbie. I’d be curious to know what your cortisol levels are. I’m finding that it is very important in relation to not only your adrenals but thyroid function as well. I believe something is making your thyroid work way too hard. Have you had your iodine level checked?
Do you track your temps? This too can provide valuable info.
Hello Mike,
I had the ASI test done (privately) July last year and the Adrenal Function was low throughout the day & evening, I was told to take Nutri Adrenal but that disagreed with me and I couldn’t take it, My private DR thought that Vitamin C with Liquorice & Gingseng Tincture would be enough to get them working again. this was wrong and as the months past I was getting extremely Ill, my Temp would be around 34.2 and my pulse would be about 98bpm and had lots of terrible symptoms including struggling to breath & Chest Pains. In Feb this year he told me to get Hydrocortisone – It was nearly to late – I didn’t even have the energy to lift my hand, I just laid on my bed praying that I wasn’t going to die. After approx seven hours after taking just 5mg of Hydrocortisone – It was wonderfal and I though I was then on the road to recovery. I was wrong and soon realised that taking more than 5mg would cause terrible symptoms including the feeling my chest was burning, sweating, struggling to breath and terrible pain. My GP was not interested in checking Iodine – and advised me to not take vitamins because they were danagerous. He said my Adrenals were fine and all that was wrong was that my TSH was aliitle high. I just don’t know what to do, I can’t take anymore (than what I am doing Hydrocortsone) & can’t take the Thyroid Medication. I have had stomach problems for years and wonder if thats part of the problem
Debbie, have you considered you may be intolerant to inactive ingredients in the pills? You may want to try a compounded thyroid supplement. My understanding is that Westhroid Pure and Tirosint are gluten-free.
I am a male who has been taking straight T3 (Cytomel) for a number of years for my autoimmune thyroid disease. At 40 mcg per day (spread out over 4 doses), my TSH, FT4, and RT3 have always been very low with my FT3 running between 4.0 and 5.0 pg/mL. In addition, I have to supplement calcium and magnesium at 133% RDA or more due to my high calcitonin (thyroid tissue flooding my bloodstream due to autoimmune attack), low PTH, and low potassium. Recently, acute hypothyroid symptoms started coming back (dry skin, painful finger and toe joints in the morning, and shoulder and neck muscle pain). Lab test indicated no RA and my typical results, with the exception that my TSH is now 11.5. What would cause hypothyroid symptoms with a high TSH, even though my FT3 is at the high end of normal? T3 resistance? My doctor does not have any ideas besides pituitary adenoma for the high TSH, but thinks my hypothyroid symptoms are due to the relatively high amount of refined sugar I have recently had in my diet.
Further info: My testosterone levels are normally quite low, though they were not tested with this lab. My corrected serum calcium was at 8.5 mg/dL, which is very strange for the amount of calcium I take, and my VitD25-OH was 37.1 ng/mL, though I have been taking 5000 IU per day of VitD3 for years. My serum iron was at 153 ug/dL, which is unusually high for me. I have also been taking low dose naltrexone for few years in order to keep my thyroglobulin antibodies down near 1000 IU/mL from their previous high of 16,000.
Thanks for taking the time to write all these informative articles, Chris.
I was wondering if you could write an article about the converse – over medication with synthyroid and if there are any patterns that won’t show up on TSH.
For example, my levels have been fluctuating for over a year now after many years treatment for hypo, with my need for synthyroid mostly steadily decreasing. I am again having symptoms of hyperthyroidism, and the nurse taking the blood thought I was hyper as the veins on my arms and hands are very prominent, but the TSH came back firmly in mid normal range.
Does one feel it long before it shows in tests or are there other causes? Hopefully others might find that subject helpful too.
I read your article because I have been taking Thyrax, levothyroxine. for 4 years now and somehow I feel rotten sometimes and good at other times. Anyway I try to get more info on the thyroid.
What strikes me is that in yuour five types of thyroid disorders I find none of the ‘normal’ types (which I had). High TSH and low fT4….how is that possible???
I am sorry…. I see they are the ones that don’t show up in tests….
It gets to be a lot of work, when searching for suppliers of NDT’s [Natural Desiccated Thyroid].
My Doc told me she wanted me using “Westthroid–the kind that has no “inactive ingredients” except inulin and MCT’s”. OK, great!
Several days & hoards of phone calls to lists of pharmacies showed:
1. Doc wrote the script using old name [WestThroid], and failed to included “WP” in order to get the kind she discussed. She didn’t know that it came in bottles of #100, or she’d have weritten it for round numbers, instead of “a 90 day supply”.
2. American pharmacies apparently tend to be labeled “NatureThroid”, not “WestThroid”, and few understand the difference between “Regular” and “WP” or “Pier”.
3. ANY pharmacy can order things not on their formularies: but they usually refuse to order anything not on their lists from their main suppliers.
Some will order it, but will charge you dearly for it.
It is most always “out-of-pocket”.
4. It comes in bottles of #30, #60, #100, for instance. If your Doc orders a quantity of pills that is less than a full bottle, you still pay for those wasted pills the pharmacy cannot give you.
5. Smaller pharmacies/stores are more likely to either carry it, or, order it for you.
6. IF you are a Medicare recipient, and your coverage is rolled into an Advantage Plan, you MIGHT be able to have your Plan’s pharmacy fill an order from an outside-the-system Doctor for this med.
BUT you might need to spend time, phone calls, and numerous days to achieve them filling that script, and may or may not get some coverage for the cost of it.
7. NDT’s are cheap.
Pharmacies that charge large prices, are usually paying for high overhead like a remodel or move of their store, etc. [like one Compounding pharmacy in our area, which quoted almost $80 for #180 NatureThroid, [more than 4 x the practitioner cost].
Wholesale cost for NatureThroid Regular, is less than $11 / #100.
Wholesale for NatureThroid WP #100, is less than $17 or so…just to give you a clue.
MOST Pharmacies will try to have people believe that all meds are expensive, that NDT’s are more costly than man-made, etc.
But NDT’s are still way cheap! Don’t let yourself be buffalo’d into paying too much for them.
8. Any MD, ARNP, or PA, [and others?] usually can order NDT’s directly from the companies that make them, at wholesale, or close to it—IF they are willing to do that [not all are willing].
Practitioners authorized to prescribe meds, can then fill the orders they write for these—AND save their patients money, too.
Many practitioners who prescribe and sell/provide other supplements, have included NDT’s in their stock, too. We used to do it at our office, keeping a bottle of Armour on hand to at least get patients started while they found a regular supplier; a practitioner needs to know: they need to sell whole bottles, not partials [sensible]; selling/providing a whole bottle of #100 tabs, makes it easier for everyone….most practitioners have no idea how hard it has become to find NDT’s in stock anywhere, much less the rarely stocked “WP” form.
Is this a joke? “Now, follow me on this. Who goes to labs to get tested? Sick people. If a lab creates its “normal” range based on test results from sick people, is that really a normal range? Does that tell us anything about what the range should be for health?”
That is one of the most absurd supposed-medical line we’ve ever heard. Don’t blindly follow absurdity, no matter how simple it sounds.
Veronica,
Who is “we” and what is absurd about it? This is a pretty well-known fact. Labs test the community of people, which includes various genetic populations on an American diet, and some with non-diagnosed diseases. How can a true “normal” range be established from that. Merck Manual seems to be a better source of what is normal.
I’m starting to suspect that I have a thyroid condition of some form. I’m displaying some of the symptoms, not to mention that my diet is clean (90-95% paleo), I’m doing appropriate workouts, and I’m not overeating calories, yet my weight remained unchanged in a three-week period and my body fat % went up by 0.9% in that same time frame. Since many of these patterns won’t appear on standard thyroid panels (I have a dr appt this Monday), how should I go about further investigating this? Should I see a practitioner of another specialty? I’m going to request that all thyroid-related tests be done when I’m at the doctor, as well as my cortisol levels and any other hormone levels.
Thanks so much!
So I am one of those people that has had conventional thyroid tests that are “normal”, but suspect that I am actually hypo. I think my best route would be to do the lab tests independently, and out of pocket at this point. Are these tests normally HSA-elligible? How do I find a good lab? I live in Los Angeles. Thanks!