Lab results in - please help

[thethinme]

Hello all, I've been waiting for a month, but here are my lab results. For reference, I put the previous one from last month below.

MyPCP called me to give me the results. She was really happy as she said that my TSH went down, and therefore is "normal", and I won't be needing to take medication. I pointed out that the American Endocrinologists Association lowered that reference range number to 2.5-3 but it didn't really affect her opinion. She said IN CASE I want to get pregnant, I should contact her as it's better to be in the 1.5-2.5 range. (hmm if the body feels better for pregnancy at that range, wouldn't it make sense that overall I would also feel better in that range??? lol.) oh well.

She said she knows I have symptoms and pointed out that if they continue, I should come see her.

I said I would like to hear a second opinion, go to an Endocrinologist etc and she said she could recommend one from her practice group. I agreed, although I am going to see another one I chose from bestdoctors.

Good news is she says all my antibodies are negative.

So, what do you guys think of my labs? Any good advice? From a first look is very clear that FT3 needs to be upped if I want to stop having symptoms. Seems the lab did not perform the Free T4 this time, as my TSH is "normal". argh.

Also, is it normal for TSH to vary this much even though I am not on meds? Does it mean something? I think I tried to avoid thyroid problematic foods this month and things I read that are not good for thyroid patients. Maybe that's why it went down?

Will see my new thyroid doctor on the 26th, wonder if he'll redo ALL exams and if my insurance will pay for it AGAIN, lol.

Thanks guys!

--

MARCH 12 2012 lab:


Tests: (1) TSH W/FREE T4 RFX (43562A)
! Send Out                  "Result Below..."                            *1
      RESULT: Sent to reference lab.
  TSH                       3.88 MIU/L                  0.40-4.50        *2
  
        TSH REFERENCE RANGE:
         FOR PREGNANT PATIENTS:
          FIRST TRIMESTER         0.20-4.70 MIU/L
          SECOND TRIMESTER        0.30-4.10 MIU/L
          THIRD TRIMESTER         0.40-2.70 MIU/L

Tests: (2) Total T3 (30536R)
! Send Out                  "Result Below..."                            *3
      RESULT: Sent to reference lab.
  T3,TOTAL                  79 NG/DL                    76-181           *4

Tests: (3) T3,FREE (30510P)
! Send Out                  "Result Below..."                            *5
      RESULT: Sent to reference lab.
  T3,FREE                   2.8 PG/ML                   2.3-4.2          *6

Tests: (4) THYROID AB (ATA,TPO) (7302A)
! Send Out                  "Result Below..."                            *7
      RESULT: Sent to reference lab.
! THYROID PEROXIDASE AB
                                            <10 IU/ML                   <35              *8
! THYROGLOBULIN AB          <20 IU/ML                   <20              *9

Tests: (5) TSI (30148P)
! Send Out                  "Result Below..."                            *10
      RESULT: Sent to reference lab.
  TSI                       29 % BASELINE               <140             *11

-------------------------------------------------------------------------------------------------------------------------------

Results from FEBRUARY 15 2012 lab:

- Tests: (3) TSH W/FREE T4 RFX (43562A)

TSH [H] 4.68 MIU/L  (0.40-4.50)

T4, FREE 1.2 NG/DL   (0.8-1.8)

- Tests: (4) Total T3 (30536R)

T3,TOTAL 79 NG/DL (76-181)

Also, my LDL colestherol came back high for the first time in my life:
- Tests: (1) Lipid Panel (CPT-80061)
CHOLESTEROL,TOTAL [H] 208 MG/DL (125-200)
LDL CHOL, CALCULATED [H] 130 MG/DL     (<130)

[gimel]

Here is a great link on this subject area, just posted by artms.

http://www.worldlinkmedical.com/blog/hypothyroid-symptoms-but-normal-tsh-levels-how-to-treat-symptoms-of-low-thyroid-by-optimizing-free-t3-levels/

[gimel]

Well, T4 is the easiest to use since it is so much slower acting than T3; however, the very limited test data from early this year indicates a potential problem with conversion (FT4 is close to midrange, while Total T3 is very low in the range).  If that is confirmed with further testing of Free T4 and Free T3 at the same time, then a T4/T3 combo type med would be a good choice.  

[thethinme]

thanks gimel! I did not tell my doctor, I didn't oppose to her recommendation but the truth is I am going to a doctor I already chose which I found on Shomon's page, called Dr. Borenstein who treats symptoms and prescribes natural thyroid if needed ;) and seems to be the kind of doctor you guys here think is the "good type".

Do you guys think I should take natural thyroid medication according to my T3 results?

here are the results in simplified form as I realized they seem confusing above. Any advice?

(1) TSH W/FREE T4 RFX (43562A)

TSH  3.88 MIU/L  (0.40-4.50)
  
TSH REFERENCE RANGE - FOR PREGNANT PATIENTS:
FIRST TRIMESTER         0.20-4.70 MIU/L
SECOND TRIMESTER    0.30-4.10 MIU/L
THIRD TRIMESTER         0.40-2.70 MIU/L

(2) T3,TOTAL  79 NG/DL  (76-181)

(3) T3,FREE   2.8 PG/ML  (2.3-4.2)

(4) THYROID AB (ATA,TPO)
THYROID PEROXIDASE AB  <10 IU/ML       (<35)
THYROGLOBULIN AB           <20 IU/ML       (<20)

(5) TSI
TSI     29 % BASELINE           (<140)

[gimel]

Just because you are being referred to an Endo does not mean that all will be well.  Be aware that many of them have the "Immaculate TSH Belief", by which they only want to test and treat based on TSH.  That simply doesn't work.  Others use "Reference Range Endocrinology", by which they will tell you that a thyroid hormone test that falls ANYWHERE within the so-called "normal" range is adequate.   This is also incorrect.  

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.  Symptom relief should be all important, not just test results.  You can get some insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is then sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

So a good thyroid doctor would listen to your symptoms and look at your test results and tell you that your Free T3 is too low in its range and needs to be increased until you get symptom relief.   Free T4 is adequate, but your don't seem to be converting the T4 to T3 adequately.  Without searching back through your previous thread, if you haven't been tested for Vitamin D B12, ferritin, and a full iron test panel, then you should also get that done.