Could someone help me with my Thyroid Panel and Iron results

[RangeretteB]

I am having hypothyroid like symptoms, such as hair falling out/breaking/thinning, being very cold, brain fog, dry skin/eyes, easily fatigued, inner ear itching, impaired memory, never feeling rested, some elevation of total and LDL cholesterols despite working very hard to lose weight (but with normal Tri's and good HDL), brittle/ridged nails, etc. These symptoms have been especially bad for the last year or so, but have appeared on and off for close to 10 years.

I have lost about 25lbs over the last year, but that was through calorie counting and weighing all my foods down to the gram. I gain weight very easily and lose very slowly, and with great effort.

The only other medical issues I have are Raynauds and osteoarthritis. The Raynauds has gotten worse in my hands and feet, but the coldness I've been feeling is now in my entire body....it just feels different from the Raynauds, which I've had since my 20's. I simply cannot keep warm.

I also have noticed some swelling/hard area on my left side of my thyroid, as well as at the midline, about the size of a nickel, when I touch that area of my neck. I can see it when I swallow, or with my head flexed backwards, but otherwise I don't think it's visible. This is a fairly new development within the last two months.

Around the time I found this swelling that my voice often becomes hoarse/strained, and I now have a slight cough with a feeling of discomfort when swallowing. For example, pills now keep getting caught in my throat often. Even liquids feel like they get trapped, as in residuals of liquids often slowly drip down my throat after I've swallowed the major portion of the liquid.

I decided to have some lab work done, as I'm a disabled veteran and the VA is quite hesitant to prescribe the thyroid and iron panels that I have seen recommended on various boards without something being out of range first. The VA strictly uses TSH, until it goes off the charts low or high. My TSH results have, over the years ranged from .86 to 2.91, on a scale of .4-4.6. Iron is usually on the low end, but just above borderline, so no further tests with them.

I have never had any symptoms of hyperthyroid, but many of hypothyroid. All my thyroid results look reasonable to me, but I still feel horrible. The iron panel I don't understand at all.

Additionally, I have a history of low vitamin D (below 10 twice, and at 31 last year (Range of 32-100) but the VA said to wait till next appointment to test it again. I'll have that tested at my next appointment in a few months. It is likely too low, again, so that may be partially responsible or contribute to for how bad I feel at present. However, getting my levels up never really made me feel much better....the other symptoms persisted.

As an aside, I was briefly on generic Synthroid five years ago, from the VA, at a low dose of 25mcg when my TSH was 2.91, but that only lasted one year. When my TSH went back down to 1.3, the thyroid meds were taken away. Again, they would not test T3 or T4, neither totals nor frees, so I have never known where I am on the spectrum, even when I was treated for hypo at that time.

Here are my current results:

TSH: .941  Range: .450-4.500
FT4: 1.23   Range: .82-1.77
FT3: 3.1     Range: 2.0-4.4
Thyroglobulin Antibody: 0  Range: 0.0-0.9
TPO: 8  Range: 0-34

Ferritin: 115   Range: 15-150
Iron: 47   Range: 27-159
TIBC: 272   Range: 250-450
UIBC: 225  Range: 131-425
Iron Saturation:  17  Range: 15-55

So, I guess my question is what does this all mean? Do I appear anemic or could my thyroid numbers be off due to estradiol and medroxyprogesterone in the last year? (I'm obviously perimenopausal at 49, but no menstrual cycle due to having Novasure procedure for heaving bleeding and multiple ovarian cysts 7 years ago). I was thinking possible Hashi's, but the antibodies don't indicate it either.

Thanks in advance and sorry this was so long. I'm just a bit confused as to what's going on and don't believe it's all just "normal" or worse, "in my head".  So, I wanted to get the board's thoughts. Maybe from that point I can do some additional research or maybe seek an outside doctor's opinion, if necessary.

I do have additional blood test levels over the past few years for TSH, cholesterols, serum calcium, general panels etc. If anyone thinks they are relevant/needed, I'd be happy to add them.

[RangeretteB]

Sounds exactly like what my labs are indicating. What an eye opener.

Had I not found the board and received your help, I would have just thought my labs were, once again, "normal", despite how I continually feel.

You are an invaluable resource, and I so appreciate your help!

I just received your message and have replied.

THANK YOU!

[gimel]

Following is a quote from the same doctor that wrote the link I gave you.

"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

I just sent you a PM with doctor info.  to access, just click on your name and then from your personal page, click on messages.

[RangeretteB]

I will definitely look into central hypothyroidism and carefully read the link you graciously provided. I'm not at all familiar with that particular class of hypothyroidism, so I now have a lot of reading to do, which is great!

I live in Arvada, Colorado, which is near Denver and Boulder. If anyone knows of good Dr's in the area, please let me know.

Thanks again! I finally have a sense of hopefulness now.

It's really sad that this all has to be so difficult for so many of us here, on the boards. Just so grateful to have the direction you've provided!

[RangeretteB]

ThankS so much for your help! It means a lot

[gimel]

With all those symptoms and your thyroid test panel I expect that you have what is called central hypothyroidism.  Central is a dysfunction of the hypothalamus/pituitary system that results in a TSH output that is too low to adequately stimulate the thyroid gland to produce thyroid hormone.  Central is most frequently overlooked because doctors are attuned to only high TSH.

So it is good tht you got the additional testing done.  From those tests I'd say that your Free T4 is lower than optimal.  Even though within the range, that does not mean it is adequate for you.  Due to the erroneous assumptions used to calculate the ranges from lab test data, they are far too broad, to the extent that test results in the lower half of the range should be suspect and call for full evaluation.  Your Free T3 result is similar.  It is only at 43% of its range.  Optimal is more like the upper third of its range, or as needed to relieve symptoms.  

Hypothyroid patients typically have low stomach acid so they do not adequately absorb vitamins and minerals.  That is consistent with your relatively low Vitamin D and likely low B12 also.  Usually I could say that about ferritin also, but your level is good.  D should be 55 min.  B12 should be in the very upper end of the range.

So somehow you are going to need to find a good thyroid doctor that will treat clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  You can get some good insight from this link written by a good thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html

Good thyroid doctors are hard to find.  If you will tell us your location perhaps a member can suggest a doctor that has been recommended by other thyroid patients.