Monday, March 4, 2013

TSH & Free T4

I have been reading all over the Internet and on other blogs about how important it is to not only get your TSH tested, but also your T4, Free T3, and Free T4. I recently read an article about the under treatment of hypothyroidism on The author, Mary Shomon explained that a lot of people do not feel well on just a levothyroxine/T4 only drug (like Synthroid, which is what I am currently prescribed). Shomon explained that she feels better taking T3, such has Thyrolar, and others feel better by adding Cytomel, or time-released T3 to their levothyroxine. Shomon also mentions that some people have success taking a natural thyroid hormone replacement, Armour. In February 11, 1999, the New England Journal of Medicine published research that shows that many people feel better on a combination of T4 and T3, not T4 (such as Synthroid) alone. Many people, like me, have a normal TSH level but are still symptomatic. Apparently the addition of T3 helps relieve depression, brain fog, fatigue, and other symptoms. (Additional information can be found at

So, after doing a lot of research I sent an email to my physician:

"Could I come in for a lab appointment some time to get my T4, Free T3, and Free T4 testing done to get a better picture of the condition of my thyroid? My TSH level came back normal but a lot of the symptoms of hypothyroidism are still present, including weight gain and low energy."

My physician promptly replied a couple of hours later:

"If you are still symptomatic, then we could increase your synthroid to 88mcg to lower your TSH below 2. Then when you return in 6 weeks, will check both your TSH and free T4."

First thing...I am so thankful to have a physician who listens to me and responds to me so quickly. She is wonderful! Second...I wonder why she plans to only test my Free T4? Although I have been doing a lot of research about this subject lately, I am still confused about exactly what T4, Free T3, and Free T4 are...any one have any further information about this?


  1. Hi Rachel~ It is wonderful that you feel so good about your doctor! What a great feeling and a huge relief!!! Personally I found I very valuable to get my Free T3 tested so I would be interested in knowing why your doc breezed over that. Free T3 was one of the biggest indicators for me initially that I needed treatment. I also found value in a reverse T3 and vitamin D (expensive) blood tests. I think getting these tests are important not only for diagnosis but as a measure of improvement down the road as well.

    I know you said you have done a ton of research and have probably been on the Thyroid Sexy Facebook page but just in case, here is a link to some info about blood tests:!/notes/thyroid-sexy/thyroid-sexy-faqs-meds-labs-levels-more/310216568997305

    I strongly feel that if a blood test is important for you, that you get that blood test. Our doctors should be a partners in our healing and it seems like you have a good relationship with yours. If it were me, I would make sure that I get that blood test. Your intuition is stronger than anything that your doctor (or anyone else for that matter) has learned.

    In the beginning of my thyroid adventure, I ordered my own blood tests. Of course it is expensive to do so without the insurance/doctor OK but I had been misdiagnosed for years. There are many different websites where you can order your own tests and I often find coupon codes online. You can order you own tests in most states but not all. Here is a list I found Not sure how comprehensive it is but should be a good start. If you doc is willing to order only some tests you want, you could supplement this way to get all the tests you want and keep your costs down.

    Sending you wishes for good health!!!

  2. Zen Thyroid,

    Thank you so much for your information about blood tests. I'm just trying to figure out why my TSH levels keep fluctuating and why I'm still symptomatic even after my TSH reaches a "normal" level. I decided to take charge and request further testing. I have heard about people ordering their own blood tests and that is still an option for me if I hit another brick wall with my doctor. Also, thank you for the wishes for good health!

  3. im unsure of any links between thryoid issues and Vitamin D, but I see where Zen Thyroid mentioned it and that made me think. As a whole, humans tend to have low vitamin D issues. We get the majority of our vitamin D through sunlight, and we dont do as much outdoors and in the sun as we used to. With my PCOS and Insulin Resistance i was told about vitamin D deficiency and its effects on fertility. Had mine tested, and sure enough I was very very low! I was taking 80,000iu script weekly for 6 weeks and now I buy OTC vitamins but I take 4,000iu daily. I have alot more energy when I am taking it regularly and feel better in general. I def recommend researching Vit D and any relationship it may have to thyroid issues and possibly getting yours checked.

  4. Rachel, Free T3 and Free T4 tell you the amount of that thyroid hormone that is in your bloodstream for your body to utilize. That is why it is important to know this number. It also shows how well you are converting T4 to T3. Not everyone is a good convertor.

  5. This is a right eye-opener for me. My hypothyroidism was caught because I'm also type 1 diabetic so it flagged up in the blood tests. They gave me levothyroxin and got my THS level corrected but I still feel...well almost as bad as before the tablets but I didn't realise more could be done! I was told the tablets would either work or they wouldn't and could take time so the links here are fantastic and I'm going to get an app with my doc asap. If there are better combos of meds out there then sign me up! I'm constantly sleeping up to 12 hours, unable to work, and spend most of my time in several layers feeling like an icicle. If there was a solution heads will roll! o________O

  6. Hi Rachel, I've written a lot about this on my blog. I went through the whole process of having T3 tested and taking T3 medicine alongside thyroxine (T4) for over 18 months. I also discovered other things that were contributing to my symptoms - for me Vitamin D and dietary stuff turned out to be very important. I encourage you to read the "adventures in T3" postings on my blog if you are interested. I now take thyroxine only and I wish I'd never bothered with the whole T3 issue although I have learned A LOT about the subject and believe I now understand why many doctors are not keen on the T3 test or treating with T3 and frankly, it makes sense to me. Sorry not to repeat the whole story on here but if you have time to read the articles please do. I think you'll find them of interest.

  7. Diet is crucial, and yes, not everyone has the same dietary needs or ability to process nutrients into necessary bio-chemicals. We are talking hormones here. Hormones are chemicals that you body builds from the nutrients you take in in your food. These nutrients are "pre-cursor" chemicals from which your body creates all the building block proteins that keep your body working properly. Iron is one crucial nutrient for building thyroid hormones. So if your iron levels are low, you may have thyroid hormone issues. And "normal" is not normal for everyone. Thinning hair is also dependent on iron levels, and a doctor may tell you that you have "normal" levels, but if you're losing hair you have to change your view of what's "normal" iron for you.
    -- InNane

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