Thyroid Disorders Community
Opinions on test results
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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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Opinions on test results

My last TSH was 4.9 at a lab where 5.0 was considered normal. My physician refused to order any more tests so I went to a private lab and had more testing. These are the results.  I expected some of the other numbers to be out of range. I would appreciate any input along the lines of what you think the test results indicate and what my next step should be.

TSH 5.700                           0.450-4.500 uIU/mL MB
Thyroxine (T4)                      6.2 4.5-12.0 ug/dL MB
T3 Uptake 28                       24-39 % MB
Free Thyroxine Index 1.7      1.2-4.9 MB
Triiodothyronine (T3) 118       71-180 ng/dL MB

Thanks!
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Avatar_m_tn
It would have been far better if you had tested for Free T3 and Free T4, which are the biologically active thyroid hormones.  The T3 Uptake and FTI tests are somewhat outdated and not very revealing.  The Total T4 and Total T3 are likewise much less useful than the Frees.

TSH is a pituitary hormone that is affected by so many things that it is totally inadequate as a diagnostic for thyroid.  At best it is only an indicator, to be considered along with more important considerations such as symptoms, and also Free T3 and Free T4.  Of the thyroid hormone tests, Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

Just because thyroid hormone test results fall within the reference ranges does not mean they are adequate for you.   The ranges are far too broad to be functional for many hypo patients.  Many of us say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.

From what you said about your doctor, I'd say that you need to find a good thyroid doctor.  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.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf
14 Comments Post a Comment
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Avatar_m_tn
It would have been far better if you had tested for Free T3 and Free T4, which are the biologically active thyroid hormones.  The T3 Uptake and FTI tests are somewhat outdated and not very revealing.  The Total T4 and Total T3 are likewise much less useful than the Frees.

TSH is a pituitary hormone that is affected by so many things that it is totally inadequate as a diagnostic for thyroid.  At best it is only an indicator, to be considered along with more important considerations such as symptoms, and also Free T3 and Free T4.  Of the thyroid hormone tests, Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

Just because thyroid hormone test results fall within the reference ranges does not mean they are adequate for you.   The ranges are far too broad to be functional for many hypo patients.  Many of us say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.

From what you said about your doctor, I'd say that you need to find a good thyroid doctor.  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.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf
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Avatar_f_tn
I was diagnosed hypothyroid when my TSH was 5.8 - not much different then your latest test.
I was put on a synthetic and my TSH dropped into range and the doctor claimed all was well.  NOPE. I felt terrible. I found another doctor that tested Free T3 and Free T4 and I was at the bottom of the range.  So I slowly went from 25 micrograms (MCG) of Levothyroxine~generic Synthroid~to 120 milligrams (MG) of Armour within 5 months.  Huge difference.  

I do realize a lot of insurance companies will not pay for additional thyroid testing, like Free T3 and Free T4, unless TSH is out of range.  Which is unfair if the lab is using an outdated reference and since it is a pituitary hormone.

At this point, being on Armour, my TSH is .008 and we (the doctor and I) are ok with that since my Free T3 and Free T4 levels need some work.  

If you are going to pay or get a doctor that will opt for additional testing gather a list of other vitamins that us hypothyroid patients usually fall short on. Mine was B12 and iron. Some hypothyroid people need adrenal support as well. A hypothyroid person can keep taking their prescribed hormone, but not feel any better if any of those vitamins and others are below where they should be.  And not just "in range".  

It ***** that it takes some major homework on our exhausted bodies to finally feel normal and active again.  

I hope you find a doctor that is works with you!  

I am lucky that my insurance has a website that I can see which tests doctors run and what they prescribe.  If I see they only test TSH I wouldn't even consider them. Or if I see that they prescribe synthetic only and not open to an NDT like Armour, I avoid them as well.
I wanted a doctor that was open minded and would work with me and didn't just enjoy hearing themselves talk.
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5816398_tn?1381252226
Thanks! Excellent information. I'll try to get the other tests and re-evaluate.
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5816398_tn?1381252226
Thank you so much for your reply. I was so caught off guard by my doctor refusing to pursue the thyroid that I almost gave up. Truthfully, I don't know what kind of doctor I'm looking for or how to go about discovering if they will treat me clinically...do you have any suggestions?
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Avatar_f_tn
It was trial and error for me.  Took me a long time to find a good doctor.  Currently I am seeing an Internal Medicine doctor.  She does tests the free T's but doesn't know where I should be.  I have seen a DO, general, neurologist, ENT, rheumatologist, etc...
That is why I researched myself, asked a ton of questions, and the STTM ladies on facebook!

I am very happy you ordered the STTM book.  I need to do that.....
I wish I would have found STTM before I spent 3 years feeling miserable, miscarriage, migraines, and tons of useless/expensive tests to only be told "nothing is wrong".

Like I said I scour my insurance companies website looking at what tests a doctor runs and what they prescribe.  I will never go back to synthetic.
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649848_tn?1357751184
You can go to any type of doctor who will test/treat adequately.  

If you want to let know your location, we might have a patient recommended doctor that you could try.  

You can often pre-interview doctors over the phone, often via a nurse, or office manager.  You should ask what thyroid tests they routinely perform (should be TSH, FT3 and FT4), what  meds they are open to prescribing (should be whatever it takes to alleviate symptoms, including cytomel and desiccated hormones), and if they are willing to treat by symptoms, not just labs (should be "yes").

It's good to read all types of books, but don't get sucked into just one, such as STTM - they advocate only the use of desiccated hormones, when not everyone needs that.  Many of us do just fine on synthetic. They are also a competing site and references are not supposed to be made.

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5816398_tn?1381252226
Barb, Thank you for your reply. I am in South Alabama and see doctors in Monroeville, Mobile, Fairhope, and Birmingham, Alabama. I also am able to travel to Pensacola, Florida. Could you point me to the list of patient recommended doctors? Thank you.
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649848_tn?1357751184
I'll take a look and see what we have....... will PM you with any info I have.
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649848_tn?1357751184
Wow - you travel a long way to see doctors.  We don't have anything in, southern AL or the FL panhandle i.e. Pensacola, but can do some research and try to come up with something.
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5816398_tn?1381252226
Thanks Barb. I've found a few names in various places.  I think I'm going to get the other bloodwork done, see what you guys think, and then start interviewing nurses to help me choose the best doctor.
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Avatar_m_tn
I have lately added a name to the list, in the Mobile area.  Also there is a doctor listed in Mobile in the Top Thyroid doctors list.  I'll PM both to sajackson.
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649848_tn?1357751184
You'll need a doctor to order the labs.  If you choose not to go through a doctor until after you have the labs in hand, you can go through web sites, such as healthcheckusa to get done what you want.

You simply order the tests, they send you a lab sheet and tell you which lab to go to, in your area, then after you've had the blood drawn, they send you the results.
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5816398_tn?1381252226
Here are the ft3/4 results. What are your suggestions? I'm going to call my nurse and ask her if the doctor will work with me now that I have two labs with a high tsh. I'm not sure what to think since the other results were within normal range. All I know is that my quality of life is deteriorating fast.

TSH+Free T4
TSH 7.010           0.450-4.500 uIU/mL MB
T4,Free(Direct)     0.85 0.82-1.77 ng/dL MB

Triiodothyronine,Free,Serum
Triiodothyronine,Free,Serum 2.5          2.0-4.4 pg/mL MB

Thanks, Audrey
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Avatar_m_tn
Just be cause your Free T3 and Free T4 results are within the so-called "normal" ranges does not mean they are adequate for you.  First, the ranges are far too broad, and second everyone is different as to the level of thyroid hormone required to relieve symptoms and feel well.  

Your Free T3 and free T4 are both in the lower half of their ranges, which is frequently associated with having hypo symptoms.  As mentioned in the link I gave you above, " the ultimate criterion for dose adjustment must always be the clinical response of the patient."   A good thyroid doctor will adjust Free T3 and Free T4 levels as necessary to relieve hypo symptoms.

With those results, you might also give the doctor a copy of the link I gave you and ask to be treated clinically, as described.  If that fails, then you should go ahead and find out if one of the other doctors will do so.

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