Help understanding Test results TSH T3 FT4

[RussAdams]

I was diagnosed in January 2009 as hypothyroid by my doctor during a normal annual physical.

I'm 54 and have been having several hypothyroid symptoms for about a year, but considered them just the effects of getting older.

Perhaps the scariest was an increasing inability to 'focus' and concentrate.  I've since read the term 'brain-fog' and it completely resonates with me!  As I make my living as a computer systems analyst this was NOT a good thing, believe me!

Perhaps the most annoying is I no longer sleep through the night.  I get about 4 hours of sleep, then my brain wants to start waking up.  Right behind that is gaining weight and a 'spare tire' I can't seem to get rid of!

To make matters worse, I'm traveling full time for work and am only rarely home in Sarasota, Florida.  I'm currently in Dublin, Ireland.  So I'm bouncing between two different doctors and two labs.

My original diagnosis was via a TSH test alone, Quest Diagnostics Sarasota, and on December 29th 2008 was recorded as:

TSH 3rd Generation 7.57 H  reference range 0.40 - 4.50 mIU/L

I started on 25mcg of generic Levothyroxine in January, February I went to 50mcg and was re-tested in March in Dublin, Ireland with the following test results:

TSH       3.61  mU/L reference range 0.45 - 3.50
T3          1.4   n/moL reference range 1.2 - 2.5
Free T4 17.8   pmol/L reference range 9.0 - 21.0

Upped the dosage to 75mcg in March after the above test results.  Then in April went to 100mcg and May to 125mcg.  

I plan on getting new blood work done this week in Dublin to see where I am now.

What tests do folks recommend besides TSH?  And what levels should I be looking for?

Should I be asking for Free T3 in addition to T3 or ?

Trying to make sense of it all, and where I should expect the tests to be to know that I should not increase thyroxine levels any further.

Oh - I'm feeling better, but not where I'd like to be.

Thanks for any help!

Russ

[JosieGo]

Hi all,

Just to let you know there's an active Facebook group called Thyroid Ireland if anyone would like to join up.  It's great for questions and answers on thyroid disease. I for one have received a lot of help there and am on my way to recovery thankfully.  Hashimotos/hypo - undiagnosed for many years before.

[RussAdams]

Thank you for your help!

I'll be back with lab results when they are available.

Russ

[goolarra]

Well, your symptoms definitely still sound hypo.  I think symptoms are key, also, but the scientific side of me says to use the labs, too.  I think the important thing is to use them in the correct order...FT3, FT4 and TSH (maybe).

The Dublin doctor is just plain wrong.  Many, many people don't feel well until they are in the lower end of the TSH reference range, or even below.  What good is it to be "normal" if you're still symptomatic?

Is it important to know what's causing your hypothyroidism?  Well, yes and no (I specialize in being helpful!).  The treatment is the same regardless of cause.  However, if you have Hashi's, you can expect your thyroid to continue to deteriorate until it is no longer functional.  Also, the bad news is that if you have one autoimmune disease, you are more likely to develop another.  This can be helpful for diagnosis of other probelms down the road.  It's another piece of the puzzle and can enlighten you when it comes to weird thyroid symptoms (like cycling from hypo to hyper).  There are also some temporary forms of thyroiditis.  Checking antibodies helps weed out those.

Good luck with your labs.  You can post them here (with their reference ranges) if you'd like members to comment.

[RussAdams]

Hi Goolarra:

Thank you for the detailed reply!

My current symptoms are:

+  Poor sleep.  Don't sleep through the night and awaken not refreshed
+  Energy problems, very tired through the day.  Mid afternoon crash.
+  Short term memory problems (I have noticed an improvement since January)
+  Still have days where it's tough to concentrate, but is much better than Jan
+  Mild depression
+  Mildly painful joints - especially in the hips (I walk a couple of miles a day)
+  Dry facial skin
+  Weak fingernails

I spent most the afternoon reading the material at Dr. Rind's site www drrind com.  Interesting postulations.  I started taking my temperature today.  Will monitor that for a while and see how it tracks against his charts.

I'll get in this week for Free T3 and Free T4 and TSH here in Dublin.

The doctor in the states is much more flexible in her prescriptions.  The doctor here is firmly in the approach of once you've hit the upper number on TSH you stop.  He said I was in range with the March labs and recommended to hold at that dosage.  I've gone up another 50mcg since then, so I'm just going to use the Dublin doc for labs.

I'm trying to treat to symptoms and not lab results, but do realize I've been staying away from the labs too long.  Was home in April and had emergency detached retina surgery so I got a bit side tracked.  Now it's time to concentrate back on the thyroid.

And no, I have not been given a reason as to why I'm having the thyroid problems.  Is it important to track down the cause?  I do not have an enlarged thyroid, nothing seemed unusual to the doctors when they palpated (correct term?) it.  Neither doctor seemed overly concerned about knowing why, so I have not given it much thought.

I appreciate any advice or direction you (or others who have gone down this road before me) would care to give.

Thanks again,
Russ

[Smilerdeb]

I totally agree with Goolarra's posting.

[goolarra]

I was an analyst all my life, too...luckily early retirement came before thyroid problems!  You're right, you can't be snoozing on the job...

You have had three increases (from 50 to 125 mcg) since your last labs in March.  That's way too long between labs when you're increasing that rapidly. You should be having labs run every 5-6 weeks until you reach a stable dose, and you should have labwork just before each meds change

In addition to TSH, you should have free T3 (FT3) and free T4 (FT4) run.  What you are calling T3 is total T3 (TT3), which is considered an obsolete test and pretty much a waste of money.  FT3 is the measurement of the T3 that is actually available to your cells. Much of TT3 is chemically bound to proteins and therefore useless for cell metabolism.

If you don't know the cause of your hypothyroidism, you might also request thyroid antibodies (TPOab and TGab) to confirm/rule out an autoimmune disease (Hashimoto's thyroiditis).

Knowing when you are on the correct dosage is tricky.  The best indicator is your symptoms.  They have to be alleviated before you stop increasing.  FT3 correlates best with sympotms of any of the three thyroid tests.  FT4 lags considerably behind FT3, and TSH barely makes it into the race.  You need to find the FT3 where YOU feel best, then use that to adjust meds rather than FT4 and TSH.  Most doctors are hard to convince of this.  TSH has been the gold standard of diagnosis for so long that it's been virtually impossible to dethrone it.

You said you're feeling better.  What are your current symptoms?