Thyroid Disorders Community
Need some help please
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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Need some help please

I am going back to the dr today and need some help deciphering my results...I have had so many issues with thyroid symptoms for as long as I can remember...I am 42 female, and am gaining weight, my hair has been falling out for years, I am exhausted, headaches and migraines constantly, have for years tried to find the source of something stuck in my throat, sometimes painful, too many digestive and bowel problems to count, including absess (abscess) and fistula for 3 years, heart palpitations and shortness of breath, infertility for 13 years (then strangely got pregnant twice), dificulty concentrating and very forgetful for every day tasks or info, pressure behind eyes, crave carbs and get shaky if I don't eat something, insomnia and sleep disturbances, irritable and cranky, depressed feeling...

I an't tell you how many times I have been to dr and they ahve always said I fall in the range for TSH...they never allowed me to look further, meaning they never wanted to run the extra tests...so finally I put my foot down iwth new dr and he got me the free t4 BUT instead of free t3 like I asked, he ordered total t3...I think that is not enough???

My TSH last month was 1.92 (reference .40 - 5.5) mU/L
My recent Free T4 is 14.1 pmol/l (reference 9. - 22.0) I would like to know how this converts to ng/l???
Total T3 1.9 nmol/l (reference 1.2-3.1)

I f anyone can help me figure this out I would be thankful...I have to go to dr today and ask for other tests, as I just feel so yucky, but I am scared he won't do it if I am in the ranges. Also my B12 was tested last month and it is 297. I think that is quite low from what I can read anywhere about the optimal levels...again if anyone has some other insights...thank you so much.

I feel lost here...
6 Comments Post a Comment
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4173379_tn?1355360151
I got the Free T4 converted...it is now

1.09 ng/l from 14.1 pmol/l

TSH 192

No Free T3, yet.

Any ideas so far?.
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Avatar_m_tn

Total Free T3 is an outdated test and does give an exact level of the Residual T3 in your body. Ask then to do the Free T3 not total. It sounds like you are having both Hyper and Hypo symptoms, make sure your MD is aware that you are having these, also your indication regarding getting shaky indicates a blood sugar issue, I have Hypogycemia, which causes low blood sugar, and in turn causes shaky and light headedness, also Diabetes can cause the same symptom, some of your symptoms could be from blood sugar issues, but you definatly are having mixed thyroid symptoms also. Your MD needs to do more lab work, such as a Complete Blood Count, The3 complete thyroid Panel and maybe a Glucose Intolerance Test to determine blood sugar issues. Best of Luck FTB4
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Avatar_m_tn
Sorry for the thypos, I meant the total Free T3 does "Not" give an exact level of the Residual or Free T3 in your Body.  FTB4
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4173379_tn?1355360151
Thanks, I have had recent blood work done also...

RBC       4.84 (reference range 3.6 - 5.0)
HgB        140 g/l (range 115-150)
Hct          .43 (range .33 - .44)
Platelets (were elevated over range last month at 387 ... range 160-380)
They have gone down this month to 299, same range.

I had a glucose fasting done 4.6...less than 5 is optimal.

I have decreased liver function...stage 2 CKD  with a number of 80, which has decreased over the last month.

I am so new to the thyroid testing and information, although for many years I have felt that there is something wrong with it...I have also wondered about Hashi's of late...never knew about that before, but I am going to a Naturepath next week so I hope she can help me with the thyroid, as she has much experience with it, unlike many drs.

I understand from my research that optimal TSH is 1 to 1.5 and optimal free T4 is 1.2 - 1.3 ng/l, so I was just wondering how that relates to my own results. I am quite upset with my dr as I specifically asked for both T3 and T4 be ran, but he copped out. He didn;t want to even run those other than the TSH.

Thanks for your response...I have had every test I can think of so far, to gauge organ functions...I even have elevated iron, which I know can damage pituitary and thyroid glands, so it all makes me wonder about the sources of my symptoms. Many diagnosed with hypothyroid and Hashi's also find out they are high in iron, even if they have been told they are anemic.

Very confusing all around...

Cheerz
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Avatar_m_tn
TSH is a screening test at best.  It is basically otherwise useless unless it shows WAY far to the extremes.

There to my knowledge is not such test as "free total T3".  I think that is a typo and should be that the "total T3" is an outdated test of little value.

TSH is only an INDICATOR hormone.  To truly get a better handle on your thyroid test you actually have to test for the two thyroid hormones that your body actually uses.  These are "FREE T4" and "FREE T3".

Free means that the hormone is not attached to a protein. Once a protein attaches itself to the hormone it becomes biologically inactive.

Many people have found they need to be WELL up into the range of BOTH of these values.  Being just "somewhere in the range" is NOT good enough for most people.  The better target seems to be to have BOTH of the following:

1) Free T4 (FT4) to be in the MIDDLE of the range (50%) or slightly higher.

AND- that means in addition

2) Free T3 (FT3) to be in the UPPER 1/3 of the range (66.7%).

Your test show that your FT4 is 39% of the range.  A fair amount below the 50% target.

Your T3 was total but as you can see it is towards the bottom end of the range.  

At the cellular level your body only uses the FREE T3 molecule. Since the TOTAL test counts both the free and attached (useless) T3 and you are towards the bottom end of the TOTAL range, not knowing how many are attached to the protein or not it would stand to reason that you'd likely be towards the low end of the Free T3 range as well. You really need to be tested to know for sure.

To test for Hashimotos there are two tests that need to be run.  TPOab and TGab.  These are two different antibodies.  Hashi's is the leading cause of Hypo in the developed world.  And the early stages of it can cause a person to swing from Hypo (low) to Hyper (high) thyroid and symptoms.  
If test come back elevated for any one of these it would indicate that you have Hashi's.

Graves disease is also auto immune and causes hyper (high) thyroid.  The definitive test for this is TSI.  Again an elevated ttest result would show positive for graves.

Most of the symptoms you list are consistent with Hypo.  Some symptoms of hypo and hyper cross over.

My wife who is also Hypo gets the shakes if not eating enough and also craves carbs.  She has been tested for diabetes and is OK but may be towards the borderline.  Might be due to her weight which also is up due to slow metabolism caused by being Hypo.

Insulin resistent patients you are Hypo are also not all that uncommon from what I've read it seems.

Understand each person is different and the target FT4 and FT3 listed above is just that, something to shoot for.  But some people feel well being lower or higher than the targets.  The secret is to if starting medications, start small and increase slowly in dosages.

The MAIN thing is symptom relief.  Find a Dr who will test BOTH the FT4 and FT3.  If they only go by TSH they will almost assuredly keep you feeling ill.  Or they will continue to tell you that you are "normal" because you fall within a reference range.  Understand that many people as stated above need to be WELL up higher than the reference range.
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4173379_tn?1355360151
Thank you so much for detailed info. I know that the TSH is a wishy-washy guide at best, however, it is good for them to treat with all three numbers in mind? I have read some Dr. Rind information, and he has a table he uses to diagnose and treat for optimal TSH, FT4 and FT3...

http://www.drrind.com/forms/ts_diagrammer.pdf

Also this is diagram is from the article he wrote which is linked here:

http://www.drrind.com/therapies/thyroid-scale

He is very consistent with what all the research is showing about new understandings of how the optimal ranges are sooooo much more sensitive and strict when it comes to effective treatment for hypo and hyperthyroid.

Diabetes runs in my family on both sides, my father and my grandfather, on Mom's side, so I need to keep this in mind, as well as liver disease and cancer in both grandparents, and as well as kidney disease, father, and decreased kidney function in myself and brother.

I have many symptoms over my lifespan that have never been able to be pinpointed or explained and neve severe enough to force the drs to take anything seriously. I had my last dr get very angry with me for asking about my blood tests that showed high iron...these were the first tests I had had done in many, many years, since I was pregnant with my now 6 year old son! So I don't think I was being unreasonable to have serious concerns based on many of the readings I got. Even my CBC's are borderline high...

Anyway, the thyroid puzzle is just another piece to decipher for me, and see if it has any bearing on the way I feel. I just want to crawl into a hole and never wake up, at the moment. But I also have a very ill husband and two small children so I force myself to put my feet on the floor every day and function to some extent.

Thanks again...slowly starting to get the idea, and appreciate all the help.
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