Odd Labs... Hypo a possibility?

[MrManGuy84]

Hi everyone.

Been trying to find the source of my symptoms for some time now. About 6 years ago I realized I was not feeling like myself. Emotionally very flat, libido missing, always tired. I thought we found the problem when we realized my testosterone is below normal (I'm a 27-year-old male) but a theraputic trial of that does not seem to be working. My doctor is interested in retesting my thyroid, which we will do soon. In the meantime I was hoping maybe you could help me interpret my previous thyroid labs.

Throughout these labs, I have also had testosterone a little bit low and prolactin just slightly high.

Aug 2007:

TSH 4.62 (0.45-4.67)

Sep 2007:

TSH: 2.84 (0.45-4.67... in reality 0.3-3.0)
Thyroxine, Free. T4Free: 0.93 (0.71-7.85)

April 2008:

TSH: 2.18 (0.45-4.67)
T4Free: 1.26 (0.71-1.85)

Later in 2008:

Free T3 4 (2.3-4.2)
Reverse T3 295 (90-350)
DHEA 829 (209-771)
Vitamin D 22 (32-100)

May 2012:

TSH: 2.32 (0.34-4.82)

------

I thought I'd eliminated hypo as a possibility years ago when we did the FT3 test and it was near the top of the normal range. Am I wrong about this? It also seems a bit odd that it was near the top when other things look somewhat suspect.

Another reason I suspect it MIGHT be hypo is that for most of my life my blood pressure has been a bit low. This was true until the last year or two... it's slightly high now, although sometimes the doc's office makes me nervous.

Anyhow, interested in your thoughts. Thanks!

[Red_Star]

I added your free T3 and reverse T3 results (i assume both are in measured in pg/mL) into the rT3 ratio calculator on Stop The Thyroid Madness.  There should be at least 20 times more FT3 than RT3 in the body so 20 and over is a healthy rT3 ratio. Your result is 13.6. The T3/rT3 ratio is supposed to reflect the tissue thyroid hormone metabolism.

"Here we show that the T3/rT3-ratio, which is supposed to reflect the tissue thyroid hormone metabolism, is significantly increased in insulin resistant subjects. This further supports a link between thyroid function and IR."

Excerpt from "T3/rT3-ratio is associated with insulin resistance independent of TSH" - PMID: 21104580 - Pubmed

Factors that can raise DHEA include:

Androgen-producing adrenal tumours
Adrenal hyperplasia
Insulin resistance
Polycystic ovary syndrome (PCOS)
Steroids or glucocorticoids (Cushing's Syndrome)
High levels of stress
Excessive exercise

Factors that can elevate reverse T3 and affect the rT3 ratio include:

Nutrient deficiencies:
- iron (including ferritin)
- selenium
- zinc
- chromium
- vitamin B6
- vitamin B12
- vitamin D
- iodine
High cortisol
Low cortisol
Stress
Insulin resistance
Insulin dependent diabetes
Impaired liver function/liver disease
Fasting
Extreme dieting
Burns/thermal injury
Aging
Chemical exposure
Cold exposure
Chronic alcohol intake
Free radical load
Haemorrhagic shock
Kidney disease
Severe or systemic illness
Severe injury
Surgery
Toxic metal exposure
Leptin resistance
Inflammation (NF kappa-B)

[Barb135]

You can't go by tests that are several years old, because things can change very quickly.  It's unfortunate that the May 2012 test was only for TSH.  TSH is pituitary hormone and fluctuates greatly, even intraday.  It should  never be used, alone, to diagnose or treat a thyroid condition.  You need to have Free T3 and Free T4 tested EVERY time you have TSH tested, because those are the actual thyroid hormones, and will give a much clearer picture of what's going on. TSH does not correlate with symptoms.

BTW - the AACE recommended, over 10 years ago, that the reference range for TSH be changed to 0.3-3.0.  Using that range, your level would close to the top.

Your 2008 vitamin D levels were very low.  Have you been supplementing for that?  Have you had it tested again, recently?  Vitamin D deficiency can cause a lot of hypo-like symptoms.

[JMcKale]

I've had my thyroid checked most of my life, every few years, because I had antibodies. In my late teens I developed issues with iron deficiency anemia, fatigue, and cold intolerance, but my thyroid always tested fine and my TSH was never above 2.7. I had the fatigue issues into my mid 20's or so and then they kind of just disappeared....I guess it could have been from the iron issue because I didn't treat it. The cold intolerance persisted but since my thyroid was fine, I chalked it up to an incident where I became severely overheated when I was 18.

I stopped checking my levels for a while, but had them tested in 2008, in my late 20's when I changed doctors, and that test came back fine. Sometime between then and 2009 I started hating cold a lot more and my hair became really dull. I can't really pinpoint when this began though. I also became very restless, and then over the course of a few weeks I started having severe cognitive issues. I did not feel like myself at all, and by the time I went to the doctors I could barely read.

At that point, my TSH was 13.3 and my FT4 was normal so I was diagnosed with subclinical hypothryoidism.

I noticed a profound difference between the symptoms I had when I was actually going into thyroid failure, and the symptoms I previously had had when my thyroid levels tested fine. The strange thing was, when I went on the synthroid, my cold intolerance completely disappeared.

The downside is, I keep getting hot.