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Hypothyroidism blood test results. Do I need a second opinion?
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Hypothyroidism blood test results. Do I need a second opinion?

I went to the doctor today once again for the ongoing symptoms of hypothyroidism. I am always cold, my hair is falling out, I'm using the bathroom once a week, I am always tried (sleep around 10hrs a day), can hardly get up in the morning, I was even diagnosed with depression and take wellbutrin, but it does not help one bit. Also it is impossible for me to lose any weight. I went up from 145 pounds January 2013 to 160lbs March 2013. I am now 5'3 and 160lbs. The symptoms have slowly gotten worse and worse over the past 8 months. In July these were all my blood results:

Cortisol, AM (baseline)= 23.9 (lab range 5.0 to 25.0)
Testosterone, free serum = 0.86 (lab range is 0.06 to 2.57)
Testosterone, serum = 44.5 (lab range is 8.4 to 48.1)
Thyroxine (T4) = 8.5 (lab range is 4.5 to 12.0)
Thyroxine, free (RIA) = 1.22 (lab range is 0.83 to 1.62)
TIBC, Component = 322 (lab range is 228 to 428)
TSH = 3.330 (lab ranges are 0.270 to 4.2)

I noticed that their TSH range levels are not .3 to 3.0... should I look for another doctor??

ALSO, I complained that not enough tests were done before and requested some new ones.
These are the ones I got tested for today:

Anti-thyroglobulin Antibody, Serum
Anti-microsomal Ab (THY.PEROX.)
T3, Total
T3, Reverse, Serum or Plasma
T3 uptake
T3 Free, Serum
Thyroxine, Free (RIA)
Thyroxine (T4, total)
TSH

Should those be enough to get accurate results? or is something important missing? Should I get a second opinion?
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Avatar_m_tn
Your Free T4 was right at 49% of the range.  Which is pretty good. But clearly you have hypo symptoms.  The addition of the Free T3 test is going to be most interesting.

I would recommend that you also get tested for Vitamin D3 and Vitamin B-12 as well as Iron and Ferritin.

All of these also if low in any one or more leave you very fatigued.

My guess and that is all it will be until you get back your labs is that I suspect you have a conversion issue.  That is you're not converting the ample Free T4 you have in your blood into the useable Free T3 that your body uses at the cellular level.

A conversion issue is determined by comparing the FT4 to the FT3 levels in terms of there reference ranges.  For example. Many people have found that they need their FT4 to be 50% of the range (which you are at or very nearly so) and also their FT3 levels will be 66% of the range.  The FT3 levels being HIGHER in the range than the FT 4 when there is plenty of FT4 avaoiable is what would indicate proper conversion.

It is not uncommon for someone to have this ratio flipped. That is their FT4 level in the range that is higher than the FT3 level.  Clear indication that a conversion problem exists.

If conversion problem exists, there are two ways to go.  One is to continue to raise the FT4 levels until the FT3 levels are raised enough to feel well. However this usually doesn't work as if you get your FT4 levels too high in the range people don't generally feel well either.  The preferred choice would be to add in a T3 medication.  SLOWLY with small increments.

You could also have your Selenium levels checked.  It is known that Selenium can help with conversion.  But it is a small boost and not a miracle cure.  Just an aid.

We'll be looking for your latest labs to help us help you for things to talk about with your Dr.
31 Comments Post a Comment
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1756321_tn?1377771734
Most labs still do not use the range 0.3 - 3.0 mU/L despite recommendations from the American Association of Clinical Endocrinologists (AACE) back in 2002. My TSH lab is 0.20 - 4.0 mU/L.

T3 uptake is an outdated test that should be replaced free T4. Total T3 measures the total amount of T3 [protein bound (unavailable) T3 as well as the free T3]. This test is not as accurate as free T3 as it can be affected by protein levels and protein binding ability. Eg: estrogen dominance can increase the amount of the protein that binds T4.

A clinical test is the myxedema skin pinch test. Look online to try this out. Myxedema is unique to hypothyroidism.
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1756321_tn?1377771734
Edit: T3 uptake is an outdated test that should be replaced by free T4.
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1756321_tn?1377771734
Double edit *sigh* lol Eg: estrogen dominance can increase the amount of the protein that binds T4 and T3.
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Avatar_m_tn
Your Free T4 was right at 49% of the range.  Which is pretty good. But clearly you have hypo symptoms.  The addition of the Free T3 test is going to be most interesting.

I would recommend that you also get tested for Vitamin D3 and Vitamin B-12 as well as Iron and Ferritin.

All of these also if low in any one or more leave you very fatigued.

My guess and that is all it will be until you get back your labs is that I suspect you have a conversion issue.  That is you're not converting the ample Free T4 you have in your blood into the useable Free T3 that your body uses at the cellular level.

A conversion issue is determined by comparing the FT4 to the FT3 levels in terms of there reference ranges.  For example. Many people have found that they need their FT4 to be 50% of the range (which you are at or very nearly so) and also their FT3 levels will be 66% of the range.  The FT3 levels being HIGHER in the range than the FT 4 when there is plenty of FT4 avaoiable is what would indicate proper conversion.

It is not uncommon for someone to have this ratio flipped. That is their FT4 level in the range that is higher than the FT3 level.  Clear indication that a conversion problem exists.

If conversion problem exists, there are two ways to go.  One is to continue to raise the FT4 levels until the FT3 levels are raised enough to feel well. However this usually doesn't work as if you get your FT4 levels too high in the range people don't generally feel well either.  The preferred choice would be to add in a T3 medication.  SLOWLY with small increments.

You could also have your Selenium levels checked.  It is known that Selenium can help with conversion.  But it is a small boost and not a miracle cure.  Just an aid.

We'll be looking for your latest labs to help us help you for things to talk about with your Dr.
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5095426_tn?1363544645
okay thank you for that information I am getting more of an idea from you guys than my own doctors! Ugh its so annoying because I feel like they have no idea what to do and what to test for and then I have no clue either and this is so important to me to get figured out I am becoming obsessed on the issue!
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5095426_tn?1363544645
Which one is Free T4? Thyroxine, free (RIA)?
I don't know the full names of Free T4 and free T3 and regular T3 and T4.  The information you gave me is so helpful and I am so grateful!!! but I'm wondering what should I be looking for in the results I'll be getting back the second time around?

Also do you have any other things you think are important to be tested for that are not listed the second time around? I am looking to get a second opinion and I want to make sure I am not getting cheated by my doctors.

I was tested for Vitamin D, 25-hydroxy is that the same? That was a 43.6 (range is 32.0 - 100.0)
Also my Sodium was 134 (range 133 - 145) Sorry I don't know if that's relevant.
Vitamin B-12 was 353 (range is 211 - 911)
ferritin was 18.... (range is 10 - 291)
Anti-microsomal ab (thy. perox) was a 14 (range is - <35)
antinuclear antibody (fana) was negative (range is -Neg=<1:80)
Anti-thyroglobulin antibody was <20 (range is -<or=40)

Sorry I would of posted these sooner but I had 4 pages of tests done and I did not notice them till now.
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5095426_tn?1363544645
Are there any other tests that would be important? I can check the 4 pages of results and see if I can fish it out! lol
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649848_tn?1357751184
Free T4 is the same as the Thyroxine, Free. Free T3 is also sometimes reported as Triiodothyronine, Free.  It's much easier to refer to them as "T's" rather than their complete, formal names. The frees are much more reliable because they measure those hormones that can be used by the body (T4 to be converted or T3 to be used by the cells), whereas the Total T3 and Total T4 measures all of each hormone, when not all can be utilized, since some is bound by protein and can't be used.

Your ferritin, Vitamin D (Vitamin D, 25-hydroxy) and B12 are all too low, even though they are within the ranges. Ferritin should be at least 70, Vitamin D should be between 50-80; preferably closer to 80 and B12 should be near the top of the range, though many doctors feel that "in range" is good enough.  Many of us don't function well with levels that low.  Has your doctor suggested that you supplement them?  
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5095426_tn?1363544645
No my doctor said that everything is within range and sent me home to deal with my symptoms. :(

He did not go over any of the results but just looked at the computer to see if any of these tests were highlighted in red (indicating a problem) =/ What happens when those things are low? Would they mimic hypo or does it cause hypo? or something else?
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5095426_tn?1363544645
also my colesterol was at a 100 (range is - <100)
Iron was 42 (range is 30-160)
Platelets at 359 (range is 144-400)

Im not sure if those are of any use either :(
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4939681_tn?1361302899
It's really good that your antibodies were negative!  That's one sigh of relief you can take:)  I found an endo that is willing to treat within the newer ref. range that Red Star commented about.  So your TSH being above 3, she would've treated your hypo symptoms with thyroid replacement meds.  Also, this (fresh on my mind because it was brought up in another post) may be of little help, but may offer you some albeit small relief until you find better treatment... you mention that you are only going to the bathroom once a week (definitely, a hypo symptom) and your sodium is low as well as your iron.  What does your chloride level look like?  If it is low, too you may be suffering a bit from low stomach acid (hypochlorhydria) causing constipation, bloating, tightness in stomach.  There are many homeopathic remedies for this and your body will be able to process those vitamin supplements mentioned above to relieve a lot of those hypo symptoms.
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5095426_tn?1363544645
Where do you live?!!? I need to find someone who will actually look deep into my results and see what the problem is, not just look and wait for a computer to say something is out of range!

My chloride is 100 (range is 96-108) I was diagnosed with IBS for my constipation and told to drink meralax or prune juice or Metamucil but all that did was make the situation worse. Half the time I just never feel like I even have to go, its like I don't even own a digestive track =/ and when I do get that "urge" which is like once a week that's when I become constipated. I can't pass it even though I feel like I have to go. Sorry if this is getting too gross! But with the supplements (miralax, metamucil, prune juice, etc) it just made me gassy and made my stomach hurt all the time (up to a point I cant move or get up) and it would be days of this pain before I can pass anything and then I'm back to feeling nothing for days, until I retake the stuff and then its a cycle of pain and suffering all over again. =/

For every hypo symptom the doctors sent me to different doctors for each symptom. For the extreme hair loss I got send to the dermatologist, for the constipation I got send to a gastrointestinal specialist, for the weight changes and heavy painful periods I got sent to a OBGYN doctor, for the tiredness and moodiness and depression I got sent to a Psychiatrist.

Like come on, anyone would see this is crazy for me to have 5 different things wrong with me. I am 99.9% sure it is all linked to one thing. :(
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649848_tn?1357751184
Iron is necessary for production of thyroid hormone; ferritin is an iron storage hormone, yours being low indicates low iron stores; your results bear that out.

Vitamin D deficiency can cause hypo-like symptoms.  Vitamin B12 deficiency can cause the most unreal exhaustion you've ever known, and if not treated can cause tingling, numbing, pain the feet and legs.  Vitamin B12 deficiency doesn't mimic hypo symptoms (other than the fatigue), but many people who are hypo, are also deficient in B12.  I take weekly shots to keep my levels up because I have Pernicious Anemia, which means I don't absorb B12 from pills or food.  

High cholesterol can be another hypo symptom.

When I was really hypo, I had to take a stool softener to help relieve the constipation. Something gentle such as Senekot S or Phillips Stool Softener is best.  Make sure you drink plenty of water.  Exercise also helps.  Magnesium supplements help some people; magnesium also helps with joint/muscle aches/pains.

It's unfortunate that you got sent to so many doctors, when all your symptoms point toward hypo.  You may have to start looking for a different doctor unless you can get one of those doctors to let you try a trial of thyroid replacement.
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5095426_tn?1363544645
The crazy thing is those tests were done in the summer time, during a time I was at the beach 2-3 times a day and getting plenty of sun, I drink a cup of OJ in the morning almost everyday, and I include Skim Plus into my diet. I also take B12 supplements (1000mcg) because I was told it can increase energy but with those results it's as if I do nothing! I already am looking for a different endo doctor, a friend of mine recommended hers so I will see if they accept my specific insurance =/ if not I am stuck with these clinic doctors that don't know what they are doing :( I will see an endo doctor at my clinic on april 9th. But he also just glanced at my results and said everything is "normal" when it clearly isnt. After seeing how his appointment goes (I will try to point out a few things in my results) depending on how he reacts I'll ask him for a trial, if not I'll ask him for a referral to a thyroid specialist, hopefully he will give it to me...
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4939681_tn?1361302899
LOL!!!  It's uncanny!  The way you describe your constipation is EXACTLY verbatim what I told my GI.  I don't have to go and it's not normal to not have to go... where is all of this food going if it's not coming out???  When I prepared for my colonoscopy, I only had to drink a couple of glasses of the 1 gallon laxative solution before I was passing clear watery fluid AND I'm a moron and forgot to stop eating 12 hours before drinking it, so that was after eating 2 meals.  So weird!  Your chloride is about the same as mine, low normal.  I'm so sick of being on the low end and high end of normal, I could scream!!!  I, too, take the B12 (1000mcg) and the iron + vit.C and Vit. D, yet all the symptoms are still there.  No relief!  I have a new theory after reading about all of this digestive stuff (not only hypochlorhydria, but also leaky gut, which both have to do with thyroid symptoms: causing them or as a result of them).  I wonder if these vitamins/minerals aren't being properly absorbed in the gut because of low stomach acid.  Maybe, just maybe, if I fix my stomach/gut the vitamins/minerals may actually have an affect on my symptoms and provide a little relief.  At this point, I'm ready to guinea pig myself just to see.  My thyroid issues aren't going away (I was positive for the thyroid antibody tests), so I may as well try anything that provides relief.  I have seen ALL of the specialists too and I have yet to convince them that all of my symptoms point directly at my thyroid.  Idiots!  

Anyway, I live in between DC and Baltimore.  If you are close by, I would definitely recommend giving my latest endo a try.  With your numbers, she would be able to try to help you.  If you aren't near, post a question about recommended endos in your area.  Someone on this forum has a list of endos in different locations that others have recommended and treat symptoms not based on the ref. range.  
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649848_tn?1357751184
Strange as it sounds, I sometimes found that my acid reflux would get better if I drank a little bit of dill pickle juice or a few ounces of water with a tablespoon of vinegar and teaspoon of honey.  It's true that sometimes, the problem is not enough acid, rather than too much.  

I was on aciphex for several years for my reflux, but sometimes it just wouldn't touch it.  Omeprazole did nothing.......  pickle juice or vinegar water would sometimes settle it.  

Also try raising the head of your bed about 3-4 inches; that helped me, too because it kept the acid from refluxing as badly.

Oh, one more thing -- OJ was/is one of the biggest offenders when it came to acid reflux for me.  Even today, I rarely have the acid issue, but OJ will do it every time. I no longer drink it, though I can occasionally eat an orange, with no trouble.
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4939681_tn?1361302899
Yes, OJ is the worst with acid reflux for me!   I don't drink it anymore either.  And now that you mention it, my husband said something about apple cider vinegar and I know I've seen it on one of those "low stomach acid" websites. Maybe I'll give the pickle or vinegar a try today.
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649848_tn?1357751184
As with everything, both the pickle juice and vinegar must be used with caution and there's no guarantee that will  make a difference.  Sometimes when I would try them, it would seem for a while to make things worse, but it usually helped after a while.  

BTW - apple cider vinegar is also supposed to help boost metabolism; haven't tried it for a long enough length of time to know whether it's true or not.  From what I can see -- all things in moderation.
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5095426_tn?1363544645
I totally agree with the part where you say where does all that stuff go lol. I ask myself that all the time, its like my body absorbed it all lmao. Looking at the test results it seems my body does not absorb vitamin D or b12. I was recommended to get b12 SHOTS, so I might ask about those. But I don't want to focus in on just one thing and have all the other million symptoms... I wan't all the things to get better. But right now I'll do anything even if its to feel a little more better, I just wish I had excellent doctors who can read my results and tell me what could be the cause, even if its in the range, because like you said, we might be in the range but we are in the low end of it or the high end when its suppose to be reverse... I am in the process of looking for a new  doctor that will really look into the problems. I will keep everyone posted, especially after the new test results, any changes in that could really help zero in on the problem when compared to the old results. Unless the new results are exactly the same as the old results! Then I'm getting no where once again!
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5095426_tn?1363544645
I love dill pickle juice so I have no problem drinking that stuff! I will try that apple cider vinegar. So 1 tablespoon in a 8 oz water with 1 teaspoon of honey? once a day or every time you drink water? does it taste good at least? sometimes I'm forced to drink stuff that is disgusting to "help me", but if its disgusting who wants to keep drinking it!
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5095426_tn?1363544645
OJ is one of the worst things to drink, I agree, I can always feel it coming back up, but I LOOVVEEE OJ, like I really do, I have to have it everyday, even if its a few sips here and there. I don't like any other juice, no apple juice, no cherry, no cranberry, so OJ is my juice go-to
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Avatar_m_tn
I have also read that acid reflux is a result of too LITTLE acid in the stomach.

And the natural reaction for a person with heart burn is to take by the hand fulls antacids. Which only make the problem worse, not better.

The way I heard it described was that the top valve on the stomach responds to the amount of acid in the stomach. With a lot of acid the valve closes tight. But with low acid the valve relaxes and leaks or opens up which allows some of the acid in the stomach up into the esophagus. And thus the burning and the term reflux which means to flow back or return.

I think most acid reflux medicines are to cause that top valve to tighten up so that it doesn't leak. But why wouldn't they treat the cause and not the symptom?

It seems like all of this is big Pharma conspiracy. They can sell all sorts of prescriptions for Xantex or prilosec etc.  Or a person could drink pickle juice or take a few table spoons of apple cider vinegar and solve it.

Similar for Thyroid. Why prescribe ONE cheap thyroid medicine which would solve 20 symptoms when they could have 20 prescriptions to cover the 20 symptoms.  They make MUCH more money selling as many prescriptions as possible.  Just my opinion and my rant that I have to get off my chest every now and again.
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5095426_tn?1363544645
I totally agree with you! Not only the the pharmacy part but beyond that. Instead of visiting just ONE main doctor that can treat all the symptoms that point to thyroid (or whatever it is), they are allowing their buddies to make money by using a gastroenterologist, a dermotolgist, a obgyn, a psychiatrist... list goes on. Then Im stuck using 10 different medications for all sorts of different stuff, and its not helping anyway!
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649848_tn?1357751184
When I drink the vinegar, water, honey solution, I only do it when I have the reflux.  I'm afraid if you drank it every time you drink water, you'd overdo in a hurry.  All you're trying to do is add a bit more acid to your stomach.  I don't think it tastes horrible, but then I like vinegar and honey.  All you need is a few ounces of water.  Experiment a little bit; try a little less vinegar, etc.  

And there's no guarantee that it will work because it's almost impossible to tell whether your reflux is caused by too much acid or too little.  I used to try either the vinegar (works best in warm water) or pickle juice, if my reflux med wasn't working.  If adding extra acid didn't help, it was back to the med.

On the rare occasions that I get acid reflux now, I find that Gaviscon works better than most meds to settle it down.

Best thing to do is get your doctor to help you get thyroid levels right and you won't have these issues nearly as much.
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5095426_tn?1363544645
okay cool, thanks for the help! Any tips how to deal with chronic constipation? haha
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649848_tn?1357751184
I take an enzyme supplement that helps both digestion, which, in turn helps constipation.  I've also read that some people use probiotics.  You could try yogurt, but  make sure it has live cultures.

Also, as I mentioned a couple days ago, further up in this thread:  "When I was really hypo, I had to take a stool softener to help relieve the constipation. Something gentle such as Senekot S or Phillips Stool Softener is best.  Make sure you drink plenty of water.  Exercise also helps.  Magnesium supplements help some people; magnesium also helps with joint/muscle aches/pains."  

Also make sure you get plenty of fiber in your diet, but not too close to taking thyroid med.  Veggies (broccoli, spinach, cauliflower, etc) are awesome for helping to alleviate constipation, as are apples (with the skin) and pears. You get all vitamins/minerals plus the filling fiber.

Be careful with laxatives, because it's easy to become dependent on them.
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4939681_tn?1361302899
Stool softness did not work for me bc, again, it's like my body just isn't producing any stool to soften.  I do take probiotics and it seems to make a difference, but not with the relieving constipation.  I actually pass mucous in my stool as though the probiotic is pushing bad bacteria out.  It makes sense since my colonoscopy was "abnormal with minor inflammation in the small intestine due to bacteria or food allergy".  My GI guessed food allergy, mainly celiac, which after extensive test came back normal.  Think he guessed wrong and it's bacteria, and probiotics should take care of it since it was "minor".  In all seriousness as nasty as it tastes my morning shot of lemon juice and olive oil is helping with the constipation/stool production so far.  I''ve also added a salad to my lunch routine, so the raw leafy greens help too!
I am profoundly outraged by the number of specialists that I've seen in the past year!  Though skeptical I bit the bullet in desperation today and saw a holistic md.  He reviewed everything extensively and knew all about thyroid illness and the plague of the unreliable reference range.  He said all that matters to him is that I FEEL better.  He also HATES antidepressants. He said that if someone is "depressed" and there has not been a recent life altering loss then depression must be treated as a medical symptom and not the cause!  I left with a long course of antibiotics (my lymph system has gone crazy/ painful and swollen lymph nodes galore) AND more importantly Naturethroid!!!!!!!  He wants to help me, but my lord was he expensive!  Desperate people have to pay.  So unfortunate!
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4939681_tn?1361302899
I've been wanting to add a digestive enzyme to my reframing.  Is there one that you recommend I look for?  Thanks!
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649848_tn?1357751184
The enzyme I use is Super Enzyme Caps, made by Twinlab.  It works well for me, but that's not to say it will work for everyone and you might want to talk to your doctor prior to taking supplements.

I get them at The Vitamin Shoppe, but I'm sure you can get them other places, as well.  Cost is around $15 for 50 capsules.  

I'm glad your doctor appointment went well.  Most holistic doctors are expensive and most don't take insurance. Did he do additional blood work?  Do you have copies of the reports?

Hope the NatureThroid works for you.
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5095426_tn?1363544645
New test results came in, need help deciphering?

Anti-microsomal ab = 21  (-<35)
Anti-thyrogloblin antibody, serum = <20  (-<or=40)
T3 free, serum = 3.3  (2.5 - 4.3)
T3 Uptake = 25.0  (24.3 - 39.0)
T3 Reverse serum = 294  (90 - 350)
T3 total = 143  (80 - 200)
Thyroxine (T4) = 10.3  (4.5 - 12.0)
Thyroxine free (RIA) = 1.20  (0.83 - 1.62)
TSH = 2.94 (0.270 - 4.2)


TSH decreased from 3.3 to 2.9
Still very symptomatic.
6 lbs weight gain from two weeks ago.

Doctor is now doing tests for cushing syndrome. Says there is no way I'm hypo.
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Avatar_m_tn
what are your calcium and serum calcium levels?
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