Thyroid Disorders Community
Test result questions
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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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Test result questions

Hi everyone. I've been trying to figure out what's been going on with my health for years. I have many of the classic hypothyroid symptoms, Mother is hypo, Grandfather was hypo, and my waking basal temp is 96.6 at it's highest. I've been getting my tsh tested regularily and it's been within range except last year it came back at .03. I just had my labs done again and here are the results:
T4 free 1.31
TSH 1.060
Reverse T3 34.4
TPO 11
Triiodothyronine free 3.2
Any insight here? Can I rule out thyroid dysfunction? Any input would be appreciated.
Thanks!


18 Comments Post a Comment
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649848_tn?1357751184
TSH is volatile and fluctuates greatly, even intraday, so that's not a good measure of thyroid function.  We do need to know the lab reference ranges for your results, since ranges vary lab to lab, so must come from your own report.  That said, if your ranges are similar to what we usually see, all of your thyroid results look good and I'd say you probably don't have a thyroid condition, but you still could.

You should have a thyroid ultra sound to check for thyroid nodules.  TPO is an enzyme used to produce thyroid hormones.  Is that the test you had or did you really have TPOab, which tests for thyroid antibodies?  You also need to have Thyroglobulin Antibodies (TGab), in order to definitely rule out Hashimoto's, because some people have only TPOab, others only have TGab, and still others have both.  Positive test for either TPOab and TGab would indicate Hashimoto's Thyroiditis, in which case, you would figure that your thyroid function will decline over time.  Symptoms often show up long before labs indicate an issue.

There are some vitamin deficiencies that can cause hypo-like symptoms. These include vitamin B12, D, calcium, magnesium, iron.  

"I have many of the classic hypothyroid symptoms"   Which ones?  
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1756321_tn?1377771734
Youtube search - "Hypothyroidism Type 2: Myxedema Symptoms" for a demonstration of the pinch test.

"Medical textbooks about hypothyroidism state that myxedema is thyroprival (pertaining to or characterized by hypothyroidism) and pathognomonic (specifically distinctive and diagnostic). Translation: if the thickened skin of myxedema is present, you have hypothyroidism. Normal skin is relatively thin, and you may easily lift it with your thumb and index finger. If you look, you’ll find a number of people whose skin is almost impossible to lift. This is due to the marked swelling and glue-like infiltration of mucin in the skin and underlying tissues that result from hypothyroidism. Women’s skin usually has slightly more subcutaneous fat than men. Hence, their skin tends to be thicker. There are many different degrees of myxedema.

Unfortunately, even if your skin is of normal thickness, you may still have hypothyroidism. It is only one of many signs of this condition. This diagnostic clinical finding has been forgotten, usurped by the almighty thyroid blood tests. Mucin is a normal constituent of our tissues, and its accumulation is often increased with hypothyroidism. However, the accumulation of mucin may only affect the internal organs and tissues and spare the skin. You may have hypothyroidism despite having normal skin."

Excerpt from Forumotion - "Myxedema"

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Avatar_m_tn
Is there a particular characteristic site or place on the body to do this "pinch test"?  Say on the forearm or doesn't it matter?
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Avatar_f_tn
I agree that if your FT4 range is approximately 0.8-1.8, your thyroid function looks good.  

Thyroid 101:  T4 is the "storage" form of the thyroid hormones and must be converted to T3, the active form, before it can be used by cells.  This conversion process is technically not a thyroid process, but a metabolic process, and takes place mostly in the liver and kidneys.  The body has only two ways to get rid of excess T4, either convert it to T3 or to R(everse)T3.  RT3 is inert.  

The only significant number I see in your labs is the RT3.  Relative to your FT3, it looks a little high.  RT3 can rise due to any number of factors, among them certain illnesses, trauma, surgery, stress, starvation (or extreme dieting), etc.  When too much RT3 is produced relative to FT3, you can be hypo at a cellular level even though your thyroid is perfectly capable of producing hormones.

RT3 is a controversial subject with many mainstream doctors who "don't believe" in it.  Research is somewhat lacking and contradictory.  You might want to research "RT3 dominance" to see if you have any of the risk factors for it.  

Good luck!    
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Avatar_m_tn
Thanks everyone. Red-Star, I did read the book Hypothyroidism Type 2, and it makes so much sense. I could relate with just about everything including Myxedema. I just cant get beyond my labs being so normal. I don't want to go the alternative medicine route either if my labs show no problems. I was just hoping that the labs revealed something that we were missing. I'm just soooo tired physically and mentally. My Mom said she felt the exact way before she got on synthroid. I guess we'll just keep looking. Thanks again and God Bless. I pray everyone finds healing.
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649848_tn?1357751184
Have you been tested for vitamin deficiencies?  B12 deficiency can cause that type of exhaustion -- even worse than hypo. It can also cause brain fog and other hypo like symptoms.

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Avatar_m_tn
Where in Penn. are you located?
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Avatar_m_tn
If you Google  "Thyroid pinch test” there is a couple of good YouTube videos showing how it is done and yes it is best done in the upper outside of the arm.

It’s quite interesting too…I have thickened skin in that area but just slightly below it and into my forearm the skin is loose… I tried it on my girlfriend and another friend (who is a bit on the heavy side) and who do not have hypothyroidism and their skin pulls away easily. Even on my fat buddy you can feel the difference between his skin and the fat below ;)… but on me (and I’m relatively thin and have been most of my life except the extra 12 lbs. I’ve gained since going hypo) the skin on my upper arm feels like it is a good half inch thick …like it is attached to my muscle. Quite strange!
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1756321_tn?1377771734
I have severe myxedema and cannot pinch any skin anywhere except the tops of my hands to some degree.  I have puffiness everywhere, thickened nose, swollen lips, very enlarged tongue, extreme non pitting edema all due to mucin build up. Okay the lips i'm happy with...but the nose! jeez lol

I've had hypothyroid symptoms for over 24 years.  I have had cellular resistance issues for decades (no labs change) and Hashimoto's thyroiditis (labs showed up subclinical hypothyroidism this year). In reality i have severe hypothyroid symptoms. My doctor calls me a strange case.

The outside of the upper arm is where this pinch test is typically done, as ktr19 also mentioned, although you could pinch your leg, belly etc to see if there are any signs of myxedema.  I can see this being a good excuse for pinching someones behind; I was checking for hypothyroidism. lol!
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Avatar_m_tn
" I can see this being a good excuse for pinching someones behind; I was checking for hypothyroidism. lol! "

Haha.. you say that but ironically that is one of the first signs I had of being hypo…  not from being pinched,  but simply my butt would be cold!

But I think were off topic!  ;)
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1756321_tn?1377771734
Butt (lol) it's a fun topic hehehe.
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Avatar_m_tn
When you say upper arm. You are refering between your elbow and shoulder correct?

It is odd.  On me below the elbow my skin will clearly separate from below and feel quite thin.  At the bicep, the skin feels three times thicker and i can't really pinch skin.  Upper thigh is also not a problem.

I will have to give this a try on my wife to see how her skin reacts to this pinch test.  

Joejo, as stated above. One of the classic signs of revers T4 dominance is the fact that all the blood labs look normal but you still suffer from Hypo.  The one theory here is that the RT3 molecule is a mirror image and "looks" so much like the FT3 molecule that the body's cells will accept the RT3 molecule thinking that it is instead FT3.  But since RT3 is inert, it does NOT do anything.  Now that one receptor is "plugged" by an RT3 molecule and can not accept the FT3 molecule it needs.  So with more and more RT3 in the blood, the more and more receptors are taking up vacancy's and there simply is not enough vacancies for the biologically active FT3 go anywhere or do any work.  The result is that there appears to be plenty of FT4 and FT3 in the blood. But neither of them are doing much.  The FT4 is being converted at too high a rate into RT3, and that RT3 is plugging up the receptors leaving the FT3 to remain "available" but having no place to go in the blood.  So it APPEARS your thyroid levels are fine and your problems can NOT be Thyroid.  However it is the elevated RT3.  But since most Drs will not even test for RT3, there is no way to know that.  And as previously stated, many Dr's don't believe in this RT3 theory anyhow.

All I can say is that several people here have reduced their FT4 medication and increased their T3 medication, thus less T4 to be incorrectly converted into RT3 and also inflate the amount of FT3 available, and they feel better.  Thus through this anecdotal testimony's would seek to confirm the theory of the plugged receptors.
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Avatar_m_tn
"When you say upper arm. You are refering between your elbow and shoulder correct?

It is odd.  On me below the elbow my skin will clearly separate from below and feel quite thin.  At the bicep, the skin feels three times thicker and i can't really pinch skin.  Upper thigh is also not a problem"

Yep, the upper arm on the outside between your bicep and triceps … and mine is the same way… near the elbow and on the forearms I have loose skin but not the upper arm.

No wonder a couple of years ago when I was really hitting the weights, I could not get that cut look in my upper arms.

Maybe when I get my meds correct I’ll hit the weights a little harder to see what happens!
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1756321_tn?1377771734
I should add i have plenty of fluid retention which is also a cause of severe odema.
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Avatar_f_tn
Have you had your cortisol tested?  I have same symptoms and have recently found out that cortisol can make one have hypothyroid symptoms.  I haven't spoken to my doctor yet, but its worth looking into.
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Avatar_m_tn
This is in response to your post dated August 30,2012, regarding your test results being normal.  You should read the book "Healing is Voltage" by Jerry Tennant, MD, MD(H), MD(P).  It is an amazing book!  According to him, fluoride displaces iodine and produces a fake thyroid hormone which shows up in labs as thyroid hormone, but does not ACT like one.  He also explains the mucin that gathers in the body that appears as fat that we can't get rid of (losing weight), it's not fat, it's mucin.  The book has so more detailed information.  God bless.
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Avatar_m_tn
It does sound like you are hypothyroid. Was that Dr Mark Starr's book Hypothyroidism Type 2: the epidemic you read? If not I highly recommend it. Most of us are hypothyroid due to the displacement (and lack of replacement) of iodine in the body's cells. It is displaced by fluoride and chlorine which are both still in too many water supplies, and by bromine which is used in foods, "medicines" and clothing furnishings etc as fire retardants.  Hypothyroidism symptoms include poor sleep, aches and pains (chronic), repeated infections, sensitivity to the cold, depression, mucin in the skin, dry itchy skin in winter, brain fog, and the list goes on. Dr Starr says the thyroid bloods are not reliable. At the thyroid Summit in June (2014) nearly all the presenters said the thyroid blood tests alone were not reliable in detecting hypothyroidism and they assessed the patient's symptoms and account of their feelings as well as Dr Broda Barne's practice of basal body temperature and yours is too low. You should start by supplementing with iodine/iodide 12.5mg/day and build upwards. Then after a month or two take ashwagandha as well - it works really well and I think it is better than taking thyroid hormones, but keep up the iodine.
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Avatar_m_tn
It does sound like you are hypothyroid. Was that Dr Mark Starr's book Hypothyroidism Type 2: the epidemic you read? If not I highly recommend it. Most of us are hypothyroid due to the displacement (and lack of replacement) of iodine in the body's cells. It is displaced by fluoride and chlorine which are both still in too many water supplies, and by bromine which is used in foods, "medicines" and clothing furnishings etc as fire retardants.  Hypothyroidism symptoms include poor sleep, aches and pains (chronic), repeated infections, sensitivity to the cold, depression, mucin in the skin, dry itchy skin in winter, brain fog, and the list goes on. Dr Starr says the thyroid bloods are not reliable. At the thyroid Summit in June (2014) nearly all the presenters said the thyroid blood tests alone were not reliable in detecting hypothyroidism and they assessed the patient's symptoms and account of their feelings as well as Dr Broda Barne's practice of basal body temperature and yours is too low. You should start by supplementing with iodine/iodide 12.5mg/day and build upwards. Then after a month or two take ashwagandha as well - it works really well and I think it is better than taking thyroid hormones, but keep up the iodine.
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