when to start medicine eltroxin

[assistpls]

I am a 52 year old female.
TSH in 2009: 5.96. (Reference range:0.35-5.5)
TSH in 2011: 4.56. (Reference range:0.45-4.5)
On 28 July 2013, TSH: 5.97 (Ref range: 0.3-5.5), T3: 119, T4: 9.1, Vit B12: 265,  Vit D: 8.44.
Took Vitamin D and B12 supplements & repeated tests on 10 Jan 2014 so TSH: 14.03 (Ref range: 0.3-5.5), T3: 108,  T4: 8.3, FT3: 2.81, FT4: 1.02, AMA<5, ANTI CCP= 0.47,  Vit D: 34.21, Vit B12: 862.
Stopped Vit D & Vit B12 supplements and repeated tests within 13 days on 23 Jan 2014 so TSH: 7.58 (Ref range: 0.45-4.5), T3: 106.51, T4: 5.99, FT3: 2.80, FT4: 1.03, TPO: 0.20, ATG: 0.95, Vit D: 27.5, VitB12: 504.
Never taken any thyroid medicines. Pls help whether to start any thyroid medicine or not and wht to do?

[assistpls]

Lipoprotein: 66.99 (range: should be less than 30)
ESR:90
ESR was 80 some years back, my doc gave some medicines.. maybe antibiotics & the ESR dropped to 40 in 2 days

[assistpls]

Maybe some additional tests detail would help:
As of Jan 10 2014:
High Sensitive C-Reactive Protein: 6.52 mg/L
(Range: less than 1 is low risk, 1-3 is average risk, >3 is high risk)
Lipoprotein

[assistpls]

My cholesterol levels as of Jan 10 2014 are:
Total Cholesterol: 149 (ref range 125-200)
HDL Cholesterol Direct: 63 (35-80)
LDL Cholesterol Direct: 63 (85-130)
Triglycerides: 90 (25-200)
Total Cholesterol/HDL ratio: 2.4 (3-5)
LDL/HDL ratio: 1 (1.5-3.5)
VLDL Cholesterol: 17.98 (5-40)
3-4 years back I had a minor heart pain, got to know there is 20% blockage, thus doc started medicines. Even before taking these medicines, cholesterol was within range but on the higher side. Probably that's the reason the doc started cholesterol medicines for me. However at that time my TSH was 5.9. Around 4 yrs back my blood pressure was very high of approx 200/90 which is now approx 130/80 after taking BP medicines.
Pls advise if it is required for me to take thyroid medicines

[assistpls]

Currently my cholesterol levels are:
Total Cholesterol: 149 (ref range 125-200)
HDL Cholesterol Direct: 63 (35-80)
LDL Cholesterol Direct: 63 (85-130)
Triglycerides: 90 (25-200)
Total Cholesterol/HDL ratio: 2.4 (3-5)
LDL/HDL ratio:

[Barb135]

Your lab is using a very strange range for the FT3... it's way too broad and your FT3 is pretty low in the range, as it is; if the range were more like what we normally see, you'd be even lower.

Rule of thumb is that FT4 should be approximately mid range and you're right there at 50%.  Rule of thumb for FT3 is upper half to upper 1/3 of its range.  Your level is only at 36%, which is a long way from optimal, but not everyone needs to have their level that high AND some people are comfortable with a higher TSH.  

High cholesterol is a symptom of hypothyroidism.  With the high cholesterol and TSH, it's possible that you're right at the beginning of being hypo, but it hasn't progressed to the point that you aren't producing hormones.  Many people see cholesterol levels come down once they start on thyroid medication.  You could start a trial dose and see if it helps bring your cholesterol down.  You may also have other symptoms that you might not recognize as hypo symptoms.  For instance, I didn't realize that the huge bags under my eyes were a hypo symptom, but they were the first thing to go away when I started on med.

You really need to get your vitamin D levels and stay on the supplement.  Vitamin D is necessary for the absorption of calcium.  You also need to stay on the vitamin B12 supplement to keep your level higher.  You don't have to take a huge dose, since it appears that you absorb it okay.

[assistpls]

Kindly assist as soon as possible please

[assistpls]

AMA on 10th Jan 2014 : <5 (negative: 34)

[assistpls]

Thanks a lot for your reply.
T3=Total T3, T4=Total T4, FT3= Free T3, FT4= Free T4.
Had Vit D powdered supplement in milk for 8 weeks i.e. 1 sachet per week and after these having a tablet daily (elemental calcium=500 mg & calcitriol=0.25 mcg). Both as per doc's recommendation. Will continue having this tablet.
I have no symptoms of thyroid. I did not even had when my Vit D was around 9. Just did my yearly tests & came to know my TSH numbers.
I am having medicines for blood pressure & cholesterol as well.
I am very confused as some doctors say I should start with the medicine ASAP whereas others say I should be in no hurry until TSH reaches 10 or until I have symptoms.
Here are the reference ranges:
In July 2013, T3=119 (range: 60-200),
T4=9.1 (4.5-12.0)
TSH=5.97 (0.3-5.5)
ANA=0.56 (negative=0.00-1.00, positive=more than 1)
On Jan 10 2014,
T3=108 (60-200)
T4=8.3 (4.5-12.0)
TSH=14.03 (0.3-5.5)
FT3=2.81 (1.7-4.2)
FT4=1.02 (0.7-1.80)
AMA= <5 (negative: 34)
On Jan 24 2014,
TPO=0.20 (upto 5.61)
ATG=0.95 (upto 4.11)
FT3=2.80 (1.4 to 4.4)
FT4=1.03 (0.8-1.8)
T3=106.51 (70-204)
T4=5.99 (4.87-11.72)
TSH=7.58 (0.45-4.5)
Your assistance is highly appreciated :)

[Barb135]

We need reference ranges for all of the tests.  Ranges vary lab to lab and have to come from your own lab report.  Also, are those Free T3 and Free T4 or are they Total T3 and Total T4?  Tests for the Total T's are considered obsolete and of little value. Anti-CCP is most prevalent in those with Rheumatoid Arthritis; I can't find a link to thyroid conditions, except that RA and some thyroid conditions are both autoimmune.

TPOab and TGab are the antibodies that would diagnose Hashimoto's; again, we need the reference ranges.

Your TSH has been consistently high, which is an indication that you need to be on medication, but we'd need to see where your T3 and T4 fall in the ranges.

Your vitamin D is also way too low.  You shouldn't have stopped the supplement.  Vitamin D deficiency can cause a lot of thyroid like symptoms.  You should continue supplementing until your levels get up to around 50-70.  What dosage were you taking?  It's safe to take up to 2000 IU, or get your doctor's recommendation.

Your vitamin B12 is also too low... even at 504.  Most ranges we see go up to around 1100 and some of us find that we have to keep our level at/near the very top in order to alleviate symptoms.  Since your level went up with supplements, that's an indication that you don't have Pernicious Anemia, but you should continue supplementing to keep your levels up.  Low B12 levels are often seen in those who are vegetarian or who eat very little meat, dairy, eggs, etc.