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High TSH and Thyroid Peroxidase Antibodies, but normal T3 and T4
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High TSH and Thyroid Peroxidase Antibodies, but normal T3 and T4

I'm a little confused about my test results, and I'm hoping that I can get some insight from the community.
Here are my results

TSH is 5.76
FT3 is 3.0
FT4 is 1.1
Thyroblobulin Auto Antibody is 27.9
Thyroid Peroxidase Auto Antibody is 453
Thyroid is enlarged, but I hadn't noticed until my Dr. discovered this (and sent me for an ultrasound to confirm).

What does this mean?  Since my T3 and T4 are in normal range, putting me on replacement therapy wouldn't really do anything would it?
Also, my blood test revealed a vitamin D deficiency.  If was 17.
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Avatar_m_tn
You really do need to supplement your Vitamin D level to get it up over the middle of its range.  

Beyond that, a test result like yours, for TPO ab, almost always means Hashimoto's Thyroiditis, which is the most common cause for diagnosed hypothyroidism.  If I assume that the ranges for your Free T3 and Free T4 are similar to those seen so often, then your Free T3 and Free T4 are within the so-called "normal' range, but your Free T3 is in the lower half of its range, which frequently is accompanied by hypothyroid symptoms.   The range is too broad to really be a functional range, due to the erroneous way it was established.  Your Free T4 would be considered as adequate.  

So first, please post the reference ranges for the Free T3 and Free T4, as shown on the lab report.  Second, please tell us about any symptoms you are having.  Third, I suggest that when you go for testing again, you should also request to be tested for Vitamin B12, and ferritin.  Even though men are usually assumed to have adequate iron levels, ferritin is so important for someone that is treated for hypothyroidism, you need to make sure your level is adequate.

  



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35 Comments Post a Comment
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Avatar_m_tn
You really do need to supplement your Vitamin D level to get it up over the middle of its range.  

Beyond that, a test result like yours, for TPO ab, almost always means Hashimoto's Thyroiditis, which is the most common cause for diagnosed hypothyroidism.  If I assume that the ranges for your Free T3 and Free T4 are similar to those seen so often, then your Free T3 and Free T4 are within the so-called "normal' range, but your Free T3 is in the lower half of its range, which frequently is accompanied by hypothyroid symptoms.   The range is too broad to really be a functional range, due to the erroneous way it was established.  Your Free T4 would be considered as adequate.  

So first, please post the reference ranges for the Free T3 and Free T4, as shown on the lab report.  Second, please tell us about any symptoms you are having.  Third, I suggest that when you go for testing again, you should also request to be tested for Vitamin B12, and ferritin.  Even though men are usually assumed to have adequate iron levels, ferritin is so important for someone that is treated for hypothyroidism, you need to make sure your level is adequate.

  



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Avatar_m_tn
Thanks for the additional info.

The ranges on the lab report are as follows.
FT3 - (2.3-4.2) pg/ml  Mine was 3.0
FT4 - (0.7-1.5) pg/dl   Mine was 1.1

I'm not sure about the symptoms.  Once the Dr. did the initial test for TSH, and said that I probably had Hashimoto's Thyroiditis, I did some research, and in hindsight, have some of the symptoms.  Inability to concentrate, callused heels, varying emotional levels (depression/mania/anger), low energy.
I never noticed the inflammation of the thyroid though.

Again, thanks for the info.
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1204245_tn?1356904325
Your TSH is above the new limit 3.3 and even above old limit 5.0
So this condition can be considered as subclinical hypo (rare among the males)
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Avatar_m_tn
Just because thyroid test results are in the so-called "normal" ranges does not mean that is adequate for YOU.  First, everyone is different and react differently to thyroid hormone levels.  Second, the ranges are far too broad due to the erroneous way they were established.  As a result, many members, myself included, say that relief from hypo symptoms required Free T3 in the upper third of its range and Free T4 around the middle of its range.  

So, with Hashi's as the probable cause it is only a matter  of time until your levels drop further and you start having even more severe hypo symptoms.  Many doctors like to wait until a Hashi's patient gets to that situation before prescribing thyroid meds.  Other doctors like to start earlier in order to try and maintain the patient's thyroid hormone levels and prevent symptoms.  

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 you need to take care of the Vitamin D problem.  You need to make sure your B12 and ferritin levels are well up in their ranges.  And you need to find out if your doctor is going to be willing to treat you clinically as described above.  If not, then you will need to find a good thyroid doctor that will do so.
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Avatar_m_tn
Here were the results of my additional blood tests.  These seem to be in normal ranges.

FERRITIN - 101 ng/ml
VITAMIN B12 - 413 pg/ml
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Avatar_m_tn
Glad to see that your ferritin and Vitamin B12 are adequate.  Now your efforts need to be focused on the Hashi's.  There are two basic approaches to treatment.  Some doctors like to wait until test results are exceed range limits (especially TSH), and symptoms are overt, before starting the patient on meds.  Other doctors will start the patient on thyroid meds earlier in order to avoid the worst of hypo symptoms.  I know which one I would prefer.

So your issue becomes one of getting your current doctor to treat you clinically, as described above, or finding a doctor that will do so.  You need a doctor that treats patients, not lab test results.
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Avatar_n_tn
my wife recently detected with thyroid problem her T3 value is 3.29  pg/ml   and T4 value is 0.69  ng/dl    and TSH value is 25.21 microIU/ml  is there any problem with this value, some time she is suffring from back pain, weakness, bone pain and breathing problem weather this is because of high TSH value ,  weather any remidy on this deseases at present she is taking LETHYROX 50 Tablet once before breakfast , weather this tablet is sufficent to recover this problem. please guide which diet should we follow.
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Avatar_n_tn
my sons T3 VALUE IS 162 ng/dl   range is 60-200  and  T4  value is 13.3  range is  4.5 -12   micro gm / dl     TSH is 2.31 micro I U /ml   range is 0.3  -5.5  let me know weather he is having any problem with this reading
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Avatar_m_tn
It would be very helpful if you can give us the reference ranges  for the Free t3 and Free T4 tests results for your wife.  Since she is having some symptoms that can relate to thyroid issues, I expect that both Free T3 and free T4 may be too low in the range for her.  TSH is a pituitary hormone that is affected by many things, such that it is totally inadequate as a diagnostic by which to medicate a hypothyroid patient.  Also, be aware that TSH does not cause symptoms.  It is only a poor indicator of thyroid status.  Free T3 is the most important test, since Free T3 largely regulates metabolism and many other body functions.  Also, Free T3 has been shown to correlate best with hypo symptoms, while Free T4 and TSH did not correlate at all.

Also, since hypothyroid patients also are frequently  too low in the range for Vitamin D, B12 and ferritin, I suggest that she should be tested for those as well.

The whole point of thyroid treatment is to relieve symptoms.  A good thyroid doctor will test and adjust Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  

It was not clear if your wife's test results were from before starting the medication,  or after.   At any rate, her meds will need to be adjusted to relieve symptoms.  So you will need to get the doctor to agree with clinical treatment for symptoms, rather than just based on test results.

Each time she goes in for tests, you should make sure it includes Free T3 and Free T4.  Also should find out her levels for Vitamin D, B12 and ferritin.  If you will get those done and post here, along with their reference ranges shown on the lab report, members will be glad to help interpret and advise further.  
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Avatar_m_tn
As for your son, I see nothing in those test results to be concerned about.  Was he having symptoms that caused you to get him tested?
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Avatar_n_tn
regarding my son he studing in std 3rd and his weight is 35kg but i never seen him complaining about tirdness or bones paining and i not realise any change in his sound because of T4 value is 13.3 and range is 4.5 - 12 micro gm /dl i think this value is slightly higher i would like to know weather this value affect for his weight gaining or he is normal doctor says not to worry, my wife thyroid report are as follows    free T3 3.29     RANGE  1.4 -4.4 pg/ml, free T4  0.69  RANGE  0.8 -1.8 NG/DL  ,  TSH  25.21  RANGE  0.45 - 4.5 micro IU/ml  i would like to know  weather above  value affect to her body symptoms which i already explained on my previous question and let me know LETHYROX 50 tablet is sufficient  for solved out this problem  or should i think about homeophathy medecine please guide me in this connection
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Avatar_m_tn
I agree with your doctor regarding your son.  Your wife's Free T4 level needs to be increased to around the middle of the range.  The Lethyrox 50 is a step in the right direction.  After she has been on that dosage for about 6-8 weeks, it would be good to go back and test again to see the result, and see if she needs to increase dosage.  While there I would also recommend that she should be tested for Vitamin D, B12, magnesium, ferritin, and a full iron test panel.  

When test results are available, please post them along with reference ranges, and members will be glad to help interpret and advise further.  
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Avatar_n_tn
thanks for your valuable guidence for me , i definatly send my wifes test result after 6 - 8 weeks
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Avatar_n_tn
My tsh is  5.8
Tpo  116.9
T3   2.75
T4   .72
I did at 1 time have graves disease, had to have radiation. Was put on synthroid for about 16 years and then my t4 was just over line on high side and t3 was over line on low side. So found Dr that finally put me on armour thyroid and feel much better, but levels are saying I'm hypo but I am gaining weight like crazy even though I eat healthy. What is going on with me
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Avatar_m_tn
Assuming those are Free T3 and free T4 results, what were the ranges shown on the lab report?  Do you have symptoms besides the weight gain?  Have you been tested for Vitamin D, B12 and ferritin?  If so , please post those as well.
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Avatar_n_tn
D is good, b12 is high and iron is very good, free t4 range is .7-1.48, free t3 1.71-3.71,tsh is .35-4.94, too is 0-34
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Avatar_n_tn
Other symptoms are hair falls out can't stop gaining weight, very little to almost no body hair, eye lashes fall out, sleepy all the time, no sex drive not to mention just feel numb in that area. I now have developed 3 bulging disks in neck, with moderate degenerative disk disease. It's like my body is being attacked. Can a person have 2 autoimmune thyroid diseases years apart. Had graves disease and now can this be hashimoto
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Avatar_m_tn
Please post the actual results for D, B12 and iron.  

From your test results you are still hypothyroid.  Even though the results are within the so called "normal" ranges that does not mean they are optimal for you.  The ranges are far too broad due to the erroneous methods by which they are established.  

A good thyroid doctor will treat a hypothyroid 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.  You can get some good insight from this link  written by a good thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html

In the link note the following.  "Thyroid tests must be interpreted in relation to the patient's symptoms. The FT4 and FT3 tests must be interpreted in relation to each other. A relatively high FT3 may compensate for a relatively low FT4. If the FT4 is below the middle of the 1 to 1.6ng/dL range, the FT3 should usually be greater than 3.5pg/ml to assure thyroid sufficiency (range 2 to 4.4pg/ml)."  Clearly your results are less than optimal, so you are having hypothyroid symptoms.  
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Avatar_n_tn
What is a good range for the tsh, tpo, ft4, ft3 in order to drop the 40lbs I have gained in about the last 2-3 months
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Avatar_m_tn
TSH is basically a useless test when already taking thyroid hormone.  So ignore TSJH.  The TPO test is meaningless when you don't have a thyroid gland.  So ignore that.  The important tests are the biologically active thyroid hormones, Free T4 and Free T3.  The following is a quote from the good thyroid doctor.

"in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT."

In addition since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, those need to be optimized also.  D should be 55-60, B12 in the very upper end of its range and ferritin should be 70 minimum.  How do your results compare to those levels?
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Avatar_n_tn
B-12 1999
Folate 10.7
Ferritin 29
D 48
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Avatar_m_tn
The B12 is higher than needed.  If supplementing, reduce the dosage.  D is a bit lower than optimal, so you could supplement with 1000 IU of D3 daily.  The worst is your ferritin.  It needs to be 70 minimum, so you need to supplement with a good form of iron to optimize.  Here is a quote on that.

"Iron deficiency

Iron deficiency is shown to significantly reduce T4 to T3 conversion, increase reverse T3 levels, and block the thermogenic (metabolism boosting) properties of thyroid hormone (238-242). Thus, iron deficiency, as indicated by an iron saturation below 25 or a ferritin below 70, will result in diminished intracellular T3 levels. Additionally, T4 should not be considered adequate thyroid replacement if iron deficiency is present."

So, in addition to supplementing as mentioned, you need to further increase your thyroid dosage to get your Free T4 up to middle of its range, and Free T3 in the upper end of its range.  By the way, to avoid false high results when taking T3 meds it is best to defer the morning dose until after the blood draw for tests.  
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Avatar_n_tn
It's funny about the iron with me, a Dr told me years ago that I need to donate blood because my iron was high. I found out later all they ever checked was my hemoglobin levels and it was always on high side so they assumed my iron was high. It's sad that I had donated for several years and I had finally got to the point of being really sick and not knowing why. So another Dr checked my complete iron levels and it come back that it was 2 and my hemoglobin was 16.1. He put me on an alert, that was about 8 months ago.
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Avatar_n_tn
What would cause no longer having the flight or fight syndrome when being in situations that should trigger it. I use to experience it when placed in those positions. I haven't experienced any of those feelings in over 2 years. I asked endo Dr and I was brushed off.
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Avatar_m_tn
That feeling is usually associated with the adrenal function.  If you get your levels optimized and start feeling good again and still notice the same thing then you could try to get a diurnal saliva cortisol panel of 4 tests taken at different times during the day, and see where your results fell compared to the range. .  
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Avatar_f_tn
I have been going back and forth with Drs. for almost 3 months due to abnormal Thyroid tests. I was leaning toward Hyperthyroid, but my last test showed possibly Hypothyroid.
My Drs. are saying they think I have temporary Thyroiditis, and they do not want to give me Thyroid medication until they are sure it is not going to correct itself.
They believe the cause is the Contrast used from the 12 CT scans I had earlier this year due to a botched Gall Bladder surgery. I ended up with Sepsis and hospitalized for 6 weeks.

My most recent results:
TSH 19.6 (.40-4.50)
Free T3 2.3 (2.3-4.2)
Free T4 .8 (.8-1.8)
Thyroid Peroxidase Antibodies 661 (.0-8.9)

I feel like I've been run over by a truck most of the time and am growing tired of waiting this out. Main Symptoms include: lost about 1/2 my hair, extreme fatigue, overall achy, brain fog/forgetful, higher than normal blood pressure.
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Avatar_f_tn
Your current labs are clearly hypo with both FT3 and FT4 on the floor of the range and TSH elevated.  

Your TPOab indicates you have Hashimoto's thyroiditis.  It's not unusual in early stages of Hashi's to swing from hypo to hyper, but you will settle into total hypo at some point.

With your TPOab, I don't know why they haven't diagnosed Hashi's and are thinking any kind of temporary thyroiditis.  You should be on meds.
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Avatar_f_tn
That's what I was thinking.  The Dr. is saying he doesn't want to put me on medication because it is a lifelong medication, and he thinks my thyroid problem will eventually correct itself.  

I don't have much faith in Drs. though, since earlier this year I had to endure one medical mistake after another while hospitalized. Came close to losing my life because of numerous mistakes.  

This is my 2nd Endocrinologist, the first one was worse.  I have an appt. with a new one, but he is booked for another 6 weeks. Hopefully he is worth the wait! In the meantime, I take lots of vitamins now, hoping something will give me some energy. Not sure what else to do
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Avatar_m_tn
I agree with goolarra.  Your labs and symptoms are those of Hashimoto's Thyroiditis, which is not going to disappear as the doctor would like.  

I felt the need to point out that being and Endo does not guarantee a good thyroid doctor.  Many specialize in diabetes, not thyroid.  Also, many have the "Immaculate TSH Belief" and only pay attention to TSH test results, which does not work for the patient.  Others that go beyond TSH usually use "Reference Range Endocrinology" and will tell you that a thyroid test that falls anywhere within the range is adequate.  That is very wrong.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve hypo symptoms.  Symptom relief should be all important, not just test results.  

I would not want to wait for 6 weeks only to find out that the Endo is not a good thyroid doctor.  If you will tell us your location, perhaps we can suggest a doctor that has been recommended by thyroid patients.
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Avatar_f_tn
Thank you gimel and goolara for your info.  The 2nd Endo Dr. I went to ordered another blood test this week.  When I saw him 2 weeks ago, he said next appt. in 6 weeks, and I pretty much demanded another blood test sooner so it's this week - even though I have to wait 4 more weeks to see him (not planning to return to him).  But I could only get him to test TSH & Free T4, even though I also wanted Free T3, Vit D & Iron panel at a minimum... It's very frustrating!  As if being sick isn't enough aggravation.

One thing he said was confusing. Last time I tested TPOab, it was approx 450. When he ran the last labs, he didn't check the form to test it again so I got the lab to check it for me.  It was 661 on that test 2 weeks later.  The Dr. said it didn't need to be tested again because when it's positive, it's positive so a follow up test isn't needed.  I didn't think to ask, but if that's the case, does that mean this is a permanent problem and not temporary? I'm getting mixed messages.

I live in Las Vegas on the west side, but will go to where ever in the Metro area for a good Dr.
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Avatar_m_tn
Sent you a PM with info.  To access, just click on your name and then from your personal page, click on messages.  
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Avatar_f_tn
Thank you for your help.
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Avatar_m_tn
You are very welcome.  Sorry I overlooked answering your question about the TPO ab test.  Having those antibodies, along with your symptoms, and your other blood test results is conclusive that you have Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously determines the thyroid gland is foreign to the body and produces antibodies to attack and eventually destroy the gland.  Along the path to total destruction the output of natural thyroid hormone is gradually diminished and has to be replaced by increasing doses of thyroid med in order to prevent hypo symptoms.  So this is not a temporary problem.  You will need that good thyroid doctor to help with your treatment.  
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Avatar_n_tn
Female,age42, total testosterone is
21.06 (5.2-69.2)
Test free .15 (.04-1.8)
Test bioavailability 4 (1.2-43.5)
Test % free .7 (.63-2.65)
Shbg 114 (16-125)
I have 0 sex drive and have also posted earlier that I am hypo and in process of bringing levels up. My cortisol from blood at 4pm was 6.3 (2.9-17.3) I am usually ready to go to sleep
Could bringing these levels up help with these issues
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Avatar_f_tn
I had bloodwork done yesterday, and you are right, it isn't getting better.

TSH 21 (up more)
Free T4 .8 (same)

So the Dr. decided to give me meds finally. I'm still going to find another doc though.  Thanks again, Lisa
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