What do my lab tests mean - hashimoto thyroiditis?

[kris0s]

Hi everyone!
So, I had hyperthyroidism a decade ago and overcame it pretty quickly by including a lot of alternative medicine with my medication, went into remission 7 years ago and overcame it again in a couple of months.  I havent been on anything since then--have had good lab tests, and I got test results from today:

TSH 3.75 *mU/L, Reference: 0.38 - 5.33
T3 1.80 nmol/L , Reference: 1.34 - 2.73
T4  129 nmol/L, Reference:  78 - 157
FT3  5.1 pmol/L, Reference:  3.8 - 6.0
FT4 13.0 pmol/L, Reference:  7.9 - 14.4
Anti TG  25 H kU/L, Reference:  less than 4
Anti-TPO   > 976 H kU/L, Reference:  less than 9

So, my general doctor says its nothing and I think its hashimoto thyroiditis.  Im waiting for an app. with a specialist which might take a while.  A year ago I started having extreme 24/7 nausea, vomiting, fatigue, brain fog, forgetfulness, unable to sleep (gym and/or nature 5x a week and a strict paleo diet/API diet).  They did a bunch of lab tests, found nothing, and said I had anxiety and gave me xanex which I dont take because I only have the feeling of having a lump in my throat (non stop).  I also think that my country has a high interval/reference for TSH and that I have slightly increased TSH which would indicate a subclinical hypothyroidism??  Any advice/input on the results and next steps would be appreciated! Thnx!!!! :)

[gimel]

I did not mention previously but in addition to Vitamin D, you should test for B12 and ferritin and then supplement as needed to optimize.  D should be  at least 50 ng/mL, B12 in the upper end of the range, and ferritin should be at least 100.

What was your serum cortisol test result and reference range?   The ranges are usually so broad that just being in the low end is not adequate.  

[gimel]

In trying to assess a person's thyroid status, the most important consideration is should always be symptoms.  You have a couple of symptoms that are sometimes related to hypothyroidism, but there are others that don't seem to fit.  The next step after evaluation of symptoms is biochemical tests.  With your test results the first thing to note is that TSH is useful as a diagnostic only at extreme levels.  Intermediate values for TSH are useful only to distinguish primary hypothyroidism (Hashi's) from central hypothyroidism.   Total T4 and Total T3 are not nearly as revealing s the biologically active thyroid hormones, Free T4 and Free T3.   Your Free T4 of 13.0 is about 80% of its range.  Your Free T3 of 5.1 is about 60% of its range.  Taken together those results  do not confirm hypothyroidism, at least at this point.  I say that because your antibodies tests show as Hashimoto's Thyroiditis, and I expect it is in the early stages based on our other test results.  

So where does that leave you?  When you look at the following list of symptoms  I located, I think it fits your list of  symptoms much better.  
The symptoms of low cortisol, or hypoadrenalism, include:

    Mental and psychological ailments such as depression
    Faintness and dizziness
    Weakness and fatigue
    Heart palpitations
    Emotional hypersensitivity
    Inability to cope with stress
    Social anxiety
    Muscle weakness
    Headache, scalp ache, or general body ache
    Severe or dull lower back pain
    Extremely sensitive skin
    Nausea, diarrhea, and vomiting
    Abdominal pain and hunger pain despite an empty stomach
    Extreme craving for salty foods
    Anxiety and jitters
    Clumsiness and confusion
    Motion sickness
    Insomnia and dark circles under the eyes
    Low bladder capacity and symptoms of IBS
    Irregular or non-existent menstrual period

So I think it would be a good idea to test for cortisol.  For that the best test is a diurnal saliva cortisol (free cortisol) panel of 4 tests from samples taken at 4 different times of day.  The less useful option is a morning serum cortisol (total cortisol) test, which has such a large reference range, it is frequently difficult to get a doctor to diagnose.   Do you think it might be possible to get the saliva cortisol panel done?  It would also be a good idea to ask for a ACTH test.  You can read about that in the following link.

https://en.wikipedia.org/wiki/ACTH_stimulation_test

[kris0s]

Hey!
Thanks for your great response.  I have probably 90% of the symptoms you mentioned on a daily basis  (I swear, ever day I imagine having a block of salt like for cattle because of the salt craving).  The doctors say that the Irregular and sometimes non-existent menstrual period  is due to PCOS.  I can do a serum cortisol test which I did a few months ago and it was fine, but I will try to do the saliva test.  I will see with my primary care physician if my country has the  diurnal saliva cortisol test (I will probably need to buy the little bottles to collect samples on the correct cycle day and bring them into the lab).  When I see my endocrinologists , I will ask for ACTH stimulation test.  The lab results from the other day also show that I am about 30% deficient in 25-hydroxy vitamin D and all I wanna to is lie in the sun all the time!  I started taking vitamin D supplements yesterday.  I will post once I have some new info.  Thank you again!