Help Interpreting/Comparing Blood Work

[k_chelle13]

Hello,

I am looking to get some old blood work (12/16/2016) interpreted and then compared to my most recent blood work. Only 2 of the thyroid panels were actually re-tested (different doctors) but they are posted in different increments and used different labs--I was wondering if it was possible to convert/interpret these?


RECENT BLOOD WORK:

TSH (mIU/L)   1.17  Standard range wasn’t listed with this but it was marked as normal in the "Result comments"
T3, FREE (pg/mL)               2.5             [2.3-4.2 Standard Range]
T4, FREE (ng/dL)                1.0             [0.8-1.8]
TG Antibodies (IU/mL)         1               [< or = 1]
TPO Antibodies (IU/mL)       93             [<9]
(I have already had this set interpreted by Barb135 on a previous post)


BLOOD WORK FROM 12/16/16:

T4           my result; 7.5 ug/dL                [Lab given Normal Ranges 4.5-12.0]
T3 Uptake                28%                           [22-35]
T4 Free                     2.1                              [1.4-3.8]
TSH                        2.206 uIU/mL            [0.350-4.500]

Even though these are a year old, I would still like to be able to get interpretations of these and then compare to my current blood work just to see/understand any changes that have occurred over time.
I also don't know what T3 Uptake is or what "optimal levels for these guys would be.

Thank you!

[Red_Star]

The August 2012 study entitled "Clinical Significance of TSH Circadian Variability in Patients with Hypothyroidism" (Sviridonova MA, et. al) showed an average morning TSH level in the subclinically hypothyroid group was 5.83 mU/L and in the afternoon was 3.79 mU/L; 73% TSH circadian variability.  

The average morning TSH level in the hypothyroid group taking levothyroxine was 3.27 mU/L and in the afternoon was 2.18 mU/L; 64.7% TSH circadian variability.  Morning: 8 - 9 am. Afternoon 2 - 4 pm.

73% variability of TSH in untreated hypothyroid patients is 2.04 mU/L. You would not see a 2 mU/L variation in healthy people.  Data from the NHANES III study of 13334 (age 20 to over 80 - black, Mexican-American, white) without any thyroid disease or antibodies showed the lowest TSH was 1.10 and the highest 2.13. The TSH rose with age.  All age groups and races were in the 1 mU/L range except 2.13 mU/L in the Mexican -American age 70 - 79 group.  

I read the book Why Do I Still Have Thyroid Symptoms? When My lab Tests Are Normal by Dr Kharrazian. Very interesting and mentions fluctuations with Hashimoto's. This is not time based but due to excess hormone being released on and off from antibody damage. I would not agree functional TSH range goes up to 3 however. Dr K also mentions in detail about avoiding gluten. I think some people might notice an improvement while others do not.  

"Hashimoto's Disease and "Normal" Lab Results

Jan - TSH 4.5
Feb - TSH 0.08
Mar - TSH 2.3
April - TSH 3.8
May - TSH 8.7
June - TSH 7.4
July - TSH 1.6

One reason hypothyroidism goes misdiagnosed is because a person with hashimoto's can present with normal TSH. This graph illustrates the monthy TSH levels of a person with Hashimoto's who is receiving no treatment. As the autoimmune condition fluctuates, TSH levels vary wildly. Using standard lab range of 0.45 - 4.5 this person would fail to be diagnosed. During the month of March the patient's TSH even falls within functional range 1.8 - 3.0. That's why also testing for immune antibodies and evaluating symptoms and history are so vital."

[k_chelle13]

Red_Star this information is brilliant and so enlightening! I had no idea that Hashimotos can cause such fluctuations in TSH but as you've described it from Dr Kharrazian's book and the "normal" lab results you posted it makes perfect sense!

This is exactly why I wanted to compare my past blood work, just to see if there were any past indications that were previously missed and such.

Thank you!

[Red_Star]

You're welcome! :)

[Barb135]

Euthyroid is having a normally functioning thyroid.

Euthyroid sick is low thyroid hormone levels in the presence of a non-thyroidal illness (NTI), without preexisting hypothalamic-pituitary and thyroid gland dysfunction.  Following recovery from the NTI thyroid function test results should be reversible.

[k_chelle13]

Perhaps it was because I had previously mentioned I was gluten and lactose intolerance then. That is really good information about soy and sugar--especially since I use a lot of soy products to avoid dairy. Wow.

Somewhere I did read (I think maybe in an Amy Myers article)  about how its suspected that intestinal permeability can be what initiates autoimmune response in the body.
Your comment about how important the balance of the gut flora really hits close to home as I'm trying to treat a bad case of SIBO presently.

Very interesting how so many other things can also affect the thyroid.

Thank you very much for all of this information Barb!

[Barb135]

TSH can fluctuate as much as 70-75% over the course of a day... That's not saying it always does; just that it can depending on the variables that affect it.

Any hypothyroidism (primary or secondary) will present with low Free T4 and Free T3.  Hypothyroidism is defined as low thyroid hormones.  TSH is only a "messenger" to the thyroid and an indicator of thyroid status; however, as we often see, it does not correlate well with actual thyroid hormone levels.    

One way to tell the difference between primary and secondary hypothyroidism is in the unmedicated TSH.  With primary hypothyroidism (that caused by the thyroid malfunctioning) there will be a higher TSH.  With secondary hypothyroidism (that caused by pituitary/hypothalamus malfunction), the TSH will be low.  In either case, Free T4 and Free T3 will be low because in the one case (primary hypothyroidism), the thyroid "can't" produce enough hormones no matter how much TSH the pituitary pumps out and in the other case (secondary hypothyroidism), there isn't enough TSH to stimulate the thyroid.

Of course, there are always exceptions to every rule and one of those is with some early stages of Hashimoto's when one can have periods of hyperthyroidism, alternating with periods of hypothyroidism.  When one is in a period of hyper, the TSH will be low and Free T4 and Free T3 will be high.  This happens as the thyroid sputters in its final attempts to produce hormones.

[k_chelle13]

Wow! 70-75% in a day, thats quite a fluctuate. Which I suppose makes it seem even more insane that so many conventional medicine doctors still see it as the golden standard...yikes.

So would a 9% decrease within a year of Free T4 seem significant then? Assuming they don't fluctuate to the same degree that TSH does daily.


And what is euthyroid?
Or euthyroid sick?

I've seen a few articles talking about treating "Euthyroid Hashimoto's" and wasn't really certain on how to interpret that.

Thank you for all of your information!

[Barb135]

I don't think I said it's important to be gluten, dairy, sugar and soy free... you probably read where I said that some people believe this as many do.  I, personally, only believe in the sugar and soy free part for everyone, though I'm as gluten and dairy free as I can reasonably be because my nurse practitioner has asked me to try an elimination diet and be off all of them.

First off - soy is a goitrogen and can inhibit the thyroid's ability to produce thyroid hormones.  That's the reason I don't eat/drink soy products but aside from that, as far as I'm concerned, soy is pig feed not people food - that's just my opinion and no one is obligated to agree.  I'm adamant about soy and check labels carefully.  

Of course, sugar is bad for all of us and especially if we have thyroid problems, because many of us are more prone to type II diabetes and/or insulin resistance. It's important to note that artificial sweeteners are just as bad, if not worse for you than sugar as they make you crave sweets more than sugar does.

Then we get into gluten and dairy... there's more gray area with these and it's a lot more controversial.  Some people believe that gluten molecules resemble thyroid molecules so closely that antibodies will mistakenly attack the thyroid thinking it's gluten.  This has not been proven scientifically.  

Another contention is that gluten causes a condition called "leaky gut" - supposedly, this is when particles of good escape the gut and enter the blood.  There is no such thing as leaky gut.  

Studies are now showing that there is a condition known as intestinal permeability which has a lot to do with the microbiome aka the good/bad bacteria in our guts.  Intestinal permeability is most associated with conditions such as celiac, IBS, IBD, gastric ulcers, allergies, infectious diarrhea, obesity-related conditions (type II diabetes, metabolic syndrome, etc).  

I had a bout with H.Pylori at the beginning of last year, so I can vouch for the difficulty of having an imbalance in the gut flora.

By the same token many people are sensitive to lactose or casein in dairy, therefore, it's best to avoid dairy, also.  

The issue with gluten and dairy is more a personal one - of course, if one has an allergy, sensitivity or intolerance, they should, by all means, avoid that food.  However, I do avoid across the board cautions against gluten and dairy.  I'm currently trying to maintain a gluten and dairy-free diet in order to see if it will help me, but that's not a sign that everyone must do so.    

[Barb135]

TSH "does" fluctuate and is affected by many variables - not just thyroid hormones.  Even the time of day the samples were collected can affect TSH - it tends to be highest in the morning and lower in the afternoon.

No, lower TSH is not indicative of Hashimoto's.  With Hashimoto's, the thyroid is being attacked by antibodies so thyroid production is being hindered as time goes on.  Your antibody count was relatively low, so that could indicate you haven't had Hashimoto's for a long time.

Typically, with hypothyroidism we expect TSH to get higher as thyroid hormones get lower.  When it's the other way around, we suspect Secondary or Central hypothyroidism.  With Secondary hypothyroidism, the thyroid usually works fine, the problem is in the pituitary/hypothalamus axis in which there isn't enough TSH to stimulate the pituitary adequately.  

It doesn't really matter what type of hypothyroidism you have, it still needs to be treated.  Many doctors miss secondary/central hypothyroidism because they concentrate on the TSH and because it's low, they think that's fine...

[k_chelle13]

I see, I didn't realize that TSH could fluctuate within the day like that. Very interesting.

How is secondary hypothyroidism determined then? Besides a less than optimal fT3 & fT4?
Since hypothetically if the thyroid is "working fine" and the problem is in the pituitary/hypothalamus axis, I'm assuming that there must be some other set of blood tests?

Also--unrelated but, I recall seeing before you had posted that with Hashimoto's it is important to be on a gluten free, dairy free (as those were my two intolerances), sugar free, and soy free diet--why is it that these 4 things should be removed from the diet? Do they affect the thyroid in some way?

[k_chelle13]

I just realized I'm assuming that less than optimal fT3 & fT4 is considered secondary hypothyroidism--but you didn't explicitly state that, so that may not be correct.
I don't know the terminology for hypothyroidism occurring with normal TSH, and lower than optimal fT3/fT3.

So since TSH can fluctuate, I'm assuming that fT3/fT4 do not as much?

in my earlier paragraph I had meant that High TSH is indicative of hypothyroid, not Hashimoto's.
But somewhere I read that at early stages of Hashimoto's it can be possible to have a lower level TSH as at the thyroid releases more TSH as it comes under attack (I have no clue if this is true, just a thought I had remembered).

[Barb135]

Hi k_chelle

The only things that can really be compared are the Free T4 and TSH since there was no Total T4 or T3 Uptake in your current blood work or antibody tests in the old blood work.  

Just for your information, Total T4 and T3 Uptake are obsolete, but I'll explain them anyway.  Total T4 is the total amount of T4 in your blood.  Most of the T4 you have is bound by a protein that makes it unavailable for conversion to T3.  The unbound or "Free" T4 is what we test because that's what's available to be converted.  The test for Total T4 includes both, the bound and unbound T4 so it's not very useful.

T4 Uptake is an indirect/ obsolete measure of Free T4.  

All of that said:  Your TSH was higher in 2016 than it is now...

Your Free T4 in 2016 was at 29% of its range and it's currently at only 20% of its range.

There's nothing the 2016 labs to compare Free T3 with, but it's currently at only 11% of range.  

With Free T4 at only 20% of range and Free T3 at 11% of range, you should be considered hypo.

I hope this makes sense and if there's anything you don't understand, please feel free to ask for clarification.

[k_chelle13]

I figured most of the information from 2016 would be completely irrelevant, it was taken by my PCP, so I was not expecting there to be much good information to utilize.

I really just wanted to see if there was anything to check over time to mirror how my symptoms have also become more severe over the year.

Does TSH fluctuate? When I went to see my PCP in 2016 this was when I first started experiencing my symptoms (textbook hypo), and they have only steadily gotten worse since then of course. So it seems interesting that TSH would drop when (correct me if I'm wrong) a higher TSH is generally associated with hypothyroid..
Unless this could some how be a different scenario for someone with Hashimoto's (as you've stated previously seems to be the case, indicated by my TPO Ab).