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Test Result Interpretation
Hello. I’m 28 and have had symptoms of hyperthyroid all of my life including anxiety/nervousness, excessive sweating, rapid increase in heart rate when nervous or doing physical activity, hand tremor, heat intolerance, fatigue, and have always been skinny despite eating a lot. My mom had her thyroid removed when she was young due to similar problems and goiter/tumor so I finally decided to get some blood work done. If anyone could help me interpret the results I would really appreciate it. It seems these numbers are within the ranges the lab gave, but I wanted to see if anything looked off to anyone as I don’t have any prior experience with this.
Reverse T3 22.4 (9.2-24.1 ng/dL)
TSH 2.47 (0.45-4.5 uIU/mL)
Free T3 3.5 (2.0-4.4 pg/mL)
Free T4 1.57 (0.82-1.77 ng/dL)
Antithyroglubulin AB (TgAb) < 1 (0.0-0.9 IU/mL)
Thyroid Peroxidase Antibody (TPO) 18 (0-34 IU/mL)
Thyroid Stimulating Immunoglobulin (TSI) 18 (0-139 %)
Thyroxine Binding Globulin (TBG) 13 (13-39 ug/mL)
Reverse T3 22.4 (9.2-24.1 ng/dL)
TSH 2.47 (0.45-4.5 uIU/mL)
Free T3 3.5 (2.0-4.4 pg/mL)
Free T4 1.57 (0.82-1.77 ng/dL)
Antithyroglubulin AB (TgAb) < 1 (0.0-0.9 IU/mL)
Thyroid Peroxidase Antibody (TPO) 18 (0-34 IU/mL)
Thyroid Stimulating Immunoglobulin (TSI) 18 (0-139 %)
Thyroxine Binding Globulin (TBG) 13 (13-39 ug/mL)
It could be a pituitary issue. Your TSH is a little high relative to your FT4 at 79% of range. When FT4 gets to that level, we'd expect your TSH to be very low, close to zero. There are pituitary issues that wouldn't show up on a scan, also, like pituitary resistance to thyroid hormone (PRTH).
I haven't had the ultrasound, but would like to so I can rule out/find any tumors. A person on another forum advised me to get scans of my pituitary/hypothalamus if other tests don't give good leads. I would consider the same for thyroid and maybe adrenals.
My mother says she was pretty young and doesn't know what she had but that they removed a goiter that was causing her to choke due to restricted airway.
My mother says she was pretty young and doesn't know what she had but that they removed a goiter that was causing her to choke due to restricted airway.
If your symptoms tend to come and go, your numbers could be fluctuating, which they often do in the early stages of autoimmune disease. Another set of labs, this time when you are symptomatic (if possible) would be helpful.
Antibodies should be close to zero. However, thyroid antibodies tend to be very high if you have autoimmune thyroid disease. So, a slight, within range, elevation really isn't conclusive.
RT3 is probably at the high end because your FT4 is high. The body only has two ways to get rid of excess FT4; it can convert it to the active FT3 or the inert RT3. Converting more to RT3 is the body's defense. Also, the higher the FT3:RT3 ratio, the more likely you'd be to have hyper symptoms. (You are correct that your ratio is 15.4.) So, a low ratio doesn't explain hyper symptoms. When I first started reading about FT3:RT3 ratio, the used to say the reference range was 10-20 approximately, the higher in the range, the better. Now, it has to be over 20, and I suspect that's a good thing taken overboard.
Have you had a thyroid ultrasound?
Do you know if your mother had either Hashi's or Graves'?
Antibodies should be close to zero. However, thyroid antibodies tend to be very high if you have autoimmune thyroid disease. So, a slight, within range, elevation really isn't conclusive.
RT3 is probably at the high end because your FT4 is high. The body only has two ways to get rid of excess FT4; it can convert it to the active FT3 or the inert RT3. Converting more to RT3 is the body's defense. Also, the higher the FT3:RT3 ratio, the more likely you'd be to have hyper symptoms. (You are correct that your ratio is 15.4.) So, a low ratio doesn't explain hyper symptoms. When I first started reading about FT3:RT3 ratio, the used to say the reference range was 10-20 approximately, the higher in the range, the better. Now, it has to be over 20, and I suspect that's a good thing taken overboard.
Have you had a thyroid ultrasound?
Do you know if your mother had either Hashi's or Graves'?
Thanks for your reply and review, I was not particularly symptomatic at the time of the test. I wasn't sure about the antibodies since they were in the middle of the ranges but I guess 0 is ideal for those. I did notice the tbg is at the low end and the rt3 is at the high end. I was reading on sttm that the free t3 to rt3 ratio should be above 20 and I believe mine is like 15.4 so I don't know if these are good clues or not but I'm trying to learn more. I'm planning on seeing an endocronologist soon and have some adrenal and general blood tests ordered. Hopefully I can get some answers with all this and maybe a future thyroid panel to see if anything changes.
Your FT4 is a little bit high. It's at 79% of range, and the rule of thumb for FT4 is 50%. FT3 is 46% of range, a little low of the 50+% recommendation, but nothing that would cause most people any symptoms.
TPOab is negative, but isn't zero, which could indicate something else autoimmune is going on. People who have Hashi's often have TPOab in the high hundreds or even thousands. TSI is tricky to interpret. 139% is the number at which most people will start feeling hyper symptoms. In fact, some feel them with lower TSI, some higher. TSI, if you don't have Graves' Disease, should be less-than 2%.
Were you having symptoms when this blood was drawn? Do your symptoms tend to come and go?
TPOab is negative, but isn't zero, which could indicate something else autoimmune is going on. People who have Hashi's often have TPOab in the high hundreds or even thousands. TSI is tricky to interpret. 139% is the number at which most people will start feeling hyper symptoms. In fact, some feel them with lower TSI, some higher. TSI, if you don't have Graves' Disease, should be less-than 2%.
Were you having symptoms when this blood was drawn? Do your symptoms tend to come and go?
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