Throid test results

[rklein]

Hi!  I have had recent blood work-up again and was just wondering in your opion if you thought my thyroid was a little low even though "in the range" of normal?  It came back lower than the last and is at .97 for the T4  free direct and the Tsh is 1.750.  She didn't run the T3 for some reason but 7 months ago that ran 1.39.  My B-12 was at 224 which she thought was low so started me on the B-12 shots.  I have been feeling very tired along with just basic muscle tiredness.  Tingling in fingers and cramping in feet and upper thigh area.  My hemoglobin and hematocrit was up just a little at 15.2 for hemoglobin and 44.5 for hematocrit.  Bilirubin up to at 1.3 from 1.1 7 mos. ago.  I guess I'm just wondering if these all seem a little low or in the more normal range.  I have so many symptoms of having a low thyroid but she say's it's still in the normal range therefore doesn't feel I need anything for it but I've read many articles on how it can show low to normal results and med's might help.  Can you give me your opinion on this?  Thanks so much.  Oh and almost forgot but I'm a female age 48.

[Barb135]

Yes, low vitamin D can cause some of those symptoms and it would be good for rklein to get that checked if she can; however, when one has vitamin B12 levels as low as hers, along with possibly low thyroid levels, it might be best to get those things on track asap.  I'm a firm believer in taking things one step at a time; it might take longer to get where you are going, but if you make a bunch of changes all at once, you don't know which helped which symptoms.  

[lmosall]

Iv'e read all the postings above, and didn't see anything mentioned about Vitamin D being tested...low, this will also produce excessive tiredness and fatigue like symptoms, along with muscle cramps and twitches. (as was mentioned with magnesium).

[Barb135]

I totally agree with goolarra about the symptoms of the thyroid issue and pernicious anemia can overlap.  

For me, the biggest thing with the pernicious anemia was the never ending fatigue - for many years; then came the tingling/numbness in my hands, arms, legs, feet.  

I was started on the B12 shots at the rate of 1 shot/week for 4 weeks, then dropped down to 1 shot per month.  The one shot per month was not enough; within a week I would start going downhill again.  Eventually, my pcp let me go to every 2 weeks because my levels would never come up more than 1/2 way in the reference range.  It will take several weeks for your levels to build up enough for you to feel much effect from the shots.

The first, worst symptom of my thyroid issues was the weight gain AND fatigue.  When the B12 shots just "didn't do it", I asked to have my thyroid levels tested and sure enough, my TSH was 55+ and my FT4 was very low.  

Trying to get both my B12 levels and thyroid levels to a point that was good for me has been a struggle, but I think I'm finally getting there.  I've recently been able to up my B12 shots to once/week and I've also gotten an increase in thyroid med.  WooHoo!!

You asked about the "free" for the blood tests.  Some of both T3 and T4 is bound by proteins and is unusable; that's why testing levels of total are pretty useless, because that only tells the total amount of hormone, but not how much is bound by protein.  Getting the "frees" tested will tell you how much hormone in your blood is available for conversion (T4) or what is available for immediate use (T3).

I'm sorry, I'm not familiar with low testosterone levels, so can't help you much there.

[goolarra]

I think most researchers say that Hashi's "runs in families", which I belive is the terminology they use when it's pretty certain that it's genetic, but that hasn't been proven.  Making your doctor aware of the familial connection to thyroid disease should be enough for her to order the antibody tests.  Once doctors know that you have an actual "disease" (proven by bloodwork), they are often more inclined to treat levels that are "in range", but low.

It would also help to distinguish what might be thyroid related and what might be due to the low B12 levels, since many of the symptoms can be the same.

[rklein]

What does the "free" mean Barb?  I was also wondering if the B-12 could be causing some dizziness and light headed feelings?  I haven't just felt the best since getting it but in all fairness I could just be feeling the drop in the B-12 and the shot may have not had enough time to replenish.  Did you have any side effects at first?  I should mention too that she also gave me a shot of testosterone because that level was very low and I did tell her I have had no sex drive what so ever.  That is a series too I believe because she said I'll get another next week along with the B-12.  I didn't realize you could give yourself a B-12.  That would make the most sense.  I've been reading about the pernicious anemia and find that interesting too with the symptoms.  I'll keep reading.  Thanks for your input on this.  I like to hear what others experience and you just learn so much.  

[rklein]

That's interesting you say it does seem low to you too.  I have so many symptoms that would make it seem reasonable to be on meds or at least try it to see if it would help.  I have been seeing my doctor's NP for the last several visits so maybe I should see the doctor next time (they like to rotate) and talk to her about those levels and I don't see the antibody test on my test so that makes me curious as well.  I'm not sure if heritary my mom who passed away two years ago had thyroid problems and both her sisters and my own sister has it too.  Thanks so much for your input.  It's just nice to hear someone else who has experience in this talk about it.

[Barb135]

I've had pernicious anemia for the better part of my life (was first dx'd with it in 1976), but like most diseases, it can show up most any time.   Your levels really did drop like a rocket didn't they?  Did your doctor mention pernicious anemia or did she suggest other reasons for your B12 to drop?  There are other things that can cause B12 levels to be low.  

I'm sure the shots will help you; they do me and I can sure tell if I miss one.  If you are going to be staying on the shots, you might want to learn how to self-inject; it's not hard to do and a lot cheaper than going to the doctor's office.  

Whenever asking for T3 and/or T4 tests, do make sure you ask for the FREE, not total.  

[goolarra]

The antibodies are called thyroid peroxidase antibody (TPOab or microsomal on lab reports sometimes) and thyroglobulin antibody (TGab).  If either or both of these is elevated, autoimmune thyroid disease is indicated.

Your FT4 is quite low...it's in the bottom quarter of the range, and the rule of thumb for FT4 is midrange.  Are you on any thyroid meds?

I'll let Barb respond to you about pernicious anemia...she knows a lot more about it than I do.

[rklein]

Thanks goolarra for your response.  I posted to Barb135 above regarding my reference ranges from the lab.  They seem to me to be "low" normal but with your response on the autoimmune diseases I don't know if she has done that.  Would that show differently that T4, Tsh, & T3?  Those are the ones that I can see on the report.  What would it say?  

[rklein]

Thanks Barb for the info.  I'm not sure why she didn't run the FT3 this last time.  According to my lab report it was "low" normal since the in mine it ranges from .450-4.500 (mine was 1.750 for the Tsh.  which was higher back 7mos ago at 2.440.  The T4 free was .97 and their range is .82-1.77.  So I guess according to the lab my doctor used it does look like low normal.  Regarding the B-12 deficiency for Pernicious Anemia, is that something that could show up as we age or is it something your born with?  I've never had a problem before but in the last 7 mos it did drop to 224 from 864.  I go back for second shot next Friday and am going to ask her to check the T3.  May I ask what your symptoms were before being diagnosed with the Pernicious Anemia?

[Barb135]

Pernicious Anemia (B12 deficiency/inability to absorb B12) can cause the tingling, as well as numbness.  I had that (pernicious anemia) for years before I was started on B12 shots and have some permanent damage due to being untreated for so long.  I still have the pernicious anemia (take shots weekly), but most of the tingling is gone.

Lack of magnesium can cause a lot of muscle aches, as well as foot and leg cramps.  I was up most of last night with the cramps because I have not been faithful in taking my magnesium capsules.  Thyroid issues can also cause these things.

I would have to second goolarra's question in regards to the reference range of the FT4; according to the range my lab uses, your level would be "low normal", but as goolarra said, reference ranges vary from lab to lab, so must come from your own report.  

Is there any way you can get your doctor to run an FT3?

[goolarra]

What's the range on your FT4?  Ranges vary from lab to lab and have to come from your own lab report.

Have you ever had thyroid antibodies tested to see if you have autoimmune thyroid disease (Hashimoto's thyroiditis)?

Has your doctor diagnosed you with pernicious anemia (inability to absorb B12)?  Pernicious anemia is an autoimmune disease, like Hashi's, and once you have one autoimune disease you are more likely than the general population to develop a second.