Help interpreting lab results

[RunnerKris]

I am a 38 year old female who has had symptoms of hypothyroidism for years but have just gotten in to see an endocrinologist recently. He has run a full panel of labs on me, of which I have gotten hard copies of the results. I have also had a thyroid ultrasound but do not have those results yet. I will have a followup with my endo in a couple weeks to go over the results but because nearly everything looks normal in my lab report, I am afraid he will say there is nothing wrong with me. He indicated at our initial visit that the fact that my periods are still pretty regular is a good indication that my hormones are functioning properly, and he doubted we would find the thyroid being the problem because my symptoms have gone on for so long (some up to 15 years). He felt if there really was something going on it would have been found sooner. Below are my lab values. I would like some help interpreting these as I know there is some controversy on what should be considered a good reference range. Last piece of info, both my parents have hypothyroidism.

TSH 2.9 (0.36-3.74)
T4 8.1 (4.7-13.3)
T3 79 (80-190)
Free T3 and Free T4 were not ordered

CBC, B12 and estrogen workup all reflect normal values

Thank you for any help you can in shedding some light on whether you think there is a possibility I am hypo without labs showing it. I have been convinced for years I probably am but nothing ever shows up in my bloodwork to warrant diagnosis or treatment.

[gimel]

Luckily I have a Colorado Springs doctor for your consideration.  Sending link by PM.

[RunnerKris]

I am in Colorado Springs, CO. Finding a local doc would be great but I'm willing to travel to Denver, if that's where I can get the best help.

[gimel]

You have two options.  One is to try to feed your doctor enough info from scientific studies, that refutes the bad info he has given you, and then persuade him to treat you clinically, as I described.  The other option is to find a good thyroid doctor,  not necessarily an Endo.  We can provide you lots of info that disagrees with the doctor; however, they are frequently so arrogant that they are never wrong, so it turns out to be futile.  So the best option would be for you to tell us of your location and see if there is a member recommended doctor that would treat clinically.  

[kevieb]

find another endo.  Your free T3 is more than likely going to be lower than your total T3

[RunnerKris]

I put a call in to my endo today asking if he would add a Free T3, Free T4 and a Reverse T3 onto my labs. He refused, saying the Reverse is not recommended so he no longer orders it and with the results from my Total T3 and Total T4 he has all he needs. I have a strong feeling I'm going to be told nothing is wrong with me. What do I do from here?

[RunnerKris]

Gimmel, thank you for your response. I will read the article closely.

I did have some of the other tests run that you mention, though not the free T3 or free T4 or the reverse T3. Below are the other results:

Vitamin D 42g (30-150)
B12 523 (200-1320)
ferritin 38 (7-137)
iron 191 (21-156)
total iron binding ca? 387 (250-450)
iron % saturation 49 (15-50)

Do these results suggest anything further to you?

My symptoms are below, in order from the ones I have had the longest to the most recent:

Migraines 30 years
Hair loss for 20 years, thinning, becoming brittle and dry over the past 8-10 years
Facial hair worsening 15 years
Severe mood swings, especially around menstrual cycle 10 years
Difficulty losing weight without dropping calories so low that I become light headed and sometimes faint 5-10 years
Eyebrows thinning over past 5-10 years
Feet and hands get cold when the rest of me is fine, sometimes tingling and feeling numb, 3-5 years
Worsening menstrual cramps 5 years
Fatigue, increasing over past 5 years, especially in past 12 months
Sleep disturbances 3 years
Forehead breakouts unlike normal acne 2 years
Nausea when hungry 3 months

Of note, in looking over my lab results that have not yet been interpreted to me by my endo, I see my estradiol level listed as 495 with the reference ranges being 34-400 for the follicular phase I was in at the time of the lab draw. I'm curious if this plays into anything.

Thank you again!

[gimel]

It is too bad that the doctor did not test for Free T3; however, if it is anything like your Total T3, which is at the extreme low end of the range, then it is no wonder that you would be suffering with hypo symptoms and not feeling well.  Even though your T4 is adequate,Free T3 largely regulates your metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

So, please tell us about symptoms that you have.

Also, be aware that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not TSH results.  You can get some good insight from this info written by a good thyroid doctor.

http://hormonerestoration.com/Thyroid.html

I suggest that you go through the info and prep for your next visit to a doctor.  Then you should ask for tests for Free T3 and Free T4, along with TSH they always test.  Also, a good idea to check for Reverse T3 as well.  Then, since hypo patients are frequently too low in the range for other important areas, I suggest that you should also test for Vitamin D, B12, ferritin and a full iron test panel.  Also ask if the doctor is going to be willing to treat you clinically, as described.  If not, then you will need to find a good thyroid doctor that will do so.

When results are available, please post results and their reference ranges shown on the lab report and members will be glad to help interpret and advise further.