Thyroid Blood Test Results - Any Other Test Needed for Evaluation?

I would recommend a free T3. T3 is the active form of thyroid hormone. If it is the normal range, especially if in the high normal range, it might behoove you to continue watchful waiting. Once you r placed on thyroid hormones, it is generally for life.

A recent study out of Hopkins showed an increase risk of osteoporosis in patients taking thyroid hormones who were over 65, even when it was dosed correctly (normal TSH)

That being said, it does sound as though your symptoms could be consistent with hypothyroidism. A dose of 25 mcg is very low, and it appears your doc is acting with appropriate caution. If you choose to go the route of taking thyroid hormones, I would discuss the Hopkins study with your doc. My “reading between the lines “ of the Hopkins study, as it is just one study and I’m sure more will be coming (though slower since most of the federal funding has been pulled) is to aim for a TSH of 3-4, instead of what was generally done previously which was simply to aim for a TSH in the normal range (around 0.5-4)

@laura1970 Thank you for your insight! Appreciate the Johns Hopkins study results, as I have osteopenia. I will discuss having my free T3 level checked with my doctor and go from there.
Happy holidays! Jamie

The thyroid testing can often feel like trial and error because standard tests (like TSH) have limitations, results can be skewed by medications, stress, or other factors, and there's overlap between normal/abnormal ranges, leading to missed diagnoses or confusion, requiring a comprehensive panel (Free T4, Free T3, antibodies) and correlating symptoms for accurate treatment.

I have been on thyroid medication since 1995, first having hyperthyroidism and taking the radiation pill to make it inactive. Then I became hypo (underactive), what I can tell you from my experience is it has been a struggle because my test results were appearing to be in normal range but on the lower end of the spectrum and I had all those symptom you have. I had to be an advocate for myself and told my doctor I needed help because even though the test stated I was normal I was not feeling normal.

So to answer your question, yes I went to both my primary and a Endocrinologist. So The T4 pill Levoxyl (Brand Name for Levothyroxine) works better for me and it was discovered that this pill was not breaking down to release the T3 hormone in my body. Then the doctors added a T3 hormone pill Liothyronine and most of my symptoms the brain fogs, fatigue, depression, hair thinning went away immediately. And yes take your mediction everyday and dont skip becasue you can loose progress made withthe medications being in your system.

But it was not an easy task and I went through a few Endocrinologist until I found the one that listens to me symptoms and not just the test. I have been good for a year now but look how long it took, so do not get discouraged.

I was diagnosed with hyperthyroidism/Graves disease about 20 years ago. It was diagnosed and treated by an endocrinologist. My Dr. told me that hyperthyroidism can flip to hypothyroidism over time. (My mother experienced this exact situation.) So I would ask for a referral to an endocrinologist. Thyroid issues are one of their specialties. They can order the appropriate tests, recommend treatment and provide ongoing monitoring. My Dr. continues to monitor me for any changes that need to be addressed.

Also my endocrinologist diagnosed me with osteoporosis. There is a connection between your thyroid situation and your bone health. So my endocrinologist did bone density tests on me, recommended treatment and continues to monitor that too.

I want to add that if you choose to take thyroid medication, this is one of the few exceptions where the brand synthroid may be worth the extra cost over the generic. I have no studies to back this up. The generic is made by many companies, many factories. Just anecdotal reports that thyroid doses tend to stay steadier with the brand which means less need for repeated testing, etc. discuss with your doc.

See if your insurance covers synthroid. My recollection from when I used to practice was synthroid was in the range of $30/month. But I looked up the price on good rx, in case your insurance didn’t cover, and 25 mcg is $150 for a 3 month supply. That seems steep and alters, for my budget, the cost:benefit ratio,

I have only used Synthroid since 1988, when I started it. Used to be free, no longer is, but I would not consider switching to generic nor has it been recommended that I do. To me it is worth paying for brand. Generics can vary where Synthroid does not, per my endocrinologist.