How can my TSH vary so much?

Hello,

I wonder how may TSH can vary so much if it is a 1-2 month average?

05/31/12 Doc Blood Draw, TSH = 1.76 uU/mL
10/26/12 ZRT Blood Spot, TSH = 3.7 uU/mL, T4 = 3.2 H ng/dL
11/21/12 Labcorp Blood Draw, TSH = 7.0 H uU/mL, T4 1.36 ng/dL
12/11/12 Doc Blood Draw, TSH = 2.85 uU/mL
12/19/12 Labcorp Blood Draw, TSH = 4.21 uU/mL, T4 = 1.62 ng/dL

My CRP is 4.4 H mg/L on 11/21/12.   My blood spot cortisol was high on 10/26/12 and my saliva cortisol was OK at morning and daytime but moved to high end at night of 0.9 ng/ml.  Usually on waking my blood glucose is around 105.  Another forum doctor is saying most likely my adrenal is the issue causing my thyroid to vary production.  TIA, Jack

[jack853]

My saliva cortisol test was taken on 12/4/12 and my Free T3 has consistently tested OK.  I feel fatigued, brain smoldering, irregular bowel, some skin inflammation on left hand, left ear, mark below stomach that is a bit flaky and not healing.  No antibodies for thyroid of note either.

[FTB4]

Request a Free T3 and Free T4 from you MD, he should not be relying on TSH in the first place, TSH is a Pituitary Hormone, The T3 is the most important draw he should do, as it is the actual hormone your body runs on. Based on out dated ranges your TSH may look OK but in a real world a TSH of 3.7 would indicate a possible Hypothyroid issue. If you get these labs,or have had them, please post results along with the ranges provided for each.  Good Luck FTB4

[jack853]

My doc is a TSH'er.  Labcorp Blood Draw via DirectLabs.com on 12/19/12 was FT3 = 3.4 pg/mL Range 2.0-4.4, FT4 (Direct) = 1.62 ng/dL Range 0.82-1.77

[FTB4]

Your Free T3 is at a good level,and so is your Free T4, Unless your levels are jumping back and forth, the labs were perfect at the time of the draw, Have had your Calcium levels checked? Just guessing at this point, maybe parathyroid, calcium level would tell. Possible other members could offer thoughts and advice. Best Regards FTB4

[jack853]

My calcium level tested fine 5/31/12 at 9.1 mg/dL (I take 'Now Foods' Calcium Citrate and Magnesium Citrate and Potassium Glutamate, all powders for last two years).  

On 11/21/12 my DirectLbas/Labcorp TSH = 7 H, FT3 = 3.4, and FT4 = 1.36
On 10/23/12 my ZRTLabs (blood spot) TSH = 3.7 H, FT3 = 3.8, FT4 = 3.2 H.

Started to feel bad after a 4/111/12 virus that took over a month to get over and never got back to normal (why I scheduled my 5/31/12 physical where my doctor pronounced me OK).  I have gotten worse since then.

[FTB4]

Did they happen to mention what the virus was? And a High Calcium level (Over 10.2 would indicate parathyroid) but yours is fine, most good levels average in the 9's   FTB4

[jack853]

Did not know what the virus was.  Blood tests did not indicate an infection on 5/31/12.  It started shortly after visiting a bar grill outside Wrigley Field on 4/11/12 where the waitress did not look very healthy.  I am pretty sure it was from her since my friend who lives down south (and we only met for two days for the baseball game) got the same symptoms and his family as well subsequently (very virulent).  It started as a sore throat then went into chest, then congestion, then stuffed up nose then massive ear ache then obvious symptoms went away but my energy was sapped and never really recovered.  On 5/31/12 I usually started to feel good after 2 pm.  Then it after 4 pm, then 6 pm, then 8 pm, then very rarely.  

[Barb135]

A couple thoughts come to mind....... # 1, blood spot tests are often not accurate, and most doctors don't accept them.

TSH is a pituitary hormone that naturally fluctuates, throughout the day.  Fluctuations are caused by a number of factors.

The first thing I'd have to know is, whether or  not you have been diagnosed with a thyroid condition and whether or not you are currently taking a thyroid medication, such as a T4 or T3 med, or an anti-thyroid med.

I'm not familiar with DirectLabs, but it sounds like it might be an online site; I know ZRT is an online site.  Why are you doing online tests, rather than regular monitoring by your doctor?

Answers to those questions, will undoubtedly bring more, but we can work through the whole thing.

[jack853]

DirectLabs uses Labcorp a well respected whole sale lab that works with major hospitals for outpatient testing.  I went with DirectLabs because I wanted a double check on blood spot tests (and it is reasonably priced) and my regular doctor is resistant to advance thyroid evidenced by only testing TSH which is not even a thyroid hormone.   On my 5/31/12 physical I stressed I was not good but he said I was fine.  I now have my results from 'Thyroid Ultrasound = OK' and 'Adrenal Stimulation Test = OK'.  I am on no medications currently and have never been treated with hormones though I was taking Zyprexa (long story) and max'd out at 250 lbs and am now 193 lbs.  I still have some midsection visceral fat that I need to lose.  24 Hr Urine Toxicity test was OK except for Arsenic at 44 mcg/spec range 0-35.  I live in a big city so maybe the Arsenic is from the water?

[Red_Star]

"Despite the clear benefits provided by DBS [Dried Blood Spot] sampling, researchers are hesitant to adopt DBS methods for a number of reasons.

The first is unpredictability: quite simply, fear of the unknown.

The second reason is status quo bias: researchers are uncomfortable changing a method that is already working, even though greater efficiencies would result.

The third reason is data comparability loss: concern for a potential discrepancy between historic plasma data vs. new DBS (whole blood) data
in the middle of the drug development.

Finally, the lack of clear regulatory guidance: there is virtually no authoritative literature or FDA guidance on the subject of changing from a plasma model to a DBS model.

DBS technology has been used for over 40 years in a narrow range of blood sampling applications, primarily in screening for metabolic defects in newborn babies. DBS technology is gaining acceptance as a potentially superior alternative to traditional methods of sample collection, handling and analysis in pharmacokinetic and toxicokinetic studies for drug discovery and development. In situations where sample handling workflow has been optimized, DBS has the potential to be a faster, less costly and a more representative alternative to traditional methods for quantitative analysis of small molecules."

Tandam Labs - Boost Drug Discovery  Efficiency – Switching from Plasma to Dried Blood Spots

***

One study this year showed the morning median TSH in patients with subclinical hypothyroidism was 5.83 mU/L and in the afternoon it was 3.79 mU/L. The range of TSH circadian variability reached the level of 73%.  Measurements of TSH were done twice a day from 8 to 9 am and from 2 to 4 pm

Study: Sviridonova MA, Fadeyev VV, Sych YP, Melnichenko GA. Clinical significance of TSH circadian variability in patients with hypothyroidism. Endocr Res. 2012 Aug 2.

***

Excerpt from the book "Why do i still have thyroid symptoms? when my lab tests are normal" by Dr Kharrazian

"Hashimoto's Disease and "Normal" Lab Results

Jan - TSH 4.5
Feb - TSH 0.08
Mar - TSH 2.3
April - TSH 3.8
May - TSH 8.7
June - TSH 7.4
July - TSH 1.6

One reason hypothyroidism goes misdiagnosed is because a person with Hashimoto's can present with normal TSH. This graph illustrates the monthy TSH levels of a person with Hashimoto's who is receiving no treatment. As the autoimmune condition fluctuates, TSH levels vary wildly. Using standard lab range of 0.45 - 4.5 this person would fail to be diagnosed. During the month of March the patient's TSH even falls within functional range 1.8 - 3.0. That's why also testing for immune antibodies and evaluating symptoms and history are so vital."  

[jack853]

My Labcorp 11/21/12:

Antithyroglobulin Ab = '< 20' range '0 - 40' IU/mL

[flyingfool]

Please check out this site:

http://nahypothyroidism.org/

Under thyroid hormone transport heading along the left side of the web page.

Look especially under conditions that affect thyroid transport and diet and weight loss.  Bottom line is that when chronic weight loss or with significant weight loss (60 lbs I would qualify as significant) can have a marked effect on the blood serum levels of thyroid needed.  In other words it is as if your body is resisting thyroid and thus you need to have a considerably higher blood levels (than would otherwise seem reasonable in a "normal" non-medicated healthy person) in order to sufficiently meet your body's needs.

This in part, may explain why so many people are even if receiving medication are not taking a high enough dosage, and are thus being under treated.  The article lists several other conditions which also contribute to this situation and shows that TSH is almost completely useless.

In summary a person with these conditions will need to have lab results much higher than a person with a healthy thyroid in order to feel well.

This forum is filled with people who prove this to be true. And is the reason why the "better" target that seems to have been found to shoot for is to have their Free T4 in the MIDDLE of the range (50%) or slightly higher AND (that means in addition to) their Free T3 in the UPPER 1/3 of the range (66.7%).  While people not needing medication and perfectly healthy can feel fine much lower in the range.

This is why it is so important to find a Dr who doen't rely on TSH which is almost worthless. ANd also do not simply medicate to get you within the range of T3 and T4 as you will likely need to be at least mid range if not higher.  The Dr must go by symptoms and use the lab results as a guide.

Dosing starting low and SLOWLY working up until labs stabilize and symptoms are relieved is the ONLY sure way to go at this thing.

Unfortunately most Dr's do not do this.

[jack853]

Thanks for the post FLYING FOOL.   Note that I lost those 60 lbs over 4 years.

[jack853]

My TPO from ZRT Labs Blood spot was 14 IU/ml range 0-150.

[sravan_k34]

go for testosterone and free testosterone test..they may help u

[Barb135]

Your original question was "How can my TSH vary so much?"  I think the whole thing went off subject........ since you aren't on a thyroid medication and don't seem to have a lot of thyroid related symptoms, or do you?  Are you saying that you never did get better after you had the virus in May?  What symptoms do you actually have that might make you think you have a thyroid related problem?

As I noted in my previous post, TSH is a pituitary hormone, which varies greatly, throughout the day and is affected by numerous things. I'm curious as to why you had so many thyroid related blood tests in such a short period.

There's nothing wrong with using online websites for lab testing.... I've actually done it myself, when my doctor refused to test the FT3 and FT4.  The site I used, also sent me to LabCorp, which, as you say is a respected national chain.  I was merely curious as to why you used online sites.  I did, also, at one time have some blood spot tests and my doctor turned up his nose at them, saying they were not accurate, but it did prompt him to run the tests via serum.  

What are the reference ranges for the FT4 tests done  10/26/12, 11/21/12 and 12/19/12?  Ranges vary lab to lab and must come from your own report; particularly, when doing the blood spot vs serum.

A weight loss of 60 pounds over a 4 year period is not drastic; in fact, it's commendable........ I don't have that much to lose, but would be happy with losing just a couple........lol

Did you have a TPO test or TPOab test?  TPO is an enzyme necessary for adequate thyroid function.  The TPOab test is for antibodies that attack the thyroid and eventually render it incapable of producing hormones.  I'd suggest you get a serum TPOab test.

[jack853]

I thought TSH was supposed to be relatively stable over a short period such as 2-3 weeks.   I tested my thyroid because it seemed originally to be the possible problem and I mistrusted the blood spot technology based on what another doctor stated about it.   My regular doc only tests TSH and possibly T4.   He understands nothing about rT3/FT3 ratio for mitochondrial dysfunction.   My Liver, Lipids are fine and have a Zero CAC Score.  It looks like my ZRT Labs test was the TPO enzyme.   My stubborn midsection visceral fat may be the cause of my high CRP as that kind of fat is inflammatory.   Therefore I would really like to get energy issue fixed so I can get that off!

Now for explicit FT4 and related tests:

10/26/12 ZRT Labs Blood Spot (7:00 am, 30 minutes after wake):
FT4 3.2 H, range 0.7 - 2.5 ng/dL
FT3 3.8 OK, range 2.5 - 6.5 pg/ml
TSH 3.7 H, range 0.5 - 3.0 uU/ml
TPO 14 OK, 0-150 IU/ml (70-150 Borderline) * Experimental test
hsCRP 4.1 H, < 3 mg/L

11/21/12 Labcorp Blood Draw (~ 9 am):
FT4 1.36, 0.82 - 1.77 ng/dL
FT3 3.4, 2.0 - 4.4 pg/ml
rT3 17.4, range 9.2 - 24.1 ng/dL
T3 Uptake 33%, range 24 -39 %
TSH 7.0 High, range 0.450 - 4.500 uIU/mL
Antithyroglobulin Ab <20, range 0 - 40 IU/mL
hsCRP 4.4 H, 0.00 - 3.00 mg/L

12/11/12 ProHealth Care Blood Draw (noon time):
TSH 2.85, range 0.35 - 4.94 uIU/mL

12/19/12 Labcorp Blood Draw (check 12/11 test, ~ 10:45 am)
FT4 1.62, range 0.82 - 1.77 ng/dL
FT3 3.4, range 2.0 - 4.4 pg/mL
TSH 4.210, range 0.450 - 4.500 uIU/mL

[jack853]

11/21/12 Labcorp Blood Draw:
Testosterone, Total 538, range 348 - 1197 ng/dL
Testoterone, Free (Direct) 18.5, range 6.8 - 21.5 pg/mL

I assume once I lose the midsection visceral fat my Total Testosterone will increase over 700.  If I didn't post before I am a 44 year old white male of Northern European stock (75% Finnish, 25% German).

[Barb135]

"I thought TSH was supposed to be relatively stable over a short period such as 2-3 weeks."  No, TSH can vary greatly, even intraday.  Levels are higher in the morning and drop later in the day. Serum TSH is usually higher in obese people and can be higher in those recovering from a non-thyroid illness.  

http://jcem.endojournals.org/content/92/12/4560.full

The ranges for the blood spot tests are WAY to wide, while the ones from LabCorp look like what we see all the time.  Your thyroid tests actually look pretty good, except that in the 12/19 lab your FT4 is way at the top of the range, which may be okay, since you are unmedicated.

From what I understand, your main symptom is lack of energy?  There are many different things that can cause that, besides thyroid.  Have you had Vitamin B12 tested?  Deficiency can cause fatigue, as well as a brain fog and other things.  Left untreated, it can cause numbing/tingling of the feet/legs/hands/arms.

Vitamin D deficiency can also cause hypo like symptoms.  Iron/Ferritin deficiency cause tiredness and/or lack of energy.

And there's the "syndrome" I went through, which was believing that I should always have energy and should never get tired....... With the help of a very good friend, I finally admitted that anyone maintaining the schedule I did, with the stress I was under, would be equally as tired.

Everything has to be looked at.

[Barb135]

Forgot to mention that RT3 result is not really significant, in itself.  It's the ratio of FT3:RT3.