Is the THS test enough?

[Mimosa68]

Hi, I'm new to this forum. I have a question: when one strongly suspects their thyroid is out of whack, is the THS test a reliable one? I've been having several symptoms of hypo for months, with little bouts of hyper (I walk and walk, I almost need to run, I feel like doing things at home like cooking, organizing stuff, cleaning, I'm hyper when I talk, I almost feel "manic", like I drank 10 coffees). Then, after about 5 days of feeling hyper, with no transition I go back to feeling like a slug, I can barely get anything done, I sleep a lot...
My THS was at 4.03 on Oct. 31. Are there more tests I can run to get to the bottom of this?

[VitaminB12]

I'm sorry to learn of the rollercoaster effect you are experiencing.

I've learned that it is a good idea to get more than just your TSH checked. Recently I also requested Free T3 in addition to Free T4 because it was suggested through this forum. Some suggest including Reverse T3 which I didn't get the doctor to agree to recently because he doesn't know how to interpret the results!

I know I have hypothyroidism, but the doctor claims my TSH is just on the high side of normal, but this is according to the old school reference range here in Canada (it has been out of whack off and on for several years).  
Yet I continue to have some symptoms that are making me uncomfortable such as feeling cold, not sleeping well, dry sensitive skin, and feeling rather emotional/stressed/anxious. So I am trying to address it through diet, exercise, and stress management. I go for bloodwork on December 9.

[Mimosa68]

My physician gave me a paper to get a neck/thyroid ultrasound. Will try and get that done soon!

[summerluvr]

should add I did have hypo symptoms for a few years, but I just thought it was side effects from cancer treatment (long term fatigue, neuropathy etc)

[summerluvr]

II am in toronto Canada.

I had a neck ultrasound for another reason and the radiologist MD flagged my thyroid and said it looked characteristic of hashimoto's.

My doctor told me good news no sign of cancer (I am a cancer survivor), but looks like you have a thyroid issue. He ordered blood work which was positive for antibody slightly high TSH (4.0).  

Can you maybe request a neck/thyroid ultrasound? It is non invasive and quick, your dr. can give you a requesisiton and you can book your own appointment. Results come via your doctor though

[Mimosa68]

I will! Thanks again for all your help!

[gimel]

I would still get those done just to confirm one way or another.  And be sure to get the Vitamin D, B12 and ferritin done also.  

[Mimosa68]

Now that I figured out my TPO and anti-thyroglobulinare negative, do I still get tested for Free T3 & T4?

[gimel]

With symptoms you have mentioned, plus the erratic TSH results that are sometimes higher than should be, something is definitely going on.  I think it would be a good idea to follow the advice of Red_Star and goolarra and get all those tests done.  Since hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin, I suggest getting those done as well.  

Since you have to deal with the public health system in Canada, I know that can be a problem for you.  You can go with the private clinic and get all the tests done, but before spending the money, I suggest that you should find out if the doctor you will see is willing to treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, instead of relying on TSH to determine dosage.  Also should find out if the doctor is willing to prescribe T3 meds like Armour Thyroid and Cytomel.  If not, then you would be wasting your money.  

The other option might be to follow the advice from a UK member that faced the same obstacles with their NHS.  This is her description of how she was finally able to get the testing and treatment needed, through learning about hypothyroidism and the type of testing and treatment she needed, and above all, being very persistent.  

"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge.  You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid.  If you fight for what you want, you will eventually find someone that is happy to go along with your wishes.  But we all have to take charge of our own health, right?"

[Mimosa68]

I looked closer at my latest labs and I just saw this:

TPO: 2 (neg.)
Anti-thyroglobulin: 19 (neg.)

Does it mean I definitely do not have thyroid issues?

[Mimosa68]

I'm in Montreal (Quebec, Canada). I know a MD who is also a naturopath who might be able to help. He has a private clinic, so it will cost $$$, but what other choice do I have. The mainstream MDs in our public system only look at the TSH number.

I found copies of old labs, here are my numbers for the TSH:

2008: 1.35
2009: 4.13
2011: 3.24
July 2013: 1.64
October 2013: 4.03  

So something IS going on, right?

[gimel]

Obviously you need a good thyroid doctor that treats hypo patients clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Where are you located?  Perhaps we can give you the name of a doctor recommended by another member.  Then you won't have to just rely on getting a doctor to believe you.  

[Mimosa68]

Thank you both for your replies. I will get those tests done...if I can find a doctor willing to believe me!

[goolarra]

I'd just like to add that TSH is at best a screening test for people who are asymptomatic.  TSH is a pituitary hormone and several steps removed from the actual thyroid hormone levels, FT3 and FT4.  Ten or so years ago, AACE recommended that TSH range be changed to 0.3-3.0.  Labs and doctors have been very slow to make that change.  According to the 0.3-3.0 range, your TSH would be considered hypo.

When you get the results of the tests suggested above, you can post them, and we'll help you interpret them.  One doesn't necessarily have to be out of range on FT3 and FT4 to have symptoms.  If you'd like to post results, please include reference ranges as well as they vary lab to lab.

[Red_Star]

It's likely you have Hashimoto's thyroiditis. When I highly suspected I had this autoimmune disease, these are the labs I requested...

TSH
Free T4
Free T3
Thyroid peroxidase antibodies (TPOAb)
Thyroglobulin antibodies (TgAb)