Please Help

[kaisai009]

I went for a general check-up with some blood test. I was worrying about my Thyroid Disorders but this doctor I went to gave me some pills to lower my Cholesterol.  Here are the blood test.

T3         129.1
FT4        1.01
TSH       9.04
Cholesterol  225
HDL-C           42
Direct LDL-C  180
BUN   6    Crestinine   Weight  104.8 kg   Creatinine   0.7mg/dL   GFR 238    eGFR (CKD-EPI) 105 ml/min/1.73m^2

[898_1]

According to the studies
http://www.ncbi.nlm.nih.gov/pubmed/14671157
One week of aspirin decreased total T(4), free T(4) (salsalate only), total T(3), free T(3), and TSH. These data confirm that aspirin, salsalate, and meclofenamate affect total and free thyroid hormone measurements

[gimel]

You don't necessarily need an Endo, just a good thyroid doctor.  Many Endos specialize in diabetes, not thyroid.  Also many of them have the "Immaculate TSH Belief" and only pay attention to TSH.  That is totally wrong.  Further if they go beyond TSH testing, many of them rely on "Reference Range Endocrinology", by which they will tell you that a thyroid test results that falls anywhere within the range is adequate.  That is also wrong.  Due to the erroneous method used to establish ranges, the ranges are far too broad to be functional for many patients.

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

So you need to find a good thyroid doctor that will treat clinically as described.   I don't have many suggestions as to how to do so in Thailand, but one way I ahve used successfully hee is to go to a pharmacy and ask if they could give me names of doctors that prescribe T3 type thyroid meds like Armour Thyroid, or other desiccated types.  If they do, that is usually a good sign.  Then you can find out more by calling the doctor and asking if willing to treat clinically as described.  

[kaisai009]

Nothing, but I was referred to him by another doctor. I think I might have to change doctor if the result is what I'm expected.  This time it will be for an endo,

[goolarra]

I'd really pursue B-12 regarding the numbness.  You want to be well up in the reference range on B-12.  

Weight gain, constipation and thinning hair are all hypo symptoms.

Most doctors put a lot of emphasis on TSH, and yours is quite elevated.  What did your doctor have to say about that?

[kaisai009]

I've gain not less than 30 pounds in the past few months without much changes in my daily diet, but I've quit my job so activities are less.  It's always easy for me to gain weight, the symptoms of thinning hair, constipation and headache are with me for a few years but recently I've got numbness in my elbows and hands, especially my left arm.  My feet are numb sometimes.  

[goolarra]

Your TSH is elevated, and your FT4 is a little on the low side.  Rule of thumb for FT4 is midrange (50%), and yours is only at 10% of range.  Many of us still feel hypo with FT4 in the lower half of the range.  I agree with gimel that I'd ask my doctor for more testing before committing to starting cholesterol meds, since elevated cholesterol is often a hypo symptom.

Aspirin would not have affected your labs.

How do you feel?  Do you have hypo symptoms?  

[gimel]

The best test, for the circulating form of Vitamin d, is 25[OH]D, also shown as  25-hydroxyvitamin D.   For B12 it is just that.  When you ask the doctor for a ferritin test he may try to substitute a full iron test panel (serum iron, TIBC and % saturation).  Those are good to know,  but insist on the ferritin test also.

[kaisai009]

Thank you very much.  I'll get all tested next week. By the way what test should I ask for to test on what you've suggested  "Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin"  

[kaisai009]

T3    129.10   Ref Range    61 - 177
FT4   1.01            "        0.93 - 1.71
TSH   9.04           "        0.27 - 4.2

I was on aspirin (325 mg) in the morning for 3 days  before taking the blood test. On the test day, none taken.   Would this have any effects on the result?

Thanks,

[goolarra]

Please post the reference ranges for your FT4 and T3.  Ranges vary lab to lab, so you have to post ranges with results.

Elevated cholesterol is a symptom of hypothyroidism.

[gimel]

Hypothyroidism does sometimes cause higher levels of cholesterol.  I think that before going on the cholesterol med I would want to make sure that hypothyroidism was not involved.  Your Free T4 appears okay.  The Total T3 is not very useful.  It would have been far better to test for Free T3 instead of Total T3.  Even though TSH is affected by so many variables that it is not a very reliable indicator of hypothyroidism, your TSH is high enough to warrant some additional tests.  

High TSH is frequently associated with Hashimoto's Thyroiditis.  Hashi's is caused by the autoimmune system somehow determining that the thyroid gland is "foreign" to the body and then producing antibodies to attack and destroy the gland.  As the gland is being destroyed over an extended period, the TSH climbs and the levels of Free T3 and Free T4 are diminished, requiring increasing amounts of thyroid medication to prevent hypo symptoms.

I think you could get a much better idea of what might be going on, if you will go back and get tested for Free T3 along with the Free T4 and TSH.  You should also request to be tested for the thyroid antibodies associated with Hashi's.  Those are Thyroid Peroxidase and Thyroglobulin antifodies, often shown as TPO ab and TG ab.     Both tests are needed.  

Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, I suggest those tests as well.

When you have further test done, please post results and their reference ranges and members will be glad to help interpret and advise further.