Question about thyroid labs

[Jenl8270]

I am new to this board, but am looking for information on interpreting some lab results. Lately, I am having symptoms such as extreme fatigue. Like so extreme. I have never been so tired in my whole entire life. My hair is falling out like crazy. There is literally almost none left on the top of my head. My skin is immensely dry, especially on my hands. It's so bad on my hands that I'm having to put liquid bandaid on them to try and seal up the cracks. I'm feeling extremely emotional and cry on a dime. I get terrible muscle cramps that send me flying out of my bed in the middle of the night. And constipation... terrible, terrible constipation. So, on 4/21, my doc did some labs and these were the results:

TSH 2.0 (ref range 0.45-4.50)
T4 free non dialysis 1.2 (ref range .8-1.7)

He decided to run a few more labs which I had done on 4/29 and these are those results:

TSH 1.12 (ref range 0.45-4.5)
T3 Total 80 (ref range 80-200)
T4 free non dialysis 1.2 (ref range 0.8-1.7)
Microsomal TPO Antibody <10 (ref range <34)

Does anyone have any thoughts as to what these results mean? Or if I need to have more labs run? Any help would be greatly appreciated.

[flyingfool]

I agree with Gimel.

Looks very much like poor conversion of T4 to T3 and need of T3 medication.  

Often times you will want to split the T3 dose into taking half in the morning and half in the early afternoon. As it gets used up in a matter of hours.  So taking it twice a day helps keep a more level amount available throughout the day.  But do not take the 2nd dose too late, or you may have trouble getting to sleep at night.

Remember that everyone is different and they feel well at different levels.  Getting the optimized dosage(s) is trial and error.  So changes are usually best to  be small and slow changing only one thing at a time.

[gimel]

You have many symptoms that are typical of hypothyroidism.  The fact that your TSH is in range, along with your TPO ab result indicates that you don't have  Hashimoto's Thyroiditis.   TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, not a diagnostic, to be evaluated along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  

Unfortunately your doctor tested for Free T4, but not Free T3, only Total T3.  We usually suggest that for best results, Free T4 should be at least mid-range, so yours is close to that.  Total T3 (or Total T4 ) represents the total amount in your blood.  Most all of that is bound to protein and thus biologically inactive.   Only small portions are free of protein, thus called Free T4 and Free T3.  Free T3 is very important because it is metabolized by all the cells of the body to produce the needed energy.  So you should make suer you are always tested for both Free T4 and Free T3 every time you go in for tests.  

If your Free T3 level is similarly low in its range as your Total T3, as I expect, then your hypothyroid symptoms are due to inadequate Free T3.  Since your Free T4 is at approx. mid-range, and your Total T3 is rock bottom of the range, I expect that the main problem is a lack of conversion of T4 to T3.  Conversion is significantly affected by levels of ferritin, selenium, zinc, and even iodine.  Since low ferritin also causes hair loss,  that might be the most likely cause for poor conversion and your symptoms; however, you need to get all 4 of those tested and then supplement as needed to optimize.  Ferritin should be at least 100, and you should discuss all 4 with your doctor, after testing.  

Finding out the cause for poor conversion and then correcting it may take some time.  In the interim, in view of the severity of your symptoms, you might ask the doctor to prescribe some T3 med short term,to raise your level, while working on getting conversion better.  Ten mcg of T3 would be a good start for a few weeks to see how you react, and then test Free T3 and see if a further 10 mcg increase is needed.  Free T3 is best in the upper half of its range, and then adjusted as needed to relieve symptoms.  

Since hypo patients are so frequently deficient in Vitamin D and B12, you should also get those tested and then supplement as needed to optimize.  D should be at least 50 ng/ml and B12 should be in the upper end of its range.

[jennyL4684]

I have same problem. My thyroid  hormone was 3.70  ref range 0.4-4.5. However, I am experiencing terrible constipation and sensivity to cold. I also have muscle cramps for no reason!  What do I do?

[gimel]

Tell your doctor that TSH is a pituitary hormone that is affected by so many things that it is totally inadequate as the sole diagnostic for thyroid status.  You need to test for the biologically active thyroid hormones, Free T4 and Free T3 (not the same as Total T4 and Total T3).

You have listed several symptoms that are frequently associated with hypothyroidism.  When you are able to get tested for Free T4 and Free T3, you can evaluate the results against the following quote from an excellent thyroid doctor.  "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

So what you are going to need most is a good thyroid doctor, by which I mean one that will treat clinically, for symptoms, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH results.  Symptom relief should be all important, not just test results.  

Do you think you will be able to get those tests done?

[jennyL4684]

I am not sure if I can. I am seeing my primary care doctor tomorrow.  The lab I used is called Quest Diagnostics.  In 2014, my free T4 was 2.3.  I did not get tested for Free T3. Now, I am not sure what is my free T4.

[jennyL4684]

Do you think  that Lab corp is better?

[jennyL4684]

same thing happened to me to in 2006. read my post about lab test is normal and still constipated question.

[gimel]

Either lab is fine.  You need to make sure they test you for both Free T4 and Free T3.