How to interpret Thyroid Blood results?

[Hades99]

I have an enlarged thyroid with cysts (had ultrasound 15 years ago). I also have many Hypo symptoms. My recent blood results are as follows:

Free T4 - 20pmol/L
TSH - 0.94mIU/L
Thyroperoxidase Antibodies - 47 U/mL

I am aware there are other thyroid tests but my doctor did not order them.

From what I can tell these results all fall within "normal" levels, so why do I feel so crappy?

Can anyone please fill me in with more information please.

[gimel]

In trying to assess a person's thyroid status, the most important consideration is symptoms.  Symptoms should then be confirmed by biochemical tests.  You have a number of symptoms that are frequently related to hypothyroidism, but you would have difficulty getting most doctors to diagnose hypothyroidism due to your Free T4 being at the very top of the range, and your TSH being .94.  Those tests do not indicate that you should be hypothyroid; however, contrary to what most doctors believe hypothyroidism is not just "inadequate thyroid hormone levels", correctly sensed by the pituitary,  which then secretes TSH.  Hypothyroidism is actually caused by "insufficient tissue T3 effect in tissue throughout the body due to inadequate supply of or response to, thyroid hormone".  This definition more accurately reflects the numerous processes and variables that affect Tissue T3 Effect.   Your thyroid status as to being hypothyroid, euthyroid, or hyperthyroid is dependent on the level of Tissue T3 Effect.  

So what does all this mean for you?  Mainly it means that need additional test data to be able to reach even a tentative conclusion of hypothyroidism.  You can read about this in the following link.  I suggest reading at lest the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.  In the paper you can see in Fig. 1 on page 7 all the various processes and variables that affect Tissue T3 Effect.  

http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf

So you need to get your doctor to do some additional tests.  From the link you can note that you need to always test for both Free T4 and Free T3 every time you go in for tests.  You already tested for TSH and antibodies, so I recommend testing for Reverse T3 at least once in order to calculate the Free T3 to Reverse T3 ratio, to determine if adequate.    In addition, you need to be tested for cortisol since it is an antagonist of thyroid.  Also,  hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin so you need to test those and if deficient then supplement as needed to optimize.  All of these are important.  If you will get those done and then post results and reference ranges here, then we will be happy to help interpret and advise further.  If the doctor resists doing these tests then show him the paper, explain their importance, and insist on all of the tests.

[gimel]

For any of us to give you a useful response we need to know the reference ranges shown on the lab report for those results.   Also, please tell us the specific symptoms you are having.  

[Hades99]

Sorry!

Free T4 - 10pmol/L  Ref. Range (10-20)
TSH - 0.94mIU/L Ref. Range (0.30-4.00)
Thyroperoxidase Antibodies - 47 U/mL Ref. Range (<60)

Low immunity, V.Low sex drive, Irregular periods, short term memory fogginess, Constipation, Dry skin, brittle nails, difficulty losing weight, swollen throat glands, visible enlargement of thyroid, mild sore throat, hoarse voice, strange aches and pains.

Female, 37yo

[Hades99]

Sorry free T4 is measured at 20