Thyroid Disorders Community
What do my labs mean?
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What do my labs mean?

Tsh 2.9 (range .45-4.5)
T4 free direct 1.09 (range .82-1.77)
T4 7.1 (range 4.5-12.0)
T3 uptake 29 (range 24-39)
free thyroxine index 2.1 (range 1.2-4.9
reverse T3 148 (range 90-350)
Thyroid Peroxidase 6 (range 0-34)
Antithyroglobuline less than 20 (range 0-40)
Triiodothyronine free, serum 2.8 (range 2.0-4.4)

Everything seems to be normal but I have so many symptoms even my body temperature at 3 PM is around 98.2, sometimes lower and other days it's 98.7. For the past several days I have been feeling ok, but I have days that I am just beyond exhausted. I cannot sleep at night, I cannot remember words, my thoughts are not coherent. I am bilingual and cannot remember either language. My hair is thinning, half a cup of conditioner will not make it normal. Gained about 10 lbs this past year and don't know how. On top of it I have plantaar fasciitis. And did I mention I am still lactating and I stopped nursing my daughter almost 7 months ago.
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21 Comments Post a Comment
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Avatar_m_tn
There are a number of things you should be aware of.  First, TSH is a pituitary hormone that is affected by many variables, including the time of day when blood is drawn, that it is inadequate as a sole diagnostic for thyroid problems.  So it is good that you were tested for the actual, biologically active thyroid hormones, free T3 and free T4.  FT3 is the most important because it is the most active, plus it has been shown to correlate best with hypo symptoms such as the ones you listed, while TSH and FT4 did not correlate.

Second, over 8 years ago the AACE recommended that the range for TSH should be reduced to .3 - 3.0.  Unfortunately most labs and doctors still use the old range.   Some doctors have suggested that the upper limit should be further reduced.  Your result is at the very top of the new range and another indicator of being hypo.  

Third, the ranges for FT3 and FT4 are too broad.  They have never been corrected as was done for TSH.  Without getting into all the details of why, test results in the lower end of their ranges are further indication of being hypo.   Your results are frequently consistent with being hypo.  You can get a lot of good info on all this from this article written by a doctor.  

http://www.hormonerestoration.com/Thyroid.html

In my opinion the best way to treat a thyroid patient such as yourself, is to test and adjust FT3 and FT4 with meds as required to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important.  I think you need to find out if your doctor is going to be willing to treat you clinically (for symptoms), as I described above.  If the doctor has a problem with that, you will need to find a good thyroid doctor that will do so.  
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Avatar_m_tn
In the middle of the last paragraph I should have included that many members here report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range.  
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Avatar_f_tn
Thank you very much for your answer. I did read the information on the web link you included. I have an appointment with the endocrinologist on the 15th of this month and I am so anxious. I hope he goes by my symptoms and helps me. But if he doesn't I am back to zero. I did find him from the stopthethyroridmadness web site and he was recommended. But just in case it doesn't can you or someone point me to a referral source by the state.

Also I did research Naturethroid and was wondering what the starting does would be in my case.
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Avatar_m_tn
Where are you located? If you identify your location, you could be lucky enough that a member can provide a recommendation for a good thyroid doctor that is based on personal experience.
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Avatar_f_tn
Hi gimel, I am right outside of Philadelphia in South Jersey.

Please tell me about the starting dose of Naturthroid.
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Avatar_m_tn


First, here is some info on recommended starting dosages.  

"Therapy may begin at full replacement doses in otherwise healthy individuals less than 50 years old and in those older than 50 years who have been recently treated for hyperthyroidism or who have been hypothyroid for only a short time (such as a few months). The average full replacement dose of levothyroxine sodium is approximately 1.7 mcg/kg/day (e.g., 100-125 mcg/day for a 70 kg adult). Older patients may require less than 1 mcg/kg/day. Levothyroxine sodium doses greater than 200 mcg/day are seldom required. An inadequate response to daily doses ≥ 300 mcg/day is rare and may indicate poor compliance, malabsorption, and/or drug interactions.

For most patients older than 50 years or for patients under 50 years of age with underlying cardiac disease, an initial starting dose of 25-50 mcg/day of levothyroxine sodium is recommended, with gradual increments in dose at 6-8 week intervals, as needed. The recommended starting dose of levothyroxine sodium in elderly patients with cardiac disease is 12.5-25 mcg/day, with gradual dose increments at 4-6 week intervals. The levothyroxine sodium dose is generally adjusted in 12.5-25 mcg increments until the patient with primary hypothyroidism is clinically euthyroid and the serum TSH has normalized.

In patients with severe hypothyroidism, the recommended initial levothyroxine sodium dose is 12.5-25 mcg/day with increases of 25 mcg/day every 2-4 weeks, accompanied by clinical and laboratory assessment, until the TSH level is normalized."
_______________________________________

Personally, I would be somewhat conservative and start with somewhere between 25 and 50 mcg for the first 6-8 weeks.  Slow and steady increases until symptoms are relieved is far better than starting too high and getting an adverse reaction.

If you want to convert these amounts to Nature-throid, then here is the conversion chart.

http://www.nature-throid.com/conversionChart.asp

If you don't gt a specific recommendation for a good thyroid doctor from a member, then you can have a look at this link.

http://www.thyroid-info.com/topdrs/pennsylvania.htm

Have a look and see if there is a good prospect in your area.  Be sure to read through the patient reviews as well.  They are very revealing.

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Avatar_f_tn
Gimel, you are a sweet soul. I did find my MD at thyroid-info. I have prepared extensive symptoms sheet plus temperature chart and a questionnaire from a bio identical hormone replacement book, so he has plenty to read at our first meeting. I also ordered the tests Janie (thyroid madness web site) recommended. I mentioned them at my first post.

Many patients left excellent reviews about him, but some left feedback that he relied on TSH quite a bit. That's why my concerns. I am always worrying ahead of time. I just want to feel better. But living in the metropolitan area I should be able to find someone else if this person doesn't work out.

Thanks for letting me know that just based on 2.9 TSH (taken at 7 AM) I need to be lower. I will go to Mary Shamon's web site since I read here on this forum that we need to be between 1 and 2.

I am 46 and female, for the record.
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Avatar_m_tn
Don't allow any doctor to base your treatment on TSH alone.  TSH is affected by so many variables that it doesn't even correlate well with FT4 or FT3, much less symptoms.  Targeting a level between 1 and 2 might work sometimes, but I would not want to count on it.  Just keep this in mind, from my prior post.  


In my opinion the best way to treat a thyroid patient such as yourself, is to test and adjust FT3 and FT4 with meds as required to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important.  I think you need to find out if your doctor is going to be willing to treat you clinically (for symptoms), as I described above.  If the doctor has a problem with that, you will need to find a good thyroid doctor that will do so.  
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Avatar_f_tn
I spent the afternoon and still keep reading about TSH not being the end all measure for being hypol, but still found several articles from Mary Shomon's web site about studies.

1. If TSH is above 2.1 there is a greater risk of developing Alzheimer's disease.

2. If TSH is higher than 2 also shows elevated homocysteine (risk factor for heart disease} and c-reactive protein (inflammation marker).

However, regarding your recommendations about medicating, I found her interview with Dr. Derry in which he claims that everyone is at 1/3 or the dose he uses to treat.

Here is the link,

http://www.thyroid-info.com/articles/david-derry.htm
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Avatar_f_tn
Hi again gimel and everyone else. Here are the results of my saliva test,

Adrenal Stress Index, free cortisol rhythm

AM 22 , (ref. value 13-24),
noon 8 (ref value 5-1)
PM 6 (ref value 3-8)
10-midnight 5 (ref value 1-4)

Lab classified all normal except the midnight as being elevated.

DHEA at 17 (ref range 3-10) classified as elevated

INSULIN ( I don't think this makes any sense since I wasn't fasting or checking when I ate) My fasting blood sugar was 89 when I did do it on with the other blood work.

P17-OH 17-OH PROGESTERONE was borderline at 114, elevated is greater than 130 and optimal is 22-100

MB2S Total Salivary SigA was 15 and depressed, normal is 25-60 and borderline is 20-25

FOLKS I REALLY DO NOT KNOW HOW TO CONNECT THESE NUMBERS WITH MY TSH AND FREE T3 AND T4. I HAVE AN APPOINTMENT ON FRIDAY WITH ENDOCRINOLOGIST AND ANY INPUT IS APPRECIATED. TELL ME WHAT TO ASK HIM AND WHAT TO READ PRIOR TO MY APPOINTMENT. I HAVE PLANNED TO FAX ALL MY LAB WORK AND SYMPTOMS PRIOR TO MY APPOINTMENT FOR HIS REVIEW AND HOPING TO GET MORE TIME FROM HIM.
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Avatar_m_tn
So your adrenal tests turned out okay.  I don't know much about several of the other tests.  What I do know is that the levels of your biologically active thyroid hormones, free T3 and free T4 are in the lower end of the range and consistent with your hypo symptoms.  What you need is a doctor that will treat you clinically (for symptoms), by testing and adjusting the levels of your FT3 and FT4 with whatever meds are required to relieve symptoms.  Symptom relief should be all important.  Frequently we hear from members that symptom relief for them required that FT3 was adjusted into the upper third of its range and FT4 adjusted to at least midpoint, without being constrained by resultant TSH levels.  If your new doctor has a problem with treating your symptoms in this manner then I think you are still going to need a good thyroid doctor that will do so.
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Avatar_m_tn
I couldn't stop thinking that I wanted to arm you with all the info I could in preparation for your appt. with the new doctor.  The thought of his reliance on TSH really worries me.  I mentioned previously why the ranges for FT3 and FT4 were too broad, without getting into the detail of why.  Well, here's the full shot that I posted previously to another member.

________________________

Many members report that relief of their symptoms required that FT3 was adjusted into the upper part of its range and FT4 was adjusted to at least the midpoint of its range.  The best reason that I can give for this is that the ranges for FT3 and FT4 have never been corrected as was done for TSH over 8 years ago.

At that time the AACE recognized that there were far more hypo people than would be predicted from their TSH reference range of .5 - 5.0.  So they purged suspect hypo patient data from the data base and recalculated the limits at .3 - 3.0.  If the data bases for FT3 and FT4 were similarly purged of suspect hypo data, from my experience with statistical analysis, I estimate that the new range limits would be more like 3.2 - 4.3 for FT3 and 1.0 - 1.55 for FT4.  I believe this is why we hear from so many people with FT3 and FT4 in the lower end of the range yet they still have hypo symptoms.  

If your doctor tries to say that you are normal because of your TSH level, then you can explain to him that since TSH is a pituitary hormone that is affected by so many variables, it does not even correlate adequately with FT4, much less FT3 and symptoms.  On the other hand studies have shown that FT3 correlates best with hypo symptoms.  And of course symptom relief should be all important.  For those reasons you should be starting on thyroid meds to increase your FT3 and FT4 levels as required to relieve symptoms, without being constrained by resultant TSH levels.

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Avatar_f_tn
Gimel, you need to understand how thankful I am that you posted. I definitely will go look for another endocrinologist if he thinks I am ok. Will keep you posted on Friday night after my visit with him.
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Avatar_f_tn
Hi gimel everyone.

I saw the endocrinologist today and said that even though I am at the high end of the top range of TSH, and taking free T3 and T4, he thinks I am NOT hypothyroid. He thinks my problem is low estrogen, I am 46. He says that because I cannot sleep at night, that is the reason for his thinking, and that people who are hypo can sleep well. My weight gain is just from being inactive and dry hair and skin is a typical deficiency of estrogen. If I take the estradiol gel that may depress my thyrorid further.

I must say my visit was disappointing. I typed up a page of history and symptoms which he didn't even read, just kept asking me questions.

Took blood to figure out my estrogen, but didn't ask me what day of the month my cycle was.

I am so tired and ready to cry. I have two small kids to take care of and all I want to do is hide.

He was recommended on the recommended doctors, and a few people did say he relies on TSH and not symptoms.
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Avatar_f_tn
Forgot to mention about still lactating, he said it's because of inflammation and proliferation of milk ducts.
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Avatar_f_tn
And of course, low libido to him is due to lack of estrogen.
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Avatar_m_tn
So sorry to hear of your disappointment with that doctor.  It is not all that surprising though.  You'd be amazed at how often that is the result.  Not interested in symptoms, just in whether the lab tests are in the "normal" range.  You'd hope for better with a trained specialist in the field of Endocrinology.  

At least the estrogen test should settle that question.  If it does not explain what the doctor said it would, then do you think he will be willing to go on to your symptoms and thyroid questions?

From your symptoms and your FT3 and FT4 results falling in the lower third of their ranges, I'm confident that is hypothyroidism.  So, of course what you really need is a doctor that will listen to your symptoms and adjust FT3 and FT4 as necessary to relieve them.  Do you think any of your doctors would at least be willing to listen and prescribe a therapeutic dose of thyroid med?  

Another possibility that members have used involves asking pharmacists for names of doctors that are willing to prescribe Armour, or Cytomel.  Usually those doctors are less rigid about lab reports and are responding to patient symptoms.  If you can come up with any names in your area, I'd be glad to help call and quiz them about how they handle thyroid patients.  Another possibility is this link for finding such doctors.  All you have to do is add in the zip code for the area of interest and the radius for the search, or give us your zip code and I'll do some tracking.

You're a lot farther along than you were.  We're all here for you, to help any way we can. possible.  

http://www.armourthyroid.com/con_phLocator.aspx
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Avatar_f_tn
You are busy taking care of and answering so many people. I will try to call the office myself before going in, but not sure how to bypass the receptionist or get an answer out of her.
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Avatar_m_tn
I have time and will be glad to help any way you'd like.  By the way, when I call, I ask to speak to a nurse.  It has never failed to get me to a nurse and get some answers.  
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Avatar_f_tn
Hi again. I have a second appointment on Monday with someone who sounds promising, but tomorrow I will call again and ask for the nurse. The receptionist has obviously accepted the thyroid calls before since she knew what to say. But with the nurse I just may ask her if looking by my numbers he would offer to treat me and not brush me off as someone in the normal range. I don't feel like going through this disappointment again.

I had good 2 days and got a lot done for myself and family. I am just waiting for the air to be let out of my tires.
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Avatar_m_tn
Good way to check out the doctor to see if he is a prospect or a suspect.  LOL  I would suggest that you start by listing your symptoms first, and then give them the lab numbers, because it is your symptoms that provide the strongest case for treatment.
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