Found my blood work paper, need clarification please

[keonsmommie]

Hi everyone, I hope that this question finds you in good spirits! I have been looking for my bloodwork paper to ask about it for 2 weeks, and found it today! So here goes, as some of you may know I have been on Synthroid 100mg for almost two months. My Dr. put me on this due to my TSH being 86.5, so he was under the assumption that I was hypo based on that and some symptoms. So any way he told me he wanted to start the meds then have bloodwork done in 2 months to see what effect the meds have I assume. So he ordered me a Thyroid Cascade Profile. On the back of the paper under this title it says, Thyroxine, Free, Direct..... Tri-iodothyronine (T3) Free..... Thyroid Peroxidase (TPO)  Is this what is in this test? Oh wait it just said one of these could be added by Reflex testing. I am confused I guess and I just want to do this with as little drama as possable. Thank you for any help, and thank you for putting up with my endless uncertainty, and helplessness!

[keonsmommie]

Thank you! You are always so helpful, and so nice! I go next week for my blood work, and my Dr usually calls me with my results a day or two later. What I will do is ask the nurse when she calls me to make a print out for me. I am still pretty cloudy and forgetful right now, I may even have a Drs appt around that time. I know he said he wanted to make a better judgement call after this bloodwork. So what ever happens I will come back and let you know, maybe by then I'll be able to tell you what it means to this lab to do a Cascade! Oh also just for the record, I am pretty new to this but I think that I remember the last bloodwork results already containing the ranges, even with out me asking. Just my luck this time they wont! :) Well, thank you again for your help! Take care now okay?!

[Barb135]

Yes, with TSH of 86.5 and symptoms, I'd agree with  your doctor that you are probably hypo.

Thyroxine, Free, Direct is what we refer to as Free T4 or FT4
Tri-iodothyronine (T3) Free is what we refer to as Free T3 or FT3
Thyroid Peroxidase (TPO) - usually this is done as TPOab (thyroid peroxidase antibodies) because they are looking for antibodies that may be attacking your thyroid (Hashimoto's Thyroiditis) which is the number one cause of hypo in the US.

Not sure about the "Reflex Testing".  Sometimes, they do TSH with Reflex to FT4, meaning that they are ordering TSH, but if it's out of range, they should go ahead and do FT4; if TSH were in range, FT4 would not be done.  

I'm not sure about a "thyroid cascade" -- maybe he did this all the way down the line: TSH first, then each of the others only if the one above it were out of range.  I've never heard of this being done, but that doesn't mean it's impossible.  There might also be a totally different explanation for that, so maybe someone else will know.

So when do you get the blood work done?  When you get results, make sure you get a printed copy and come to post the results, along with the reference ranges, since these are lab specific.

By the way, as long as you are at it, why not ask for a thyroid ultra sound and TGab (thyroglobulin antibodies), whichi is another diagnostic for Hashi's.  

No drama necessary...................lol