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What do my results mean and how should I treat?
I recently had blood work done to test my thryoid and here are the results: TSH 6.77, Free T3 4.8, Thyroglobulin Antibody 465, Thyroperoxidase Antibody >600. My symptoms are numerous: itchy skin, fatigue, difficulty concentrating, low blood pressure (100/65), trouble sleeping, bleeding gums, pressure in my left breast (heart maybe??). I did go to the emergency room back in november for heart palpitations and my heart rate was 120 bpm. I then wore a holter monitor for 3 days, and never heard anymore about it so I assumed my heart was fine. I meet with my family doctor on monday to discuss these results. I would like to know what I should be asking him, what meds I might need and what other tests I should have done. Thank you.
In view of you having been already diagnosed with Hashi's, the main concern should not be TSH. The main concern has to be your numerous hypothyroid symptoms. That small starting dosage of 25 mcg of T4 is not going to make any significant difference in how you feel, but at least it is a start. The result from it will be that the TSH level drops a bit and the output of natural thyroid hormone will then drop also and your Free T4 and Free T3 are unlikely to change much, if at all.
Serum thyroid hormone levels are the sum of both natural thyroid hormone and thyroid med. So only when TSH is suppressed enough to no longer stimulate natural thyroid production, will serum thyroid levels reflect further increases in thyroid medication. You can read about all of this on page 13 of the link above.
I a not overly optimistic about the Endo because many of them specialize in diabetes, not thyroid. Also, many of them have the "Immaculate TSH Belief" and only want to diagnose and medicate based on TSH. That is just wrong. Also, many of them use "Reference Range Endocrinology", by which they will tell you that if a thyroid test falls even in the low end of the range, that is adequate. That is also very wrong.
A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. So you need to test for both Free T4 and Free T3 every time you go in for tests. Did the doctor order those tests at your last appointment? Note that many of us have found that we needed Free T4 at least at the middle of the range, and Free T3 in the upper half of the range, and then adjusted as needed to relieve symptoms.
In addition, hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin, all of which are very important for you. So if not tested, you should get those done and then supplement as needed to optimize. D should be at least 50, B12 in the upper end of the range, and ferritin should be at least 70.
So if you find that you need a good thyroid doctor, as described above, then let us know your location, and perhaps we can suggest a doctor that has been recommended by other thyroid patients.
I wouldn't suggest following the naturopath's suggestion to look for other inflammatory markers until after you have resolved your thyroid deficiency. Also, palpitations and air hunger can be symptoms of hypothyroidism.
Serum thyroid hormone levels are the sum of both natural thyroid hormone and thyroid med. So only when TSH is suppressed enough to no longer stimulate natural thyroid production, will serum thyroid levels reflect further increases in thyroid medication. You can read about all of this on page 13 of the link above.
I a not overly optimistic about the Endo because many of them specialize in diabetes, not thyroid. Also, many of them have the "Immaculate TSH Belief" and only want to diagnose and medicate based on TSH. That is just wrong. Also, many of them use "Reference Range Endocrinology", by which they will tell you that if a thyroid test falls even in the low end of the range, that is adequate. That is also very wrong.
A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. So you need to test for both Free T4 and Free T3 every time you go in for tests. Did the doctor order those tests at your last appointment? Note that many of us have found that we needed Free T4 at least at the middle of the range, and Free T3 in the upper half of the range, and then adjusted as needed to relieve symptoms.
In addition, hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin, all of which are very important for you. So if not tested, you should get those done and then supplement as needed to optimize. D should be at least 50, B12 in the upper end of the range, and ferritin should be at least 70.
So if you find that you need a good thyroid doctor, as described above, then let us know your location, and perhaps we can suggest a doctor that has been recommended by other thyroid patients.
I wouldn't suggest following the naturopath's suggestion to look for other inflammatory markers until after you have resolved your thyroid deficiency. Also, palpitations and air hunger can be symptoms of hypothyroidism.
Ok. So I met with my MD yesterday.....and for the first time, I felt like I really had to push him to get what I wanted, and even then I didn't get everything. LOL. He didn't want to treat me just yet,and here's why: when he first tested my thyroid in December., my TSH was 12. He then had me re-test (about 4weeks later) and the TSH result was 6.77. So it appears as though my TSH is regulating itself. (??) My doctor was reluctant to prescribe me medication, but wanted to wait and retest me again in about 6weeks. I get his point. my TSH could still be coming down...But I wanted drugs anyway, given my symptoms. So with some pushing, he prescribed me a low dose of Synthroid (25mcg). I then asked if he wanted an ultrasound of my thyroid, and he said no, that he didn't feel like it was necessary. He said he didnt' feel any lumps, and that my thyroid wasn't "too swollen". So, again, I insisted and he finally caved. The one thing he offered up on his own was a referral to an endocrinologist, so I'm happy about that. I think if I'd had to push for that referral, he'd probably hand me one for a psychologist as well. LOL.
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I should add, that I think my TSH level dropped around the same time I went Gluten-Free and Dairy-free. And what didnt I get from my MD? More blood work to look for other inflammatory markers (as recommended by my naturopath) and a referral to a cardiologist (heart palpatations landed me in the ER in November, I take frequent deep breaths casue I dont' get enough air, and I have a feeling like someone is pressing their finger on my chest).
You should make sure they always test for the biologically active thyroid hormones, Free T4 and Free T3 every time you go in for tests. If the doctor resists, just insist and don't take no for an answer. They are important.
Without Free T4 you only have a partial picture of your test status. Clearly you have the number one cause of diagnosed hypothyroidism, which is Hashi's. Even though your Free T3 is at 55% of its range, it may be that your body is converting more T4 to T3 in an effort to maintain thyroid function as well as possible. So, again you need to know Free T4. In addition there are other tests that would be useful for diagnosis. Hypo patients are so frequently deficient in Vitamin D, B12 and ferritin, those should be tested and supplemented as needed to optimize. D should be at least 50. B12 in the upper end of its range, and ferritin should be at least 70.
You can read about this in the following link. I recommend reading at least the first two pages and more if you want to get into the discussion and scientific evidence supporting the suggestions on page 2.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
Some doctors would ignore your symptoms, look at your test results and say that you have Hashi's, and your TSH is above range, but your Free T3 is in the middle of its range, so you don't need to do anything right now. That would be wrong. A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms. Symptom relief should be all important, not just test results. So that is what you should expect from your doctor on Monday. If there is disagreement, give the doctor a copy of the paper in the link above and tell him that clinical treatment is what you need.
In addition to the above recommended tests, as suggested on page 2 of the paper, I would also ask to be tested for Reverse T3 (along with Free T3 from the same blood draw), cortisol, and an ultrasound of the thyroid gland.
Please let us know how it goes with the doctor.
Without Free T4 you only have a partial picture of your test status. Clearly you have the number one cause of diagnosed hypothyroidism, which is Hashi's. Even though your Free T3 is at 55% of its range, it may be that your body is converting more T4 to T3 in an effort to maintain thyroid function as well as possible. So, again you need to know Free T4. In addition there are other tests that would be useful for diagnosis. Hypo patients are so frequently deficient in Vitamin D, B12 and ferritin, those should be tested and supplemented as needed to optimize. D should be at least 50. B12 in the upper end of its range, and ferritin should be at least 70.
You can read about this in the following link. I recommend reading at least the first two pages and more if you want to get into the discussion and scientific evidence supporting the suggestions on page 2.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
Some doctors would ignore your symptoms, look at your test results and say that you have Hashi's, and your TSH is above range, but your Free T3 is in the middle of its range, so you don't need to do anything right now. That would be wrong. A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms. Symptom relief should be all important, not just test results. So that is what you should expect from your doctor on Monday. If there is disagreement, give the doctor a copy of the paper in the link above and tell him that clinical treatment is what you need.
In addition to the above recommended tests, as suggested on page 2 of the paper, I would also ask to be tested for Reverse T3 (along with Free T3 from the same blood draw), cortisol, and an ultrasound of the thyroid gland.
Please let us know how it goes with the doctor.
1 Comments
Thank you so much for all of your advice and recommendations. This information will be helpful when I meet with my doctor in 3 days. He usually isn't dismissive of any symptoms I have, however I don't know how extensive his thyroid knowledge is. This info is good ammunition just in case. I will keep you posted.
You certainly have a lot of symptoms that are often associated with hypothyroidism. In addition your TSH and TPO ab and TG ab tests are indicative of Hashimoto's Thyroiditis. In order to comment on your Free T3 level, I need the reference range shown on the lab report. Also, do you have Free T4 test results and range?
1 Comments
My doctor did not request that my Free T4 be tested so I don't have numbers for that. My Free T3 is 'normal' but I just put it in my post for reference. The lab report says that the normal range for Free T3 is 3.1-6.2
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