Appropriate Thyroid Tetst

[curious101]

Hi Dr.  Approximately 7 years ago I visited my GP complaining of general fatigue.  He ran a blood test and discovered that my TSH level was high.  If I remember correctly, the number was around 7.  I was told that the normal range for this lab was 0.7 to 5.80.  He put me on 0.50 mcg of Synthroid.  Several months later my TSH had reduced to 5.50.  I was told that was within the normal range and everything was fine. I have struggled with weight (6'-1", 230 lbs, male), thinning hair and fatigue/sluggishness, hypertension ever since.  Recently, after switching doctors (insurance)and doing some research I asked to have my TSH checked.  It was still in the range of 5.5 which was just below the upper range of the "lab's" normal range.  I told my doctor that I had read that TSH should be closer to 1.0 and should absolutly be below 2.0.  He raised my dosage to 0.88mcg Levoxyl (also insurance) and said to wait 6 months to retest.  The 6 months is now up and I'm planning making the appointment.  My questions are:

1. What should tests shoule be done?  Free T3, Antibody, thyroid ultrasound, etc.  Both past and present GP's only seem to order the TSH, but that seems insufficient based on my research.

2.  Why are the normal ranges different from different labs?

Thanks for the help!

[Mark Lupo, M.D.]

The value of the free T3 is debated.  I use it in my hypo patients if the TSH is at goal (0.5-1.5 in my opinion/experience) and a patient still has symptoms.  Then, if the free T3 is in the low/low normal range I would consider adding T3 to the treatment.

The antibody tests helps establish the reason for the hypothyroidism -- ie, an immune system attack against the thyroid (Hashimotos').  I usually check it.

The ultrasound is something I do in most of my thyroid patients to detect any nodules and to see if there is evidence of inflammation in the thyroid gland.

The normal ranges vary from lab to lab - ask to get a copy of your results.

[doodlebug1]

Hi curious1. I know you directed your post to the doc, but hope you won't mind input from another hypo person. One thing I have discovered over and over is that going simply by the TSH range can leave me still hypo, as I've noticed in others. Instead, my doc doses me by the free T3, which is now at the top of the range, and I have no more symptoms. Also, I was on Synthroid and later Levoxyl for 17 years and never, ever completely rid myself of symptoms. It's only when I switched to natural thyroid hormones, also called Armour, did I finally rid myself of all symptoms and gain GREAT energy. What you are on is simply a T4-only med. T4 is a storage hormone. Armour, on the other hand, gives you exactly what your own thyroid would be giving you--not just direct T4, but also direct T3, T2, T1 and calcitonin. I have been VERY impressed.

I was sorry to read that your doc would make you wait 6 months!! It only takes T4 about 5-7 weeks to build and show it's full effect by many articles I have read!!

I hope you will do Google research on "natural thyroid hormones", just as it appears you have already done on the TSH. It will be very worth your time!!

[ArmourGal]

There was an excellent article in the 2/24/2001 edition of The Lancet titled "Interpretation of thyroid function tests" which is a good one on explaining why TSH, Free T4 and Free T3 should all be run.  The article also mentions thyroid antibody testing.  And I agree that all of these are important for initital diagnosis.  My diagnosis would not have been overlooked for over two decades had this protocol been followed when I presented with complaint.  

After diagnosis, it is most important to me now to know my Free levels.  I think Free T3 is extremely important as it is known that many hypos do not covert T4 to T3 well.  I guess this is why many Synthroid users still have symptoms...not enough active thyroid hormone.  So I think if more docs would use this test, they would see that their T4 meds weren't doing the job for their patients.  Dr. Richard Young, author of Thyroid - Guardian of Health, has proposed that the Free T3 test may well become the new testing standard for thyroid function.  

As for different Free ranges...yea, they do vary a bit among labs...so that's why it's always important to get a copy of your lab results so you also know the ranges.   Then I think it's important to see where you are in range i.e. lower 1/3? midpt? etc. The TSH has a fairly standard range.

[doll face]

I still have not spoken with my doctor. as I live in Tn and they are in Mich. I can not just go run up there. I have faxed, called and now even got my sister in law going up there for me. All I get is a receptionist saying that all your levels are "in range" They still haven't even told me if I had a antibodies test or not.

While I cannot just write myself a script for Armour, I have increased my levothroxine from 50 mcg to 75 mcg. It is not ging to fix things but it does seem to help a little.

I guess I am going to have to make time for a trip up there. Thank you both for all info and more importantly for making me realize this is not all in my head. I'll let you now what happens.

[curious101]

Thank you everyone for the input.  I plan to ask my doc for free T3, antibody and ultrasound in addition to TSH at my next appointment.  Seems like the prudent thing to do.

[JEPG]

I recently had my thyroid antibodies checked. The lab stated that <35 was normal. Mine were over 325! I don't go see my endo until November. I do not feeel good. My cholesterol came back high also. Is there a correlation?

[ArmourGal]

High cholesterol is an indicator of hypothyroidism.  Mine was high and when it was rechecked three months after starting ARmour Thyroid, it was back in normal range.  That is the experience of many on my yahoo Natural Thyroid Hormones forum too.
Is there any reason why you just can't see a regular GP sooner?...many of them do treat hypothyroidism.  
cindi

[ArmourGal]

I have found that when a doc's office is reluctant to give a copy of YOUR labs...that WRITING a request letter for usually gets me very prompt action.  In the US, they are required by law to give you a copy, although I believe they can charge you for the copying...but I've never had one do it.

[doll face]

I do have copies of my latest blood test. I sent it to them. But they say that everything is in range. I guess I will try to get ahold of my hepatologist and see if he will put me on Armour, till I can get to Michigan. (He is the one that started me on the Synthroid in the first place) Seeing as I increased my own dosage of the Levoxthryoid I will be running out sooner than expected. Still trying to find out if I ever had an antibodies test done.

[JEPG]

I see my endo next week. I have a list of questions/concerns for him. I guess I am also worried that my thyroid has been swinging from hypo to hyper and back for the past 4 years. It was regulated for a while but seems to be off again. My antibodies were really high at 335. Normal on my lab sheet was <35!I recently found out that Hashimoto runs in the females in my family.