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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
blood test results
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.
blood test results
by annieface, May 20, 2006 12:00AM
HI I JUST RECEIVED BLOOD TESTS RESULTS FROM MY DOCTOR..I HAVE BEEN EXPERIENCEING HORRIBLE SYMPTOMS FOR QUITE SOMETIME...FATIGUE, DEPRESSION, MUSCLE ACHES, GASTRO PROBLEMS SUCH AS BLOATING, CONSTIPATION, THE DRYEST SKIN EVER, AND A LOT OF WEIGHT GAIN, THESE ARE THE ALL THE SYMPTOMS I CAN THINK OF RIGHT NOW...MY TSH TEST CAME BACK AS 6.88, MY T3 UPTAKE (WHICH I NOW READ IS NOT A GOOD TEST)IS 26, T-4 THYROXINE TOTAL IS 8.6 AND THE FREE T-4 INDEX (T7) IS 2.2...HE NEVER RAN A REGULAR T-3 TEST...ALSO I HAD A THYROID ULTRA SOUND DONE AND I HAVE A NODULE ON THE LOWER POLE OF THE RIGHT TYHROID LOBE...NOW THIS DOCTOR OF MINE DIDN'T THINK ANY OF THIS WAS A BIG DEAL BUT SUGGESTS I GO TO AN ENDOCRINOLGYST..I WAS QUITE UPSET OVER HIS NON CARING ATTITUDE..I AM TIRED OF FEELING THIS WAY...COULD SOMEONE GIVE ME SOME INPUT PLEASE? THANK YOU
Doctor's Answer
by Mark Lupo, M.D., May 20, 2006 12:00AM
, May 20, 2006 12:00AM
Would do FNA biopsy of nodule if >1-1.5cm, repeat TSH, check antibodies and likely start thyroid hormone treatment.
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Although the FTs are important to relate thyroid disorders,
TSH is the best test to relate whether a person is hypo or hyper.
Serum FT4 measurement is a more reliable indicator of thyroid status than TSH when thyroid status is unstable. When thyroid status is stable and hypothalamic-pituitary function is intact, serum TSH measurement is more sensitive than free T4 (FT4) for detecting mild (subclinical) thyroid hormone excess or deficiency.
As previously suggested, go to an Endo who deals with a lot of thyroid issues. Have TSH, both FTs, full antibodies and the nodule revisited. No use getting up set with your doctor for something you can not control, other then going to a new doctor peferably an Endo. Getting up set only casues stress which is not good for thyroid, TED, weight gain/loss, etc. or general health.
Good Luck!
What would constitute the hypothalamic-pituitary function NOT being intact? I believe that I have adrenal issues (low cortisol, low DHEA and low ACTH) -- would this affect the thyroid tests? What tests would be best for me? My TSH has fluctuated from 0.9 to 1.58 (ref range 0.5-5.5) but my Free T4 has remained constant at 1.1 (ref range 0.8-1.8). Don't have Free T3 (prim doc and endo both poo-poo it -- ugh!), but my Total T3 was just below mid-range...
I still have all the symptoms but the tests don't "prove" it. U have made every lifestyle change I can -- I eat fruits, veggies, whole grains, protein, all organic (milk, too); I exercise 4-5 x a week (pilates, don't have stamina yet for my low-impact aerobics), get plenty of sleep, drink plenty of water, don't drink alcohol or soda (drink one cup coffee couple times a week), etc., etc., etc.
Anyway, I'd mostly like to remedy the unrelenting fatigue and irritability. It would be great not to have dry hair, skin and not be constipated. I'd be happy if I could sleep through the night and be refreshed in the morning. I'd love to not be cold all the time (my bbt is 97.2-97.8, and does fluctuate during the day...)
Any thoughts? How do you feel about self-treating? If a possibility (want to be safe), what would you recommend?
Thanks!
I don't know if this will be of any help since we all are different and our system react differently, but I hope you soon find wellness.
Good Luck!
Get a hard copie of your test with Lab ranges. If Lab suggest, then treatment is warrented. Once on treatment with meds. you need to have Labs done at least every 6 weeks to 3 months until your levels are stable, then every 6 month until levels stay stable for a year and when stable for a year, once year is fine. This is not for Armour or T-3 replacement - you would need to go more often, like every 4 weeks but no more than every 6 weeks.
Good Luck!
TSH 1.4
FT4 1.7
FT3 2.6
Brief history: Hashi's, half thyroid removed with large nodule a week ago, been on various mcgs of Levoxyl for about a year, currently on 137 mcg. Do I need to add Cytomel (sp?) to my Levoxyl...or go on Armour? Or am I ok with the FT3 as it is? I can't seem to find anything about the FT3 number being in this range online. I'm positive it was my Ft3 that was tested though, I saw it filled out on the form and specifically asked for it to be tested. I know that my TSH is good...it was 28 at one time...yuck! That's about the extent of what I know though. =) anyone know what this reading means? Thanks!
Your FT-3 looks correct according to Quest Laboratory.
You might be having a conversion problem.
You could try supplements, selenium in small dose working up to 400 mcg but no more then 600 mcg with the same amount of chromium, and zinc working up to 50 mg per day. Or eat brazil nuts if you can afford the weight. I take the selenium route and sometimes eat the nuts as well regardless of the supplements. This route will take longer if its going to work than T-3/Armour which are chemicals that our body is not use to. Plus Armour is said to cause TED. I prefer the natural route, supplement first. It has been working for me, however we are not all alike.
Or check with doctor about adding T-3, if you have no heart problems of any sort. I think adding T-3 to your T-4 meds would be easier to regulate then Armour. But that is just my thought.
Best to check with or inform the doctor on all the above.
Good Luck.
I do have a rapid heartbeat already...I don't have a heart condition...yet. It runs heavily in my family though. This is the one thing that makes me afraid of Armour etc...when I went hyper last month, it was just awful, my heart pounded and I hated the feeling in general. According to my endo's office all my labs look "perfect", and I feel decent (just had surgery so it's a little hard to know for sure). I'll read up on the Selenium...I will start slow...I do know you have to be careful with it. Thanks for responding...it's good to know my labs are finally getting to where they should be! Thanks!
Selenium is an anti-oxidant and important for proper thyroid function and selenium is also an important heavy metal chelator, among a few other things.
Zinc’s important role is in maintaining the immune system, thyroid function and is essential for vision, among other rolls.
Copper works closely with iron in the synthesis of blood, is involved in the production of energy and most reactions that consume oxygen or oxygen radicals. Copper, along with Zinc and Selenium, is a free radical scavenger. Copper helps in wound healing.
Good Luck
hypochondriac (spelling). i also have hepatitis c which i was treated for about 4 years ago...but i didn't clear the virus...i now found out that the medicine they gave me for the hepatitis c can cause autoimmune thyroid disease!...so i am not assuming this is how i got this thyroid problem...biggest mistake i made was in letting them treat me with peg-intron therapy for the hepatitis c...it was a living hell while on the treatment..and now i am still suffering from it!...sorry to go on and on..thanks for listening.
I'm assuming your endo will test your antibodies and that should give a clearer picture about the Hashi's (which is an auto immune disease). I know what you mean about the weight. I went about a year undiagnosed and gained a lot of weight. It's not easy. Hopefully your endo is a good one and will get you feeling better...I know it seems so bleak right now. Your TSH is high and certainly you have a ton of the hypo symptoms. It makes sense that you don't feel well. I was so sick before treatment. It did take a while, but I'm just now starting to really feel better. I did feel better before the surgery, but they wanted to be sure my nodule wasn't cancer, so they went ahead and removed half of my thyroid and the nodule. It came back benign. The whole "getting regulated" process was hard (especially with Hashi's)...I'm feeling like there's a light at the end of the tunnel now. I do hope you'll feel that way soon too. You're going in the right direction. Anyone who's been hypo knows you're not a hypochondriac...it's funny...I've heard a few hypo people say that. I said it too. I wonder if it's because we don't have "sick symptoms"...you know, like sneezing or coughing...I don't know! I know I just felt like I thought people were looking at me as if I were "faking" or something. Just find it interesting that a lot of people seem to feel like hypochondriacs with this disease. Don't be hard on yourself though, being hypo stinks and it's not your fault your thyroid freaked out on you! I'm still a little in shock that this all happened to me...it just came out of nowhere it seems. I hit forty and fell apart! =)
I know how hard it is. At least you have an appt. with an endo and are taking action. That alone will start to make you feel more positive.
Each Lab has their own method of testing where one Labs range will differ from another Labs range, so what might seem a high or low range, really is not by that Labs method.
However as a reference: According to Quest Lab who uses a premier endocrinology laboratory, the Nichols Institute in San Juan Capistrano, CA, as their reference laboratory for 18yrs up:
THS 0.6 - 4.6 µlU/ml
FT-4 0.9 - 1.6 ng/dL
T-3 80 - 180 ng/dL
F-T3 2.3 to 4.2 or 230-420 pg/dL
AACE - American Association of Clinical Endocrinologist recommendation that TSH range be lowered to 0.3 to 3.04 however its just a recommendation, not that the range be changed. The recommendation is for diagnosis and not for treatment.
THS High reading is hypo and low reading is Hyper
F/Ts High reading is hyper and low reading is Hypo
Hope this helps.
A TSH would related if you are hypo however a full thyroid panel would related other thyroid issues or if you might become hypo in the future (per Lab test).
Per new england journal of medicine "the symptoms of both hyperthyroidism and hypothyroidism are non-specific and can be mimicked by other health conditions. Thus the practice of prescribing thyroid treatment on a clinical basis alone without biochemical confirmation carries potential risks."
If a full thyroid panel relates no thyroid problems, I would have the doctor check for other health issues that share your symptoms - there is a lot out there.
T3 159
ANTI TPO < 10
I forgot to ask for you Labs ranges. But what I read is that your levels are in the normal range. However the way that they are relating to each other, could suggest generalized ill-health; ‘sick euthyroid’ syndrome. Your T-3 is running a little higher than TSH and T-4 which might suggest early signs of T-3 Thyrotoxicosis, but not there yet. The T-3 is increased in almost all cases of hyperthyroidism and usually goes up before the T-4 does. Thus the T3 is a more sensitive indicator of hyperthyroidism than the Total T4. Also a slightly elevated T3 levels may occur in pregnancy or during estrogen therapy.
So I would have Labs done on a regular bases for just incase to catch it before it goes to beyond.
Some people might have antibodies that show no evidence of thyroid disease,and also, other autoimmune disorders are sometimes positive for antibodies. I would have Comprehensive Metabolic Panel (CMP) done because symptoms run close to those of thyroid symptoms. Other than that, its a wait and see situation.
This is probably not incouraging to you, for I am sure you are looking for a fast solution to all your ails, which is normal when we are not feeling our best. Any way good luck to you!
I do anyway because I have the test done early in the AM as soon as they open and depending where I am at in line.
Hypos need their Labs done as late as possible in the day for that is when they are the most hypo. And no fasting necessary, I would assume, unless the doctors office tells you otherwise.
Make sure the Endo deals with a lot of thyroid patients per year, for most of them deal with and know more about diabetics then thyroid. Also make request for TSH, both FTs and all antibodies for hyper and hypo. Good luck!
I had a TT 7 weeks ago. I had "normal thryoid levels" before my surgery. I had tumors with hurtle cells present is why they did a TT. I was on 125 mg of synthroid starting the day after surgery. I just went to my 6 week appointment with my surgeon and he did my labs. I asked the lab if they were testing for T3 and they said yes, but I don't see it.
My blood work came back as:
TSH 4.91 range (0.27-4.20) seems high..
T4 8.6 (5.1-10.8) what is a good level?
FRI free T4 9.6 (4.5-9.5) what is free T4?
TUP 0.09 (0.80-1.30) what is TUP?
First,last friday when I called the office, the nurse told me my labs were in and she upped my Synthroid to 150mg which I filled and have been taking since sunday. Today I got a letter in the mail from my doctor with a presciption for 137mg and he told me I should follow up with my general practioner in 6 weeeks. What's up with that? I have been feeling very tired and low energy so I was glad my dose was 150mg. I'm not so happy to go down to 137 until the next lab reports. And I thought I would be seeing the endo for follow ups, not my GP.
I called the endo office and they said the same about seeing my GP because they only continue to see people with cancer or complications. I am grateful I don't have that, but would be more comfortable seeing an endo. Does anyone else follow up with their GP?
Thanks for your help!
Laurie
TSH is a little high and is probably why doctor upped med dose, but, 150 I would think is too high for now because your TSH is not that far off and besides its better to go slow, that is, up a little at a time, with that in mind I would go with the doctor on the 137. For T-4 or all the levels, as long as they are in Lab range is good. However they go by the FT-4 which measures the concentration of free thyroxin, the only biologically active fraction, in the serum. The free thyroxin is not affected by changes in concentrations of binding proteins such as TBG and thyroid binding prealbumin. Thus such conditions as pregnancy, or estrogen and androgen therapy and certain drugs, do not affect the FT4, but will the T-4.
From time to time we will need dose adjustments, therefore we need to have Labs done and see doctor at least once a year after we have been stable on the same med. dose for a full year. However until that time, and in the beginning, it will be every 6 weeks to 3 months.
TUP (T-UP or T3U or T-3 Uptake) = Triiodothyronine uptake, however the results are normally given in percentage - Thyroid Hormone Binding Ratio (THBR). An indirect measure of binding protein, the T3 uptake reflects available binding sites (ie, reflects TBG). This is not a measure of T-3.
My Internist dia and treated me, and, I am still seeing an Internist because they believe in surgery as the last resort, and so do I. You can always go to an Endo if ever there is a problem your reg.doc can't handle.
Good Luck!
it sounded like the TUP does not show my T3 levels and it seems like they didn't do my T3.
And are you saying that it seems like I would be fine going to my GP to continue to get my labs ordered and figure out the correct amount of Synthroid.
Also, have you heard that Synthroid may not be tolorated as well if you are lactade intolorant? I read Synthroid has lactade as an inactive ingredient. ANd that Levoxine (I don't know how to spell the other presecip. drug you can take if you aren't taking S. Anyways, I don't do dairy so I was wondering.
I imagine it would only be a teeny amount!
Thanks,
M
No problem.
That is how I understand it. If your TUP, is T3-Uptake, then it would not be the measurement of T-3. However TUP results normally are in percentage and the levels you are giving is not, so its a little confusing and I could be wrong.
Correct, Synthroid has lactate as an inactive ingredient where levoxyl (Levoxin) doesn't. If it has just a teeny amount, its enough to be a problem for some in tolerating it.
If its ok with your GP it should be ok with you, unless or until, you have a special thyroid issue that is out of your GP realm. If you research and learn your thyroid issue, you and your GP can work together in your treatment. You always have the option to go to an Endo and a good doctor while suggest it, if and when, the issue is out of his/her realm.
To figure out the med dose, some times the initial dose is calculated by the patients weight, other doctors will start out at 100. Whatever, it is suggested to start out with small dose and work up so as not to over shoot you optimal level for you to feel your best at. This is to prevent bouncing back and forth with levels and med dose changes, which could be a set back and take longer to reach optimal level(s).
Good Luck!
~~~~~~~~~~
I am not a Doctor or in the Medical field.
My statements are meant as suggestions only
not as a diagnose or treatment,
that is between you and your doctor!
T3 Uptake: It is an old test designed with a purpose of indirectly measuring T4! It was developed before T4 levels were able to be measure accurately. The assumption was that if the patient had a high T4 level, the blood proteins would be saturated with it. Therefore when mixed with T3 (which is easier to measure), the blood proteins would take up very little T3. Thus a low T3 uptake implies elevated T4 levels and vice versa. Thus the T3 Uptake test is actually an antiquated, inaccurate way to measure T4 levels.
~~~~~~~~~~~
I am not a Doctor or in the Medical field.
My statements are meant as suggestions only
not a diagnose or treatment.
That is between you and your doctor
My GP is very easy to talk to and he is the type of doctor that will do any tests or will try any medication I suggest (that makes sence to him!) so I quess I will give him a try to get my levels level!
I started out at 125mg the day after surgery.
I am hoping to get my energy back and am relying on the correct amount of thyroxine to take. I feel so dependent on that pill!
I will be anxious to see the next blood work results and will make sure they test my T3.
Have you heard of taking selenium to help with T4-T3 conversion and has it been helpful? I have thought of adding this to my list of supplements. I added evening primrose oil.
I don't tolorate vitamins, but herbs and oils do fine. Just not vitamins.
THANKS!
M
maccie, you are welcome. I just hope I am of some help, no matter how little.
Having a doctor, any doctor, who is willing to work with, to listen to and hears his/her patients is half the battle of our illness. I am glad you have one.
Yes, I have heard of the relationship between selenium and conversion. I take selenium along with all my other vitamins and minerals in which they contain no additives, sugars, artificial color, sodium free, wheat, gluten and dairy.
If you decided to take selenium work up slow to, but no more than, 600 mcg. per day. If you can afford the calories brazil nuts are loaded with selenium.
Keep in mind that it does take time for your body to heal. That little pill works the same as our healthy thyroid hormone would, so we do rely on it for our health. If we knew what our thyroid levels were at our healthy state, it would make it easier to shoot for those levels, but if you are like me, I had/have no clue. So it is a hit and miss situation until we find that level which makes us feel our best.
It takes time but you will get there, just don't rush or you might find yourself on a rollercoaster ride of your life.
Good Luck.
~~~~~~~~~~~~~~~~~~
I am not a Doctor or in the Medical field.
My statements and comments are meant as a guide only,
not a diagnose or treatment. That is between you and your doctor.
So I DO KNOW WHAT my T4 was before surgery. It was
T4,Free 0.07 range (0.55-1.50)
TSH 0.83 (0.34-4.82)
T3 total 86 (60-181)
Those labs were done back when I first noticed the nodules last July.
So is T4 Free different then what my most recent labs revealed
which seems to be T4?
And the important one is T3 free, not so much T3 is that correct?
I did look at selenium at the coop today. They had 50 or 100mcg
and I didn't know which to get so I didn't get any.
I am thinking to wait until after my next labs to really know what my T3 is on it's own. Does that make sense?
I HATE ROLLERCOASTER RIDES but I do so want to feel better.
I would love my get-up-and-go back!
Patience is a good virtue so thanks for that reminder.
M
I meant Labs when at our healthiest, before being sick with thyroid. The ones you listed don't look too healthy :) Both FTs, FT-4 and FT-3, are the ones to have done. However T-4 and T-3 do have their important in diagnosing in relationship to all the rest.
Start out with 100 mcg and work up slowly to 600 mcg of selenium per day, depending on how you feel, that is, if you start to feel hyper don't go up but instead do down. Don't take over 600 mcg. per day. Do you have amalgam fillings? If you can't take in supplement form then look up what foods contain the highest of theser and add them in large amounts to you daily food intake.
I think it would be a good idea to see what your next Labs are like, that is, you'll need both FTs to know, for its how they relate to each other that tells the conversion story.
ROLLERCOASTER RIDES, meaning, bouncing back and forth with med dose changes and levels, like a ping pong ball. So slow is best ;)
GL
I have hypothyroidism, I went to the emergency room having horrilbe chest pains on my left side, felt like someone was sitting on my chest and was having spasms in my chest,with pains in my shoulder blades, my feet and ankles are swollen. Not to mention horrible headaches. Wasn't sure what was going on, when they took my blood, my results on my TSH were 123.35. I've never heard of it being so high, is that dangerous? The doctor told me she thought I had gallbladder disease, but when the ultrasound was done, they showed no evidence of it. Did find out my kidneys are not filtering right, whatever that means, my potassium and calcium was low. Not sure what is going on, if someone could give me some light on the issue that would be great.
TSH is high but I have heard of higher, in fact here. That might be why you ended up in the ER. Are you on meds., did they raise your dose??
Yes, being too hypo, for too long, can be dangerous, causing life-threatening myxedema coma/crisis which changes mental status, including lethargy, stupor, delirium, or coma. Lack of thyroxine (T4) and triiodothyronine (T3) influence brain function therefore thyroid hormones are critical to cell and organ metabolism and with an inadequate supply for an adult, energy production declines, and the action of other hormones is affected. Plus overly hypo can cause other health problems as well, such as for one, Cardiovascular problems.
I hope you are getting properly treated.
Good Luck!
~~~~~~~~~~~~~~~~~~
II am not a Doctor or in the Medical field.
My statements and comments are meant as a guide only,
not a diagnose or treatment. That is between you and your doctor.
Infertility problems when 26 years old. Found microadenoma 6 mm because prolactin levels high ..89. As far as I know, thyroid was tested back then and nothing was noted. Took meds to suppress prolactin...came down to normal levels...ok for 8 years.
No luck getting pregnant...inseminations, 3 IVF, no luck. After end of treatment - year later- got pregnant-miscarried at 7 wks. No more fertility treatments and no children.
Now age 40. 2 years ago, diagnosed with thyroid virus. Retested, and TSH, T3 & T4 in normal range. Last year, got prolactin tested...slighly elevated to 39.3..TSH- 1.41. Did not do anything.
Still gaining weight, tired, vaginal dryness, cycles went from 28-29 days to 25, dry skin, join & muscle pain, loosing focus, memory and concentration..sometimes nurse has trouble finding heart rate, low blood pressure 90 /65 or 105/70..not always.
Did blood tests few days ago. TSH now 3.57, anti thyroid peroxidase 45.6, Thyroglobulin anti <20, Prolactin 30.3, T3-2.6, T4-1.38
What do you think? My endo said see you in 6 months.
Thanks everyone
Good Luck!
~~~~~~~~~~~~~~~~~~
I am not a Doctor or in the Medical field.
My statements and comments are meant as
information only, not as a diagnose or treatment,
for that is between you and your doctor.
I have a quick question if anyone can help. My thyroid levels have been crazy for over a year and we were having trouble regulating them. On May 20th my TSH was 57 pretty high, the doctor raised my synthroid from 125mcg to 200mcg. Now on june 20th my TSH is 1.77. My question is is this possible to be totally regulated in 1 month?? My doctor wants to do the blood work over because he is just as surprised as I am.