Author Topic: Can you have an underactive thyroid even if your TSH is normal?  (Read 3890 times)

March 21, 2011, 07:28:24 pm
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Just a question. My TSH came out 2.17 which is well within the normal range. But I have symptoms like 30pounds weight gain (which could be due to PCOS too or hypothyroid).

March 22, 2011, 09:17:38 am
Reply #1
The $64,000 question.  Is 2.17 normal?  At 2.25 I was dead on my feet!

Your TSH should be around 1 to be optimal and your T4 close to the top of the range.  Did you get your T4 done?

AN

March 22, 2011, 09:45:31 am
Reply #2
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Hi Ishy,

I agree with Anstey - it's always worth remembering too that, as the likes of Dr S points out - the reference ranges will include people with undiagnosed hypothyroidism and so what is 'normal' is even more open to interpretation! 

Carolyn
Diagnosed hypothyroid Jan.2009; diagnosed Hashimoto's Jan.2010 and started on T4. Dr now says, from my medical history, I've been hypo for at least 58 yrs!!  Confirmed vitiligo May 2011.  Still on the rollercoaster ride of trying to get better...

March 22, 2011, 04:28:57 pm
Reply #3
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Just a question. My TSH came out 2.17 which is well within the normal range. But I have symptoms like 30pounds weight gain (which could be due to PCOS too or hypothyroid).

Many people who don't have thyroid problems and have never taken thyroid medication in their life will have a TSH of around 1 or 2+. So it's really important to consider wherever you've been diagnosed hypothyroid previously. This is what i've noticed, people on thyroid medication for diagnosed hypothyroidism tend to say they feel better with a TSH of 1, i just don't think it's so necessary to have a TSH that low if you arn't medicated for hypothyroidism already. It would be insane if every person who had a TSH of 2 got diagnosed with hypothyroidism. Half the population would be diagnosed with it.

Weight gain can be and usually is caused by many other factors unrelated to thyroid illness.

There probably is a very small chance that someone, previously undiagnosed, never treated for hypothyroidism before, could have a tsh of 2 and be hypothyroid. This would indicate a problem with the pituitary gland in sending TSH signal though and that's such a rare thing to have it makes it extremely unlikely. A simple Free T4 test would help a lot in a case like that.
« Last Edit: March 22, 2011, 04:35:16 pm by cmorgan00 »

March 22, 2011, 05:18:25 pm
Reply #4
Just a question. My TSH came out 2.17 which is well within the normal range. But I have symptoms like 30pounds weight gain (which could be due to PCOS too or hypothyroid).
Just to let you know that I have PCOS as well as under active thyroid so know how you feel, along with hypertension as well. mmmm, oh well. the things we have to put up with.
Ladywriter1968

March 22, 2011, 06:08:07 pm
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Just a question. My TSH came out 2.17 which is well within the normal range. But I have symptoms like 30pounds weight gain (which could be due to PCOS too or hypothyroid).

Many people who don't have thyroid problems and have never taken thyroid medication in their life will have a TSH of around 1 or 2+. So it's really important to consider wherever you've been diagnosed hypothyroid previously. This is what i've noticed, people on thyroid medication for diagnosed hypothyroidism tend to say they feel better with a TSH of 1, i just don't think it's so necessary to have a TSH that low if you arn't medicated for hypothyroidism already. It would be insane if every person who had a TSH of 2 got diagnosed with hypothyroidism. Half the population would be diagnosed with it.

Weight gain can be and usually is caused by many other factors unrelated to thyroid illness.

There probably is a very small chance that someone, previously undiagnosed, never treated for hypothyroidism before, could have a tsh of 2 and be hypothyroid. This would indicate a problem with the pituitary gland in sending TSH signal though and that's such a rare thing to have it makes it extremely unlikely. A simple Free T4 test would help a lot in a case like that.

I have to comment here that it's NOT highly unlikely as I myself only had a TSH of 1.84 on diagnosis and most people I know in fact had a TSH hovering around that point at diagnosis.

The TSH test alone is hugely fallible and should never be looked at in isolation from T4 & T3 when considering a diagnosis of hypothyroidism.

I agree that if everyone with a TSH of that level were treated for thyroid disease it would be a much higher number than are treated now but I actually think that would be the right thing to do in most cases as thyroid disease is widely under diagnosed.

Most people I know that have had their thyroid checked as part of routine tests or because they were ill and it was down to something else had a TSH around the 1 mark.

The TSH levels are set in a bell curve (and as with any bell curve reference there are always people that lay outside of that which is why isn't always dangerous to have a lower TSH reading) - and in fact it's an unneven curve that does point more towards true 'normal' as being closer to 1.

Included in the original set of patients for the study group to make that TSH reference range in the first place were people that also had thyroid antibodies but as yet no clinical signs or symptoms that could be attributed thyroid disease.... well they didn't 'catch up' with those patients later on to find out if they'd developed symptoms or been diagnosed with thyroid disease did they? So the actual test is based on very shoddy science.

Also, given what we know about the many symptoms of TD compared to what doctors actually think are the signs and symptoms I would question how many of the patients in the original sample group actually were symptomatic but didn't know it.

CCB. x
« Last Edit: March 22, 2011, 09:45:39 pm by CindyCB »
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March 23, 2011, 11:28:29 am
Reply #6
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Well ok perhaps this is true, but I still don't agree with telling a yet to be diagnosed person that their TSH should be 1 and their T4 should be at the high end of the range. I think some people who have hypothyroidism are too used to aiming for TSH less than 1 and T4 top end of the range. When it comes to T4 it isn't a case of "the more the better" because the range has 2 ends, if you're too high, you're hyperthyroidism, too low, your hypothyroidism. For the average person who has never taken thyroid medication they should be worried if their T4 is in either the low or high end. Better to be roughly average.

Perhaps a TSH less than 1 and high end T4 does make some with hypthyroidism feel better, but it's a whole different thing when talking about an untreated person who's test result comes back with a very normal tsh of 2 and possibly average T4. Hypothyroidism has such a large list of symptoms that it's all too easy to put hypothyroidism to blame even when there's no blood test evidence of a thyroid problem.

From my own experiences, just doing regular exercise for a few months and then stopping can raise the TSH to around 2 or 3 and cause symptoms which could be seen as hypothyroid. Also who knows what other things could cause the same effect, most probably some stress related things but maybe more too.
« Last Edit: March 23, 2011, 11:32:07 am by cmorgan00 »

March 23, 2011, 11:58:51 am
Reply #7
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I don't want you to come on here and tell new members that they most likely don't have hypothyroidism with a normal TSH when you don't have all the facts, such as T4 and T3.

A friend of mine (who is hypo) was speaking to an endo recently who told her that anyone with a T4 under 16 would raise her suspicion as most people feel ill when it dips under that.

When we say that a T4 reading should be close to the top end of the range that means within the top quarter of the range and that's for someone with or without a diagnosis of thyroid disease. That doesn't mean we are telling every undiagnosed member that their levels should be pushing hyper to feel well.

When on treatment some patients require their levels to look hyper on paper, providing they are not symptomatic of hyperthyroidism.

While we all appreciate that your case is a special one it is also fairly rare - I would like to point out again it is also possible to be hypothyroid without thyroid antibodies. It is even possible to have autoimmune thyroid without it showing on the blood tests. It has been proven in certain cases and don't forget that the human body makes thousands of antibodies, we only know a couple of hundred of them currently so who is to say the current tests aren't missing sero-negative cases of TD?

There are many, many symptoms of thyroid disease and they are different for everyone - that's why it's important to always rule out other factors - most doctors do not know how many problems thyroid disease can cause so while I agree it can be easy to put everything down to thyroid problems it would also be foolish to rule it out as a cause.

And yes of course stress and other factors can play a big part in hypothyroidism, that's why it's important to look at ALL the facts carefully together with signs and symptoms rather than base a judgement on TSH alone, which you should know as well as anyone, as it's fallible.

CCB. x
« Last Edit: March 23, 2011, 12:01:46 pm by CindyCB »
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March 28, 2011, 06:37:31 pm
Reply #8
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Thanks for all your responses. I just came back from a full thyroid function blood test. I just got results back from the test I did in June 2010 and it came out 0.94 which is great. But 9 months later it is now at 2.17. I don't know if this is a cause for concern or if this is normal.

March 28, 2011, 07:06:47 pm
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March 28, 2011, 07:10:01 pm
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ishy, how did you feel last June?

Steff.

To be honest I felt horrible because I developed psychosis. But we don't know what caused it yet and I'm on medication for it. That's why they are checking me for thyroid issues as well as my kidneys to see if there is anything there that caused it. I still had the symptoms of weight gain though.