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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?
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?
Best Answer
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.
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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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.