Pleases help me understand lab results

[moonlightdance]

It's been ongoing for a few years, extreme fatigue, weight gain (I rapidly gained 15 lbs in less than a month, 2 separate times) twice I've had a burst of sudden weight gain, thinning hair, ringing ear (for a year), and brain fog.  I had blood work drawn, with the following results:

TSH 1.22 (0.40-4.50)
Free T4 1.0 (0.8-1.8 ng/dL)
Free T3 2.7 (2.3-4.2 pg/mL)
T3, Total 83 (76-181 ng/dL)
T3 Uptake 31 (22-35%)
T4 (Thyroxine), Total 6.6 (4.5-12.0 mcg/dL)
Free T4 Index (T7) 2.0 (1.4-3.8)
Thyroid Peroxidase Antibodies 2 (<9 IU/mL)
Thyroglobulin Antibodies <1 (< or = 1 IU/mL)
T3 Reverse, LC/MS/MS 17 (8-25 ng/dL)

I don't know what the numbers should be but the numbers seem like they are within that specified range, so does that mean that they are all normal and that my thyroid is not the cause of what has been going on w/ my body.  I have a Dr. appt coming up soon and I'll be bringing my blood work results with me but I need to have some type of personal knowledge before hand.

[gimel]

The biologically active thyroid hormones are Free T4 and Free T3, not Total T4 and Total T3.  The amount of FT4 and FT3 that is available is dependent on TT4 and TT3 levels as well as the amount of Thyroxine Binding Globulin which, in turn is affected by other variables.  So what I mean is that it is far more useful to know FT4 and FT3 than if you only know TT4 and TT3.  Also, since the TPO ab and TG ab results were negative, there is nothing apparently wrong with her thyroid gland.  It is most likely that there is a dysfunction in the hypothalamus/pituitary system resulting in TSH levels that are inadequate to stimulate enough thyroid hormone production.  

[moonlightdance]

I wanted to give an update.  The doctor I went to was great and actually listened to me instead of just looking at test results. He started me on a low dose of Nature-Throid last month and wanted me to come back into the office in about 8 weeks to evaluate whether that dosage is right for me (It's not btw, I can tell that it's much too low of a dose based on the way I'm feeling still).  

My 2nd appt to see him again is next month, hopefully when he adjusts the dosages at that appt he doesn't have me wait 2 months again before readjusting it if necessary, it seems to me that a month of adjustment to a new dosage would be enough to know if the dose is right or not, maybe not though.

[telus2]

Hi Moondancer
I'm sure you are aware that Naturethroid is natural desiccated thyroid (NDT). I do hope that your doctor has experience with it.

If you have not already done so, I strongly recommend that you read this article about NDT: "19 Mistakes Patients Make (or their Doctors make for them!)"  
The key points to start with are numbers 2 and 13.

I will try to briefly explain the problem with too low a dose. You can see from your previous lab results that your natural thyroid was definitely producing some thyroid hormone, just not quite enough. So your doctor may have started you with a low dose to "top-up" your natural production. But when you reach a certain level of NDT, the T3 in the NDT is fast acting and will make your TSH go quite low (lower than with your natural T3). When your TSH goes very low, your natural thyroid stops producing.

For argument sake, let's say that the small NDT dose you are taking is less than what your natural thyroid was producing, but it is big enough to suppress your TSH and turn-off your natural thyroid production. You can see that in this situation, you would now only be getting the hormone from the NDT which is less thyroid hormone than when you started the NDT, that is, you would be more hypo.

This is a common occurrence with NDT and unfortunately some doctors do not know this. If this happens then you need to be taking a "full replacement dose" of NDT. To make matters worse, some doctors will look at the very low TSH and refuse to give you more NDT and you can end up worse off than when you started.

So while NDT can work, you need to be working with an experienced doctor and/or be very familiar yourself.

good luck.

[telus2]

I do not agree that Total T3 and Total T4 are not very useful. They should be at about the middle of the range (at 50% of the range).

The middle of the Total T4 range is 8.25. Your Total T4 is 6.6, which is only at 28% of the  4.5 - 12 range.
The middle of the Total T3 range is 128.5. Your Total T3 is 83, which is only at 7% of the 76 - 181 range.
Both of these results are abnormally low.

I think what needs to be determined before you start to take any medication - is why are these numbers low? What is wrong with your thyroid??

Another thing I would watch for is:  are you in the midst of rapid changes happening to your thyroid? You might get follow-up tests in a month to see if there is any big change.

You might ask your doctor to refer you to an endocrinologist; however many endocrinologists will be as unhelpful as your family doctor.

[moonlightdance]

telus2, thanks for your input and suggestions, I really appreciate it.  I have a new Dr. appt w/ a different doctor next month, hopefully that appointment goes much better than the first.  I'm hoping that this doctor can figure out what is going one with me medically and give me some relief from it.  I've read of so many people on various online forums talking about how hard it was to find a good thyroid doctor and many of them had to visit 4 or 5 doctors (or more) until they finally found one that would help them.  I really hope that's not the case for me.

[gimel]

Due to the influence of the AACE and the ATA, most doctors prescribe T4 meds like Synthroid or Levoxyl, which is conveniently taken only once a day, due to the long half life of T4 med.  Those are okay as long as the patient's body adequately converts the T4 to T3.  If not, in order to raise the Free T3 level enough to relieve symptoms, it becomes necessary to either add a T3 med like Cytomel, or switch to a desiccated type like Armour Thyroid, which contains both T4 and T3.  

[moonlightdance]

gimel, thank you for your previous help.  I wanted to give you a quick update.  I went to the Dr. appt (he was a family Dr.) he said that my TSH and FT4 numbers were "fine" and in range.  Nothing I said seemed to change his views so the appt ended and I left disappointed and unsure what to do next.

I had read online that your blood work numbers can be different if the blood is drawn first thing in the morning,  so I ordered my own lab work and did the testing first thing in the morning when the lab opened.  Here are those results, I'm unsure if these numbers are better than the first ones I posted from just a few weeks ago or not.  

newest test-
TSH   2.77  (0.40-4.50)
Free T4   0.9  (0.8-1.8 ng/dL)
Free T3   3.0  (2.3-4.2 pg/mL)

[moonlightdance]

Also, I was very surprised that my TSH result was so different from the first test  a couple weeks ago, is that strictly because this time I tested first thing in the morning before eating, or is that normal for it to fluctuate that much depending on the time of day?

[gimel]

Just tell the doctor that you would like to be treated clinically as needed to relieve symptoms, by adjusting Free T4 and Free T3 levels.  Also, ask to be tested for Vitamin D, B12 and ferritin.  Those are very important for a hypo patient.

Last, be sure to at least read the first two pages of the paper linked in the above link.  

[moonlightdance]

gimel, thank you so much.  You have been very helpful and I really appreciate it.

[moonlightdance]

Another question for you.  If the Dr. prescribes me meds, is there any kind in particular that you recommend to start with? Thanks again :)

[gimel]

In the words of a good thyroid doctor, "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."  

Symptoms should be the most important consideration in diagnosing a potential hypothyroid patient.  You have many symptoms of being hypothyroid.  In addition the lab test results for free T4 and Free T3 fit the pattern of being hypothyroid, even though within range.  The ranges are far too broad to be functional across their entire breadth, for everyone.  The test results for T3 Uptake, Total T3 and T4, and Free T4 Index are outdated and not very useful.  

From your symptoms, your Free T4 and Free T3 and TSH I'd say that you have central hypothyroidism.  With central there is a dysfunction in the  hypothalamus/pituitary system resulting in TSH levels that are too low to adequately stimulate output of thyroid hormone from the gland.  

You are going to have to find a good thyroid doctor that will treat clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  I say that because from treatment your TSH will typically become suppressed below range, which causes some doctors to erroneously diagnose hyperthyroidism.  It is  hyperthyroidism only if there are hyperthyroid symptoms due to excessive levels of Free T4 and Free T3.  

Based on the outdated testing done by your doctor I am not optimistic that he will be a good thyroid doctor; however, you can get some useful info from the link in the following and give it to your doctor and see if he is willing to treat clinically as described above. If not you will need to find a doctor that will do so.

http://www.medhelp.org/user_journals/show/2019570/Diagnosing-Treating-Hypothyroidism-A-Patients-Perspective?personal_page_id=12021

[moonlightdance]

Thanks gimel, my appt is tomorrow afternoon (Thursday).  You're not the only person that said to have the Dr. put a lot of focus on the Free T3 and Free T4 levels and not as much on the TSH levels right now.  I don't have a lot of knowledge of thyroid issues and so I hope the Dr will at least listen to any suggestions that I have. Do you have any pointers for me, any ideas on what I should suggest to the Dr. regarding my care.

[gimel]

I would take both.   Good thyroid doctors will not be swayed by slight differences in the results.  Your symptoms and less than optimal FT4 and FT3  levels should be clear evidence that you have central hypothyroidism and need thyroid med.

Any possibility of getting tested for Vitamin D, B12 and ferritin now and supplementing as needed toward optimal.  That might help get you on the road to feeling better while waiting for the appointment.

[gimel]

I just sent you a PM with info.  To access, just click on your name and then from your personal page, click on messages.

[moonlightdance]

Thanks, I got your PM

[moonlightdance]

Wondering if I should take both tests results with me when I go for my appt., would the 2nd results help me or hurt me?

[gimel]

TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  Tests have shown that TSH has a Circadian Rhythm and can vary as much as 70% over the whole day.  The only real value for TSH is to identify overt hypothyroidism (TSH > 10) and to distinguish primary from central hypothyroidism.

Both tests show that your Free T4 is too low in the range.  It should be mid-range at minimum for best effect.  Your Free T3 results likewise are lower than many people need to relieve hypo symptoms like you have.  

So at this point you need to see a good thyroid doctor that will treat clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant  TSH levels.  Symptom relief should be all important.  Also since hypo patients are so frequently low in Vitamin D, B12 and ferritin.  Those should be tested and supplemented as needed to optimize.  D should be 50 min., B12 in the upper end of its range, and ferritin should be about 70 min.

If you will tell us your location perhaps we can suggest a doctor for you that has been recommended by other thyroid patients.  

[moonlightdance]

I'm in Oakland County, Michigan.  How do I even go about finding a doctor that will treat clinically instead of only going by my TSH levels?

[moonlightdance]

I'm in Oakland County, Michigan.  How do I even go about finding a doctor that is known to treat clinically instead of only using TSH levels?

[moonlightdance]

Sorry for the double post, I didn't think it posted the first time

[moonlightdance]

I wanted to add to my post that I'm a 45 year old female