Help with lab results

[Jenn1302]

Hello everyone,

I was wondering if you could help me interpret my current labs.
Here are my labs (done 8/1/2014):
TSI: 44 (range <140)
TPO: 781 IU/ML (range:<5)
T3: 89 NG/DL (range: 83-160)
T4: 7.6 MCG/DL (range: 5.1-11.4)
T3 Uptake: 29.4% (range: 21-38)
Free T4: 2.2 (range:1.0-4.0)
TSH: 2.0 uIU/ML (range: .35-4.9)
My TPO antibody value is 5 times what it was last year!! (in May 2013 my TPO was 149 IU/ML range:<34)

In 2011 I had very low TSH, borderline high Free T4 and hyperthyroid symptoms. In March a doctor told me I was hypo (TSH was around 4.0, free t4 was around 1.0) but then my thyroid hormones went back to normal (TSH:1.7, Free T4: 1.2).

I know my tests are currently normal (except for the TPO), but I have symptoms that started over the past couple of years.
My current symptoms are:
* Excessive sleep (9-10 hours per night which is roughly 2X the amount of sleep I used to get)
* Frequent dehydration
* Heart palpitations
* Mild enlargement of the thyroid gland. I can see it and I hate the way it looks :(
* Thyroid tenderness
* Increased thyroid vascularity that is consistent with autoimmune thyroiditis.
* Horrible skin texture (e.g. enlarged pores)
* Black bags under eyes
* Paleness
* Interstitial cystitis

I never had these symptoms before my thyroid started acting up. Could these symptoms be related to my thyroid even though my tests are normal? Is there some way to get rid of them? The doctor says that these symptoms are not related to my thyroid and that people with Hashimoto's/thyroiditis often have an enlarged thyroid and it's nothing to worry about as long as the thyroid functions normally. What else could be causing these symptoms?

Also, what does my TSI value mean? Do most healthy people have it around 0-2% (based on http://www.livingwithgravesdisease.com/diagnosis/lab-tests)?

Thank you in advance.

[Jenn1302]

Thank you so much for your help.

[gimel]

So, in addition to getting started on thyroid hormone med, your Vitamin D is below range.  It should be around 55-60.  Your ferritin is also way too low.  For women the recommended level is 70-80 minimum.   So you have lots to talk about with your doctor.  

[Jenn1302]

Thank you for your help. I take a multivitamin that has 100% of the recommended daily intake of vitamin D2.

Here are my vitamin D, B-12 and ferritin labs:
Vitamin B12 788 pg/mL (range: 250-900), March 2014
Vitamin D 25-hydroxy, serum 21.3 ng/mL (range: 30.0-96.0), July 2014
Ferritin, serum  9.28 ng/mL (range: 16.00-204.00), July 2014

[gimel]

Sent you a PM with some info on doctors for you to consider.  Just click on your name and that takes you to personal page.  Then click on messages.

What was your B12 level?  How much iron do you take?  You can take supplements for D as well.  If you cannot absorb enough iron or D, then you may have to get shots to get you moving in the right direction.  

Clearly you need to get started with thyroid hormone med.  It may well be that your palps are due to being too low and that raising your levels will benefit.  So, the best approach is to start on a low dose and always increase slowly until you reach optimal dose.  

[Jenn1302]

Thank you so much for your informative response. I live in the Boston area and so far I've seen 2 different endocrinologists who diagnosed me with Hashimoto's but then they said that my symptoms are not related to my thyroid and that currently my thyroid functions normally. Also, they didn't check my Free T3. Any advice or doctor recommendations in the Boston area would be greatly appreciated.

I recently started seeing a functional medicine doctor and I'm thinking of asking him for advice. So far we haven't discussed my thyroid issues much, but I'll mention it next time I see him. Has anyone here seen a functional medicine doctor for autoimmune thyroid issues? Were they helpful?

My ferritin and vitamin D are low, and my vitamin B12 is within the normal range. I take iron daily and consume dairy products, but my ferritin and vitamin D are still low. How can I get them in the normal range?

I'm kind of afraid to start thyroid replacement therapy because I've been told that it could make my palpitations worse (and it's also mentioned in the last paragraph of the letter http://hormonerestoration.com/files/ThyroidPMD.pdf). But treatment could also make my symptoms and palpitations go away right? What should I do?  

[gimel]

Your doctor is basically clueless about Hashimoto's Thyroiditis and associated hypothyroidism.  Most of the thyroid tests that were done are outdated and not very revealing.  Instead of the Total T3, Total T4, FT Index and T3 Uptake, It would have been far better, and less expensive, to just run Free T3 and Free T4, along with the TSH they always insist on running. In the future you should insist on always testing for Free T3 and Free T4.  

Apparently you have had to live with the Hashi's for several years now.  I say that because you had some hyper symptoms back in 2011 and then you have become hypo.  This is not atypical of Hashi's.  AS the Hashi's antibodies attack the thyroid gland, sometimes nodules form that leak hormone faster than normal, causing you to cycle through periods of being hyper, then reverting to hypo.  

Now it appears you are definitely hypo, based on the most important indicator, which are symptoms.  Just because lab results fall somewhere within the so-called "normal" ranges does not mean that all is okay for you.  The ranges are far too broad due to the erroneous method used to establish them.   For your doctor to say that your thyroid is not the problem is ridiculous.   Unfortunately it probably the rule, rather than the exception among doctors.  

On the other hand, 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.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

So I suggest that you read and absorb the info in the link.  Then you can either discuss with your doctor and see if he is willing to treat clinically, by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms.  I'd be surprised if he is but, if so, then it is well past time to get started with thyroid med.  If not, then you will need to find a good thyroid doctor that will do so.  If you will tell us your location, perhaps a member can recommend a good thyroid doctor in your area.  

One last thing, is that hypo patients frequently are also too low in the ranges for Vitamin D, B12 and ferritin.   so you should make sure to get those tested at first opportunity.  All are very important for a hypo patient.

[Jenn1302]

Sorry, that's Free T4 index. I guess the doctor didn't check my Free T4.

[gimel]

Please double check the range listed for Free T4.