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Avatar universal

Confused about lab results

Hello.  I have a question about my thyroid panel labs.  I've researched them and am confused if it's Hashimoto's or if it may be a pituitary problem.  I had my first labs done last year at about this time because of all the symptoms I had of hypothyroidism (lethargy, fatigue, weight gaine, dry skin).  My results were as follows:

T3 total: 1.17 ng/mL               (normal: .58-1.59)
T4 free: 6.59 ug/dL                 (normal: 5.06-9.42)
T4 capacitaion: 1.04               (.69-1.41)
TSH: .17 uUl/mL                    (.35-4.94)
T4 total: 7.23 ug?dL                (4.87-11.72)

I took levothyroxine for 3 months and then was retested in January of 2009.  My lab results were the following:

TSH: 1.78 uUl/mL                   (.35-4.94)
T4 Total: 6.78 mcg/dl              (4.87-11.72)
T3 free: 2.64 pg/mL                 (1.71-3.71)

My doctor said my labs looked normal so I could stop the levothyroxine for about 6 months and then test again.  I have been in a "mental fog" for the last few weeks and my hands are dry all the time and my face looks puffier to me for some reason.  I don't feel as fatigued as I did when I was first diagnosed, but the "mental fog" and decreased memory is what has me confused  So I waited only 5 months to retest, which would be just a few days ago.  My results were the following:

T4 total: 6.51 ug/dL                   (5.53-11)
TSH:  0.664 uUI/mL                   (0.465-4.68)
T3 free: 4.94 pmol/L                   (4.26-8.1)

What is your opinion on this?  Could it be Hashimoto's or a pituitary problem?  How stressed out about this should I be?  Thank you and have a wonderful day.

17 Responses
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Avatar universal
Those tests are all indicative of hyperthyroidism, with the most likely cause being Graves' Disease.  Please tell us about any symptoms you have.
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Avatar universal
Hello! I did a thyroid test and this is what came out Sir, the TFT result for  TSH. : 0.001 mIU/ml (0.35 - 4.94) TT4. : 20.0 ug/dl (4.87 - 11.72) TT3. : >8.0 ng/ml. (0.58 - 1.59) please can someone explain this??
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Avatar universal
DeQuervain's was what I thought I had until my antibodies proved me wrong.  

If your free's continue to come up, your current symptoms (brain fog, fatigue) might just be alleviated also.  It takes longer than you think to get back to 100% once you've been hypo for a while.

Keep an eye on your thyroid for a while.  Seeing an endo seems like a really good idea.

Best of luck with this and with your studies!
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Avatar universal
Hi again.  Sorry I haven't replied.  I've been busy with school. :(  I'm guessing I probably had De Quervain's or some other typ of subacute thyroiditis.  The only real complaint I have right now is that memory fog.  I don't know how much of that is just that I need to concentrate more with my memory, or the thyroid problem.  But I'm guessing it's not the thyroid.  Apart from feeling tired, it could be to my iron falling, which does tend to happen to me every once in a while.  I guess my next step is to see an endocrinologist just to check my results and let me know what I should do.  I'm glad it was just a transient thing.  Thank you for the help.  :)
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Avatar universal
Well, it's not Hashi's.  

Your TSH has actually fallen since January.  At it's highest in January, it was 1.78.  Now it is only 0.664 (quite low).  All except the very first are in reference range.

Your FT4 has come up considerably since March.  In March, it was at the bottom of the range.  Now, it is up into the middle third (barely, but still a good showing).  

Your FT3 in January was just into the middle third of the range, and the current one has fallen again into the lower third.

So, TSH and FT4 are both improving.  Did you have symptoms back in March when your FT4 was 0.8 (very low)?  FT4 was all that was done in March, is that correct?

It's unusual that any of your labs could have improved over the last six months since you weren't on meds.  This has to mean that your thyroid is "working better" than it was.  As I mentioned earlier, usually in the cases of temporary thyroiditis (which can last for months or more), when the FT3 and FT4 start to come up, the patient is "weaned" off of levo.  Their dose is slowly decreased to give them some support while their thyroid continues its recovery.  

However, I still can't piece together why you are having symtoms now when your FT4 is better than it was in March.  Can you shed any light?  
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Avatar universal
I got my antibody results today.  They are the following:

Anti thyroid antibodies: 20 UI/ml  (0-100)
Antibodies to thyroglobulin: 40UI/ml  (0-100)

I guess this means it was a transitory thing.  It's just strange that my T3s are low and my TSH is starting to get high.  I think there's a problem with my conversion of T4 to T3.  Let me know what you guys think.  Thanks.
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Avatar universal
I will let you know tomorrow what the antibody tests say.  Hopefully it was a temp thing.  But I still wonder what caused the cognitive decrease.  I have trouble with my memory and since that is the one thing that I need to study for my exam, it really worried me.  But it's weird that my TSH and T3 are on the lower end and have been getting lower every time.  It could be that my poor little thyroid is trying to respond to the high TSH secretion from my pituitary.  We'll see. :)
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Avatar universal
It is confusing and interesting that your FT4 actually went up.  One explanation, as you said, is a Hashi spike.  Another might be that you actually had a temporary thyroiditis, and your thyroid's starting to kick in again.  Usually, in temporary cases, the patient is weaned off thyroid meds her thyroid is recovering.  The antibody tests will tell.
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Avatar universal
I got my results back from my free T4 and they are the following:

1.32 (normal values 0.8 - 1.9 ng/dl)

This is a lot higher from when I did T4 free in March.  Which does seem strange.  Unless I have Hashi's and are going through a hyper stage.  I won't get the results for the antibodies until Thursday.  I'll post what the results were then.
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Avatar universal
You know, I was looking over at my lab work that I had done in March.  I had these done right after the ones I had in January because by March, I was feeling tired and my blood pressure was up.  I figured I was having issues with my thyroid.  I didn't include them in my original post because you couldn't really see a difference.  Well, I looked at them today and in these I ordered a T4 free and here were the results:

T4 Free  0.80 ng/dL   Normal values 0.70-1.48

If I was that low 3 months after stopping the Levo, then I hate to see what they look like now, almost 6 months later.  Tomorrow I'm having the antibody tests and a new T4 free done and then I'll going to re-start the Levo.  

I need to see an endocrinologist, but right now with my crazy schedule, I think I'm going to wait until after my exam.  Meanwhile, I can start back up on my meds.  Thanks again for the help.
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Avatar universal
Elevated TPOab and/or TGab indicate Hashi's, which is hypo.  
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Avatar universal
Thank you again for your help.  I'm going on Monday to get the TPOab, TGab and FT4.  In case you're interested, I looked up the antibody tests in Spanish and they are the following:

Anticuerpos anti-peroxidasa itroidea
Anti tiroglubulina

I just translated the English ones and did a goole search to make sure they were correct.  Thank you again for your help.  As soon as the results are in, I will post them.  

Just out of curiosity, if the test turn out positive for the antibody tests, does that mean hyper or hypo?  
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Avatar universal
My Spanish, Butterfly, does not extend to medical terminology!

Your TSH of 0.664 is in the lower end of the currently accepted TSH reference range (0.3-3.0).  TSH is counterintuitive...as it gets lower, you move toward hyperthyroidism, as it gets higher, toward hypo.  Your TSH indicates that you could be slightly hyper.

HOWEVER, your latest FT3 is quite low in its range.  And it's fallen since the previous labs.  In January, it was in the bottom of the middle third of the range.  Now, it's quite low in the bottom third of the range.  This indicates hypo, and that you are getting more hypo all the time.

So, your TSH and your FT3 are contradictory.  FT3 and FT4 are much more important than TSH.  They are the actual thyroid hormones (TSH is a pituitary hormone), and are much better indicators of thyroid status than TSH.  

I think (not a doctor, just a fellow patient) that you are hypo and need to be back on levo.  

Get your FT4 to see how that looks, along with antibodies (whatever they may be called!), and post those if you'd like members to comment further.  

Best of luck!  
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Avatar universal
So what would my TSH levels suggest?  Hypo or Hyper?  I hate being confused. :)
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649848 tn?1534633700
COMMUNITY LEADER
HypER and hypO symptoms can sometimes mimic one another -- i.e. fatigue ---

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Avatar universal
Thank you for your comments.  The first set of lab results were a full thyroid panel...minus any antibody tests, etc.  My doctor gave me the lab sheet filled out so that after 3 months I could take it back to get more lab work done and those were the only parameters she wanted to check.

I did recently switch labs.  This one is at school and a lot quicker in terms of turnaround time.  And I also discovered, a lot cheaper than the one I used to use.  It's just for convienience that I used this lab.  The TSH value of 0.664 is the current one.  I had this one done on Tuesday of this week.  Now I know what values to actually order at the lab.  I'll go next week and have the antibody ones done and the free T4.  I think the free T3 was done with my last lab last week.  

Is the level of TSH indicative of hypo or hyper - thyroidism?  I just discovered that a low TSH means hyper and a high TSH means hypo.  That had me so confused.  I asked 3 more doctors about this and they all said hypo.  But I'm still not satisfied with the diagnosis.  And it bugs me that endocrinology is my worst area of study!!  Or could it be Hashimotos with periods of hyper and hypo?  

As for the medication being stopped, I thought that sounded very strange.  And that's why I'm still looking for more information.  And it is strange because I have had symptoms of both hyper and hypo.  I had my hormone levels checked back in 2005 and 2006 because I was sweating a lot, etc. and they results were "normal."  But I never saw the values.  And then the low TSH was found last year because I was really tired all the time and irritable.  That's all gone, but I feel like my memory and cognitive functions are below normal.  

Any other advice?  Anything else I need to do?  So then I need the antibody tests and free T4.  Do you have any idea what the antibody tests are called in Spanish?  I'm in Mexico, so that's why I'm asking.  Thank you again for your help, I truly appreciate it.
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Avatar universal
It would be really helpful if your doctor was consistent about the labs he was ordering.  Why the flip-flopping around?  Total T3 and total T4 are considered obsolete tests and pretty much a waste of money.  It's free T3 and free T4 that are much more indicative of thyroid status.

I also notice that the reference ranges have changed on your tests.  Have you switched labs?

The only way to diagnose Hashi's is to have thyroid antibody tests...TPOab and TGab.  Without these, you are just guessing.

I wouldn't stress out like it's going to kill you tomorrow, but I think I would pursue further testing.  Ask for FT3 and FT4, along with a current TSH, and antibodies.  

Since you have hypo symptoms, don't wait until they get worse to pursue this.

It's unusual for a patient to be put on thyroid meds and then taken off once their labs are "normal" (we hate that word).  The labs are only "normal" because of the meds.  By and large, and except in the case of temporary thyroiditis (relatively rare), once you are on meds, you are on them for life.
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