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hypothyroid or not?
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hypothyroid or not?

I have had chronic depression and chronic fatigue for several years. I sleep most of the time when I am not at work, but I am always tired. I hate life and often wish to end it! Results of recent blood test are:  TSH =  1.12 uIU/mL, T3  Free =  3.7 pg/mL, T4 Free = 0.8 ng/dL, Thyroid Peroxidase Antibodies = 13.9 IU/mL  (all apparently normal). This is where it gets weird: Thyroglobulin Autoimmune Antibodies = 43.2 IU/mL, Norepinephrine Plasma =  820 pg/mL, Cortizole PM = 10.1 ug/dL (all high readings). My doctor suspects Hashimoto's Thyroiditis, but is this possible when TSH, T3 Free, T4 Free and TPA are all normal? The only thyroid reading that is off is the Thyroglobulin Antibodies. I'm certainly no doctor. I just want the truth! I can't take this level of depression and constant fatigue any longer. I've had it! I want answers or I want out and I do mean out! ALL THE WAY OUT!  As in, no turning back OUT!
10 Comments Post a Comment
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Avatar_f_tn
Some of us with Hashis's are TPOab positive, some TGab positive and some both.  So, yes, it's very possible you have Hashi's.

Please provide the reference ranges on your FT3 and FT4.  Ranges vary lab to lab and have to come from your own lab report.

A "usual" range for FT4 is 0.8-1.8.  As you can see, your FT4 is right at the bottom of the range.  For a number of reasons, thyroid ranges are very flawed.  As a result, many of us don't feel well until FT3 and FT4 get to midrange or above.  Your FT4 is a long way from midrange.  

Is your doctor considering starting you on thyroid meds?  

Have you had a thyroid ultrasound?  
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Avatar_m_tn
First off, thanks for your concern, whomever you are. On my lab results the reference ranges were: T3 Free - 2.5 to 3.9 pg/ml, T4 Free - 0.6 to 1.1 ng/dL. I don't know if my doctor is planning on starting me on thyroid meds. She wanted me to get a thyroid ultrasound at the lab across the street (which I did). I don't know the results of the ultrasound yet. I haven't seen her since she told me the initial indications of my blood tests. I probably, won't see her again 'til after  New Years. It's such a busy time of the year to try to take care of things. Thanks, once again.
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Avatar_f_tn
That's one of the narrowest ranges for FT4 that I've ever seen (which is a good thing), however, it's also one of the lowest, topping out at 1.1 (which isn't such a good thing).  We have to use your lab's range.

That changes things a little.  Your FT4 is actually at about 40% of range, rather than on the bottom.  That's a little on the low side for most of us on meds, but considering you aren't on meds, it doesn't bother me a lot.

Your FT3 (the test that correlates best with symptoms) is actually quite high in the range.  Once again, your lab's FT3 range suffers from the same narrowing and lowering as its FT4 range.

What was the range on your TGab?  I ask because TGab can be "somewhat" elevated with other autoimmune diseases as well.  "Somewhat" is seldom defined.
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Avatar_m_tn
The Thyroid Perox Ab Reference Range is: 0.0 to 35.0 IU/mL and the Thyroglobulin Auto Abs Reference Range is: 0.0 to 40.0 IU/mL. Thanks, for looking into these things. I appreciate it.
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Avatar_f_tn
TGab is only marginally elevated.  It's at 43.2 with top of the range being 40.0.  I would consider that distinctly borderline.  Many of us are diagnosed with Hashi's with antibody counts in the high hundreds or even thousands.  To give you some perspective, my TPOab was 900+, and my TGab was 3,000+.  I don't know if I mentioned above that TGab can be somewhat elevated with other autoimmunes as well.

Have you explored other autoimmunes?  Pernicious anemia?  Its symptoms can be very similar to thyroid symptoms.  Have you had your B-12 levels tested?

Another common deficiency that can have symptoms similar to hypo symptoms is vitamin D.  Apparently, with ubiquitous use of sunblocks, we're all in danger on this one.  Vitamin D often has to be well up in the range, too.

IIron and ferritin deficiencies can also contribute to symptoms.

I have to tell you that the ranges your lab uses are nagging at my brain a bit.  The FT3, not so much.  It has a lower-than-usual top end, but not so bad.  However, a "usual" FT4 range is 0.8-1.8.  On that range, many of us find FT4 has to be around midrange (1.3) for hypo symptoms to go away.  The top of the range your lab uses is 1.1...not even midrange on 0.8-1.8.  That's not a badly printed "7" after the decimal point, is it?  

FT3 correlates best with symptoms, but the balance of FT3 to FT4 can't be ignored.  FT4 is the reserve tank for when your FT3 gets low.  

If your doctor's willing, you might try a trial dose of thyroid meds to see if you feel better.  At the same time, I think I'd also explore some of the other possible causes of your fatigue and depression that I've mentioned.
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Avatar_m_tn
I too was thinking exactly what gimel stated.

i would highly recommend you get tested for;
Vit D
Vit B-12
Iron
Ferritin

Particularly Vit D & B-12 many people find they need to be in the very upper part of the ranges in order to feel well.

All of the above are all related to fatigue.

Many people with a severe deficiency of B-12 or pernicious anemia need to have weekly injections in order to get the levels up enough.

I would also have them re-check the Free T4 and Free T3 tests just to make sure there was not some sort of anomaly and also re-verify the ranges.

low thyroid a relatively common symptom is depression that can be lessened or eliminated when the INDIVIDUAL gets thyroid level optimized to THEM.
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Avatar_m_tn
No, the T4 Free reference range is actually printed very clearly and reads 0.6 to 1.1 ng/dL. I was also, tested for Vitamin B12 levels and strangely enough it is on the high side, not the low side. The test shows Vitamin B12 at 1174 pg/mL with a reference range of 211 to 946 pg/mL. There probably isn't anything wrong with having a little too much B12 in one's system, but then I don't really know. I'm just clueless and searching for answers. (I'm an electronics technician and this isn't electronics.)
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Avatar_m_tn
Vit D is made by the body from sunlight on the skin.  In the winter time at higher latitudes in the north the sun is not out very long. And it is cold and we are covered up.  So the ability to make Vit D is very limited for the body.

Interesting that your B-12 is high. That is good.  But may want to check on Vit D3 and iron/ferritin as those are also related to fatigue.

That is a VERY narrow range for FT4.  And while it "looks pretty good" with such a narrow range you may want to be higher in the range to feel well.  But you'd have to convince a Dr. to give a trial dose of T4 to find out.  It would most likely be a very low dose since your FT3 are pretty high in the range.  But again that seems to be narrow range as well.

BTW I meant Goolarra not gimel in my reference to agreeing with what was stated above.
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Avatar_f_tn
Well, take heart...my husband is a cabinetmaker, and HE diagnosed my hypo when several doctors had failed to do so!  If he could do it, so can you.

I just did a quick google of high B-12 levels and found that it can indicate liver disease or leukemia, but further testing is required to confirm either of those.  Hepatitis might be something to research.  Most conversion of T4 to T3 happens in the liver.  It's kind of interesting that while your FT4 is low, your FT3 is quite high...could be due to a liver ailment.  Just brainstorming...    
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Avatar_m_tn
I appreciate all of your thoughtful comments. Your concern is uplifting, in itself.
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