(High R-T3) Help w/ lab interpretations?

[SunshineFLA]

Hashi, Hypo, Hyperthyroid or something else?
Can someone help me possibly interpret my lab results? any ideas on possible causes? Do these test confirm a thyroid condition? I do have a goiter that has gone up& down in size. It's enlarging(?) now.
Everything that's not listed was in optimal range, right in the middle.

*Vitamin D still slightly low. B12 perfect
*Have high cholesterol, ldl & triglycerides.
*This is the 3rd time my CBC has come back looking like this in the past 1.5yrs
        Thanks for any help!


Reverse T3 28
Range 8-25

T3free 2.8 (comes back lower w/each test)
Range 2.3-4.2

T4 1.2
Range 0.8-1.8

TSH 1.53
Range 0.40-4.50

TSI <89
Range <140 (% baseline)

TBG 46.5
Range 13.5-30.9
--------
Ferritin 5
Range 10-154

Saturation 3%
Range 11-50

Iron bidding 577
Range 250-577

Iron total 19
Range 40-190

Urea nitrogen (bun) 6
Range 7-25

Carbon dioxide 19
Range 20-31

White Blood Count 12.4
Range 3.8-10.8

Hemoglobin 11.3
Range 11.7-15.5

MCV 74.5
80.0-100.0

MCH 23.6
Range 27.0-33.0

MCHC 31.7
Range 32.0-36.0

RDW 15.7
Range 11.0-15.0

Platelet count 457
Range 140-400

Absolute Neutrophils 8816
Range 1500-7800

[SunshineFLA]

I happened to look at my previous blood work and there is a test called: 'thyroid peroxidase antibodies and thyroglobulin antibodies' on there. It was done a few months ago & not with this current blood work I listed above. (If timing matters?) I think this was something I needed done? Sorry my brain is literally not cooperating w/me. Everything is confusing..

Thyroid peroxidase antibodies: <1
Range(?) < 9

Thyroglobulin antibodies: 1
Range(?) < or =1
This one is in the red zone on the quest diagnostics scale. I'm confused if that's ok or not.

My apologies if this should've be mentioned previously or if this isn't the correct test. I just saw this and thought it sounded familiar.

[Barb135]

Those are the right tests for Hashimoto's.  The Thyroid Peroxidase Antibodies (TPOab) is negative, indicating that you did not have Hashimoto's at the time the test was done.  The Thyroglobulin Antibodies (TgAb) is "barely" positive, indicating that you probably do have it, since your result is 1 and negative would be less than 1.  

It wouldn't hurt to get these tests repeated, in case the antibodies simply hadn't ramped up yet at the time they were done.  Sometimes, they can be higher or lower than others.  

Going back to your previous post from yesterday - it's perfectly okay to discuss the PCOS because many women with hypothyroidism are diagnosed with PCOS, as well as insulin resistance and other related conditions.  I, personally, have insulin resistance/per-diabetes and Metabolic Syndrome, which add extra "interest" to my thyroid condition.  

I was just reading an article/podcast about the various types of PCOS, one of them being high androgens (testosterone).  I've had a hysterectomy and I've never been sorry I did it, but thinking back over the whole ordeal, I sometimes wonder if I really needed it or if I really had PCOS, along with an undiagnosed thyroid condition... In hind sight, the symptoms and labs all add up.

Anyway, what I was reading is that for those with the high androgens, an anti-inflammatory diet is the best way to treat.  This includes avoiding wheat, cow dairy, vegetable oils, and sugar.  They're saying that there probably is a low level of insulin resistance; it just doesn't show up on blood tests.  Aside from that, sugar is inflammatory and everyone benefits from avoiding it...

That would bring me to my next question - have you ever been tested for food allergies?  There are tests that can be done to test for those?  Here's the article, if you're interested in reading it.

http://pcosdiva.com/2016/08/types-of-pcos/

I'm finding for myself that diet makes a huge difference in how I feel... that gut microbiome is very important and so is inflammation.  I went through a bout of H. Pylori, which is a bacteria that takes up residence in the gut.  That, by itself, does quite a number on you, then the antibiotics needed to eradicate it also take their toll.

If we don't have what we need in our gut, we're going to feel bad all over. At least that's the way it worked for me and that's what I've heard from others, as well.

It's a whole other area to delve into than thyroid, but for me, it's been a very important area and goes hand in hand, but I'm still working on it.  

It's important to note that I'm not advocating any special diet; I'm suggesting that you get tested for allergies and avoid only those foods you might be allergic to or that cause inflammation in your body.

[SunshineFLA]

Thank you both! I just happened to look back over my papers I printed out for testing that I asked my PCP to do. The Hashimoto test was on there, but they didn't run it. I wonder why? I also did ask for Lupus testing, was told again to see a specialist for that, I am. I'm going to ask again for the Hashi test & depending on how educated the Nurse is on Thyroid issues, stress to her I most definitely need the test done. If still a no, then as suggested I will just pay cash and go to the lab and have it done.

The b12:
Taking high doses of Metformin for along time seemed to be the cause for the b12 dropping. That's what I'm told anyway... I have no idea w/my ex-Endo was thinking putting me on it & why I listened. it seems to be taking awhile coming back up, though. (So does the vitamin D) Maybe I'm impatient- but I thought after all these years my levels would have come up with taking supplements?

In regards to my Pcos- *Sorry I know this discussion is for Thyroid issues, but I see some issues w/pcos & Thyroid that I thought I might mention.
Pcos & Hypo do go hand in hand. There are so many of us w/both, i totally ignored this.
Also, As i mentioned previously I have what's called 'Pcos type 2' or Non-IR Pcos (Non- insulin resistant/non-diabetic) we're less talked about, the 'IR pcos/type 1pcos' women are basically the "face" of All pcos types.
we have no issues w/insulin/diabetes, but often have Testosterone dominance, high triglycerides, Vitamin D &/or Iodine deficiency, hormone-disrupting toxins in our bodies, thyroid disease, adrenal issues etc.. blood sugar lowering drugs will have no effect on my type of pcos & neither will losing weight or going on Birth control pills. (side note I'm not very 'lean' now since all this thyroid stuff has happened-now I definitely have to lose the lbs. thankfully A1c/Glucose is still good) It's recommended we are dairy free, supplementing w/zinc, iodine, Vit D, magnesium & a few different herbal medicines for my Pcos.

I mention all of the pcos stuff because I'm seeing these two issues (Hypo/pcos) basically  disrupting one another. Same/similar symptoms vitamin issues etc.
But I so agree, Gimel! I need to find out what the reason is for the levels being up/down. There has to be something further back behind this pcos/Thyroid business.

Supplements:
100,000iu vit D weekly-I think going on or over 2yrs now.
400mg magnesium- taken 7yrs
Prenatal vitamin-B12-zinc- taken 13yrs
Spearmint capsules-haven't taken long enough
progesterone cream- haven't taken long enough.
I eat mostly clean (I slip up w/ice cream) was always very active etc.
Will check into iodine/zinc.
And starting back up on the iron. I've never 'felt'  anemia without extreme blood loss- I'm guessing this is why I didn't realize I was once again anemic. (6th time, shocked I didn't get)

Hopefully I get answers from my doctors soon.

Thanks again to you both.
I hope you both (and previous people who've helped me before) realize what a great help & service you provide to complete strangers. All of the reading/replying/knowledge I always get on here, I'm beyond grateful. Thank you!!

[gimel]

Barb has already covered a lot of things.  Your Vitamin D is too low, it needs to be at least 50 ng/mL.  Your ferritin is terribly low.  It needs to be at least 100.  So you need to supplement for those to optimize.  

Your Free T4 is slightly below mid-range, which would be okay, if your Free T3 were in the high end of the range; however, that is not the case.  Your Free T3 is only at about 26% of its range.  In addition your Reverse T3 is above range, which adds further to your hypothyroid condition.  Reverse T3 is a mirror image molecule of T3, but is biologically inactive.  There is evidence of RT3 binding to membrane receptors and producing hypo-metabolic effects.  In the following link you can read on page 13 that “Leptin resistance; Inflammation (NF kappa-B); Dieting; Nutrient deficiencies such as low iron, selenium, zinc, chromium, vitamin B6 and B12, vitamin D  and iodine; Low testosterone; Low human growth hormone; Insulin dependent diabetes; Pain; Stress; Environmental toxins; Free radical load; Haemorrhagic shock; Liver disease; Kidney disease; Severe or systemic illness; Severe injury’ Surgery; Toxic metal exposure” are said to be causes for excess conversion of T4 to Reverse T3.  

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

Your biggest problem thyroid wise is that your ratio of Free T3 to RT3 is only 1.0, when it is recommended to be at least 1.8, and some sources say 2.0.  So your hypothyroidism so far appears to be mainly a conversion problem, rather than a problem with the hypothalamus/pituitary/thyroid gland function.  So you need to correct known deficiencies with the above variables, especially low ferritin (iron) and low Vitamin D as a start, and see the effect on your RT3 and FT3 levels.  

[Barb135]

Well, just between you and me, your B-12 isn't "ideal"... I use the same lab with the same ranges and I have to keep my B-12 right at the top of the range or even higher in order to feel well or even sometimes "human"...lol

I can tell you where to get the antibody tests for Hashimoto's without a doctor's order if you're willing to pay out of pocket, because it's not covered by insurance.  You can order the tests online, pay with a credit card, they send a lab order via e-mail, you walk into the nearest LabCorp and voila, you have your Hashimoto's confirmation or not... let me know and I'll PM the information...

You know you have a goiter, so I guess that means you've had an ultrasound?  Do you have nodules?  Perhaps you can link me to previous threads so you don't have to repeat everything you've posted before?  

We don't have to have bleeding issues to be anemic... simply not eating enough iron rich foods will do it; that's why I asked if you're vegetarian or vegan because a lot of people who don't eat animal products are anemic if they don't make sure they replace the iron with supplements or iron rich plant products.

As far as being out of breath - being hypothyroid can cause that - that was one of my worst symptoms (store that away for when you need it...lol).

PCOS and insulin resistance (pre-diabetes), typically, go hand in hand; it's rare to see one without the other, eventually, and they're treated the same way - the same diet and if adhered to, Type II diabetes can be prevented... I know this because, so far, I've prevented it, but I'm not doing well enough so I'm getting closer to the diagnosis...

I don't see anything in the tests that indicates problems with the kidneys, so we sure wouldn't want to give up there... This is out of the thyroid disorders area, but maybe if you tell us what the problem is, in your kidney area, we might be able to help.  If it's any consolation, I've had kidney stones (worse than child birth - yep it is) and I currently have adrenal adenomas, so I might be able to help you out with pain in that area...

Last, but not least, if you let me know where you are in FL, maybe we have a better doctor who will be willing to help you... You can send me your location information via PM.

[Barb135]

Both your Free T3 and Free T4 indicate hypothyroidism, with Free T3 at only 26% of range and Free T4 at 40% of range...Most of us feel best with Free T4 at about mid range and Free T3 in the upper half to upper third of its range...

Can you please tell us what thyroid replacement medication you're currently on and what dosage, as well as how long you've been on it?  

I'm sure gimel will be along soon and he'll address the high rT3.  It's not the actual rT3, itself; it's the ratio of Free T3 to rT3 that's important.  

Can you please post your actual "slightly low" vitamin D and "perfect" vitamin B12 levels?  What you think is okay might, in reality, not be...

High TBG indicates hypothyroidism, but can also be caused by some medications, such as estrogen containing birth control pills, prednisone, etc.

High cholesterol is also a symptom of hypothyroidism.

TSI is the definitive test for Graves Disease, which technically is negative because it's less than the reference range.  I'm not sure why that was done if you're hypo, since Graves is associated with hyperthyroidism.  Have you been tested for Hashimoto's?  I know you've posted previous blood work, but I don't remember what tests or results you've had done.  for Hashimoto's you need TPOab and TgAb.

Your ferritin and iron are both way too low, indicating that you need to supplement.  Iron is necessary for the proper synthesis of thyroid hormones. Your red blood counts bear out the low iron levels and the need for iron supplements and iron rich foods.

High white blood count high neutrophils indicate infection/inflammation in the body.  

If I were your doctor, I'd say you have hypothyroidism, but I'd also say you're very anemic and without iron the thyroid can't work properly.  Are you a vegetarian/vegan?

[SunshineFLA]

Vitamin d- 30 (it's slightly up since March)
Range 30-100

B12- 658
Range 200-1100
The lab Quest diagnostics says this is in ideal range, I have no idea.

I've yet to find a Doctor to do the Hashimoto test. I was lucky & found a nurse practitioner who was willing to run these test for me last Friday. I don't go back to her until the 29th & my Endo until the 8th. So meanwhile I'm over here trying not to freak out.

I've never been on any type of thyroid medication. No doctor that I've been to (Endo, PCP, Gyn) believe I have a thyroid disorder & dismisses my goiter. They all want that TSH to rise or drop. - irritating

I had no idea I was anemic, but have been so many times due to uterine fibroids in the past that I can't believe I missed this! I didn't put two & two together because I've had no bleeding issues. And I've only ever been anemic when bleeding. Now it makes since why I feel out of breath too

I wish I was Vegan or Vegetarian, lol
I only eat two meats, White Chicken & Red meat.
Of course lots of veggies, minimum dairy. Maybe that's why??
I also do have Pcos, if that matters
No type 2 diabetes or insulin resistance

This infection thing is worrying me. This is the 3rd time in 1.5yrs it's come back like this. Last time I was having emergency surgery for my  gallbladder & the Doctor told me about an infection. The ER doctor & Surgeon both said they were puzzled by what this infection was. I did have 12 medium sized iv bags of some kind of antibiotics. (I'm allergic to penicillin so whatever would be okay for me to take)
My kidney (I thought Adrenals) area has been killing me for these past few years. So I'm kind of panicked about my kidneys. My Mother had kidney disease. Now she's upset because she had the same reoccurring infections showing up in her blood work and was severely anemic.

I could just fall down & cry because I knew something wasn't internally right. Thank you kindly for the reply!!