Lab test results

[Jenn1302]

Hello Everyone,

I was wondering if you could help me interpret these lab results. After months of having the wrong tests done, I finally had both Free T3 and Free T4 done.

T4 serum free: 0.97 ng/dL (0.7-1.48)
TSH: 2.16 u[iU]/mL (.4-3.98)
T3 free serum: 2.4 pg/mL 2-3.9

Thyroid antibodies:
Thyroid peroxide ab: 781iu/ml (<5) H, August 2014
TSI: 44% (<140) August 2014
Thyroglobulin Ab: 83.9 IU/mL (0.0-19.0) H, March 2014

I have been diagnosed with Autoimmune Thyroiditis. Based on the above labs am I currently hypo or normal? Thank you in advance.

[Jenn1302]

Thank you so much for your help!

I've had two thyroid ultrasound scans over the past year and they never showed any nodules. I never had any thyroid scans done back when I was hyper, so I don't know what my thyroid looked like back then. Can nodules form, make you hyper and then go away entirely?

My doctor actually tested everything before starting me on supplements. He started me on supplements because my levels were low.
Vitamin D 25-hydroxy, serum 21.3 [L] ng/mL (range: 30.0-96.0), July 2014
Ferritin, serum  9.28 [L] ng/mL (range: 16.00-204.00), July 2014
Magnesium: 1.7 (range: 1.6-2.5), August 2014
Zinc: 59 [L] ug/dL (62-104), July 2014
Selenium: 79 ug/L (50-117), July 2014
Copper: 94 (53-166), July 2014
Also, I was told I was anemic by several doctors before I started seeing this doctor.

He's treating me with doxycycline because I tested positive for a strain of bacteria that's been linked to high levels of thyroid antibodies/Hashimoto's. This doctor is actually not an endocrinologist, he's a functional medicine doctor and I'm seeing him for all the 5-6 different conditions that I'm currently suffering from. I asked him about my thyroid because I was hoping he could help with that too, because traditional medicine hasn't been very helpful.

[gimel]

So your doctor diagnosed Autoimmune Thyroiditis Hashi's).    I would certainly expect that from your labs and symptoms.  With Hashi's the destruction of the thyroid gland sometimes causes nodules to form that can leak hormone faster than normal, resulting in periods of being hyper, then returning to hypo.  You can find out about nodules with an ultrasound of the thyroid gland.  

It will be interesting to see what your doctor proposes for treatment.  I like that your doctor told you to take Vitamin D, iron, magnesium and zinc.  I would have liked it much better if he had tested those before starting you on supplements.  Also, I have reservations about your doctor based on his saying he was trying to lower your antibodies with doxycycline.  I don't understand that.  Studies have shown that you can lower antibodies with selenium; however, the reduction is not huge and it doesn't change the condition of you being hypo.  I expect that you are going to need a good thyroid doctor.  So, if you will tell us your location perhaps we can come up with a doctor recommendation for you.  

[Jenn1302]

Thank you for your response. What I said is based on how I felt, TSH and FT4.

[gimel]

In answer to your question I'd say yes, that the worst of those symptoms would occur only in cases of severe or long term untreated hypothyroidism.  That is just an opinion based on expectations.  I posted the whole list just to show you that palpitation, etc. could be related to hypo as well as hyper.  

When you say that your thyroid sent between hyper and normal, was that based on how you felt, or TSH tests, or what?

[Jenn1302]

Thank you so much for your help! These are scary symptoms... Some of them are much scarier than my palpitations. Most of these happen only when you're severely hypo right?

When I said "my thyroid values tend to fluctuate a lot (I have a history of hyperthyroidism and my TSI is not 0)", I meant that up until last year my thyroid mainly went between hyper and normal and the possibility that I may have both Hashimoto's and Graves has recently come up.

What I meant by "my TSI is not 0" is that it's detectable (>2%) but currently not high enough to be hyper. Based on the articles below I could have Graves because " individuals who are normal do not produce TSI and have levels <2% activity" and my TSI is 44%.
1. http://www.livingwithgravesdisease.com/diagnosis/lab-tests
2. http://books.google.com/books?id=Pjf_XuCmbTEC&pg=PT186&lpg=PT186&dq=%22TSI%22+%22%3C2+percent%22+thyroid&source=bl&ots=tmBU1Rh8XM&sig=pgrXvWMNqMcrClwMtlNIA9Q0Ris&hl=en&sa=X&ei=IJ8bVIC5E9iryASTioKQCA&ved=0CCoQ6AEwAg#v=onepage&q=%22TSI%22%20%22%3C2%20percent%22%20thyroid&f=false.

[gimel]

There is a common misunderstanding that heart palpitations are related only to hyperthyroid type symptoms, and that taking or increasing thyroid med will make it worse.  From the very long list of symptoms that can be related to hypothyroidism, this is the section of heart related symptoms.

Heart:

    High blood pressure
    Low blood pressure
    Slow/weak pulse (under 60 bpm)
    Fast pulse (over 90 bpm at rest)
    Arrhythmia (irregular heartbeat)
    Skipped beats
    Heart flutters
    Heart palpitations
    Chest pain
    High cholesterol
    High triglycerides
    High LDL (“bad”) cholesterol
    Mitral Valve Prolapse
    Atherosclerosis
    Coronary Artery Disease
    Elevated C-Reactive Protein
    Fibrillations
    Plaque buildup
    Fluid retention
    Poor circulation
    Enlarged heart
    Congestive Heart Failure
    Stroke
    Heart Attack

Please clarify what you mean about "thyroid values tend to fluctuate a lot and that you have a history of hyperthyroidism and your TSI is not 0".

[Jenn1302]

Thank you all for your responses!

I don't know what my doctor thinks about these results yet, because I got these lab results from the patient online portal. I have an appointment with him in a couple of weeks, so we'll see what he thinks then. Last time I saw him he said that my antibodies were very high and he is currently trying to lower them with doxycycline (here is more information about this: http://www.thyroidpharmacist.com/blog/infections-and-hashimotos). He also told me to take vitamin D, iron, magnesium and zinc.

I get symptoms sometimes but some of them kind of come and go.
Symptoms that won't go away, but they do fluctuate to some degree:
Palpitations : PVCs/PACs/possibly also NSVT
Pale skin and black circles under my eyes.
Enlarged pores
Frequent dehydration
Swollen throat (I've been told it's related to the thyroid inflammation)
Very mild thyroid enlargement

Symptoms that come and go:
Excessive sleep (10 hours per night)
Slow heart rate (50-55 bpm)
Dry skin

My thyroid has been fluctuating and causing problems for the past 3.5 years, so I know I'm probably going to have to take thyroid meds at some point. The thing is that I am a actually little hesitant to start thyroid medication now, because of my heart palpitations and because my thyroid values tend to fluctuate a lot (I have a history of hyperthyroidism and my TSI is not 0). While I know that there's a chance that thyroid hormone replacement could make my palpitations go away, it could also make them worse. The idea that my palpitations could get worse scares me, because they already feel bad enough...

[flyingfool]

First question is how do you feel?

Do you have any symptoms of being Hypo?  THAT is the true determination factor into whether or not you are "hypo".  The lab numbers would suggest that you likely do have hypo symptoms.

Hashimoto's which is the autoimmune condition you have is progressive. What this means is that over time your thyroid gland will produce less and less hormone. This means that if you are not symptomatic yet, you will be at some point.  Thus you will be on thyroid medication at some point in the future.

Dr's appear to be in two camps.  One camp is that they will wait to prescribe you medication until you feel terrible or the lab numbers reach a limit to what they biasedly believe is the point you need to get medicated.  The other camp is that the Dr will prescribe a starter dose of medication when symptoms are mild and then stay on top of the progression of the disease.

Personally I would recommend going with option 2 above.  That is as soon as you feel symptoms to start on even very low dose of medication.  I believe there is no reason what so ever to suffer and feel terrible before you get medication.  Especiallywhen you are almost 100% assured of being on medication sooner or later.  It may as well be sooner and not put you through suffering of symptoms.  After all it is not the Dr who has to feel like crap.  he can tell you "you are fine and your labs are in normal range", when you feel like crap.  he gets to go home at night feeling fine, while you and your loved ones have to live with you feeling terrible.  If that is the case you need to find a new Dr who believes in treating the Patient and not a lab value!  Unfortunately that is easier said than done.

[gimel]

Totally agree with Barb.  For further confirmation, this was written by a good thyroid doctor.

"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

If you are curious as to why we say that you are hypothyroid, even with your test results still falling in the so-called "normal" ranges, have a look at this link.

http://www.hormonerestoration.com/Thyroid.html

[Barb135]

In my opinion your FT3 and FT4 are way too low in the ranges and you should be considered to have hypothyroidism.  

Is your doctor willing to start you on replacement hormones?