lab results - can you help interpret?

[mhnky80]

Hi all ... I haven't heard back from my doctor yet regarding labs I had done earlier this week.  I'll list them below:


25 Hydroxy, Vitamin D               21.2 ng/ml   (ng/ml )
T3, Free                                     3.6 pg/mL    (2.0 - 4.4 pg/mL )
Free T4                                       1.01 ng/dL (0.89 - 1.76 ng/dL )
Thyroid Peroxidase Antibody     1002 IU/mL (0 - 34 IU/mL )
Results confirmed on dilution.

Thyroglobulin Ab                         2.3 IU/mL (0.0 - 0.9 IU/mL )
Thyroglobulin Antibody measured by Beckman Coulter Methodology

TSH Baseline                             14.305 mIU/mL (0.350 - 5.350 mIU/mL )


I had labs a month ago, and this is when I was told I have hypothyroidism:
5/28/16
Free T4                                      0.71 ng/dL (0.89 - 1.76 ng/dL )
TSH Baseline                            10.065 UIU/mL (0.350 - 5.350 UIU/mL )
Glucose                                      86 mg/dL  (70 - 100 mg/dL )
BUN                                            8 mg/dL (9 - 23 mg/dL )
Creatinine                                    0.7 mg/dL (0.6 - 1.3 mg/dL )
Sodium                                       137 mmol/L (132 - 146 mmol/L )
Potassium                                   4.2 mmol/L (3.5 - 5.5 mmol/L )
Chloride                                      106 mmol/L (99 - 109 mmol/L )
CO2                                        26 mmol/L (20 - 31 mmol/L )
Calcium                                   8.5 mg/dL (8.7 - 10.4 mg/dL )
Alkaline Phosphatase             66 Units/L (46 - 116 Units/L )
AST (SGOT)                           13 Units/L( 0 - 33 Units/L )
ALT (SGPT)                            12 Units/L (7 - 40 Units/L )
Total Bilirubin                          0.5 mg/dL (0.3 - 1.2 mg/dL )
Total Protein                           6.4 g/dL (5.7 - 8.2 g/dL )
Albumin                                  3.6 g/dL (3.2 - 4.8 g/dL )
eGFR                                     104 ml/min/1.732  (ml/min/1.732 )
Total Cholesterol                    186 mg/dL (0 - 200 mg/dL )

Triglycerides                           213 mg/dL (0 - 150 mg/dL )

HDL Cholesterol                     71 mg/dL (40 - 60 mg/dL )

Sum Total LDL-Chol               87 mg/dL( 0 - 130 mg/dL )


I also have psoriasis, and psoriatic arthritis.  I was previously diagnosed with hyperthyroidism (15 yrs ago?), with graves disease, but went into remission.  Since then I've had my daughter, and the psoriasis & psoriatic arthritis has been worse.  My symptoms are consistent with hypothyroidism - extreme tiredness, weight gain, difficulty losing weight, dry itchy skin, peeling nails, swollen hands/ankles, hair loss .... some other typical symptoms.  Just wondering how, and why - and I know the lovely autoimmune disorders go hand in hand - if you have one, you often have another ...  

[gimel]

I just wanted to alert you that you should not expect to notice much from starting on 25 mcg of T4.  Usually a hypo patient will notice that their TSH will go down, thus reducing the stimulation of the thyroid gland to produce natural thyroid hormone.  Since serum thyroid is the sum of both natural thyroid hormone and thyroid med, the serum total usually will not show a significant change until the TSH is low enough to no longer be a factor, and the serum total is entirely from thyroid med.  Also, T4 has a half life of about 1 week.  That means that it takes about 4 weeks to get over 905 of the final effect on your thyroid levels.  So, at the beginning I would push for a return visit and re-testing in 4 weeks, in order to speed up the process of getting your levels high enough to relieve symptoms.  

I seem to have overlooked Vitamin D previously.  D should be about 50 min.  I suggest that you could supplement with about 2000 IU of D3 and then make sure they test for Free T4, Free T3, TSH, Reverse T3, Vitamin D, B12, cortisol and ferritin at your next appointment.


Knowing that hypothyroid patients sometimes are low in magnesium, I remembered seeing this info.  Thought you might find this interesting, since this type of headache was related to magnesium and taking it was so effective in relieving the problem.  

"Migraine often occurs as a result of low brain levels of magnesium.  One clinical trial found that supplementing with magnesium caused the complete elimination of migraine pain within 15 minutes in 80% of migraine sufferers."

[mhnky80]

Thank you all ... The doctor's office called late on Friday & has put me on 25 mcg of levothyroxine.  I see the doctor again in 8 wks.  I noticed a really bad headache after I took it on saturday morning.  I do get migraines, and this headache was very similar to when I got migraines when I was pregnant with my daughter which they said were caused by hormones.  I get migraines every once in awhile as a result.  However, today I do not have a headache like I did saturday & sunday, so I see that as progress!

We'll see what happens at my next appt - my blood pressure was also very high (for me) when I was there last week.  I figured this was also another symptom because I never have high BP.  I have printed all of your suggestions out & will talk to my doctor about them.  Again, thank you!

[gimel]

I also meat to add that serum thyroid hormone levels do not always accurately represent tissue thyroid levels and effects.  There are a number of variables that cause this.  I mentioned two above.  It is reported that the best measure of tissue thyroid levels is the ratio of Free T3 to Reverse T3.  So I think it would be a good idea to also test for Reverse T3 and also Free T3 from the same blood draw.  Excess Reverse T3 can bind to membrane receptors and produce hypo-metabolic effects.  

[gimel]

I would add that even though your very important Free T3 level does not look too bad, but you still have many hypo symptoms, that may be due to two possibilities.  One is that your body is converting extra T4 to T3 in an attempt to maintain thyroid function as best possible.  Another possibility is something called "pooling of T3 in the blood" and not getting into cells. The cause of T-3 pooling is reported to be any one of the following or a combination of the following:

    High cortisol
    Low cortisol
    High iron
    Low iron
    Medications
        beta blockers
        Amiodarone
        Iodinated contrast media
        Lithium

So in conjunction with starting on some thyroid med, I would do is to get tested for ferritin, to check for the iron issue, and also a morning serum cortisol test.  Ferritin should be about 70 minimum.  If your level is low then you could supplement with a good iron supplement like ferrous fumarate, ferrous bisglycinate, or ferrous sulfate, along with some Vitamin C and magnesium to prevent stomach issues.  If cortisol is an issue then your doctor would have to address it.

[flyingfool]

some questions:

After they diagnosed you as hypo. Did they put you on any thyroid medication?

If so, what are you taking and what is the dosage?

To answer direct at least as far as I can interpret of what I know.

You definitely have Hashimoto's. Which is an autoimmune condition that attacks your thyroid. So while you say you have Graves in the past which makes or tends to make you go Hyper.  Hashi's has the exact opposite effect.

And it appears that the Hashi's has "won' the battle. At least for the present moment.  The two antibody tests for Hashi's, BOTH are elevated which is a clear indication you have Hashi's.

So Hashi's causes your thyroid to produce less and less hormone naturally.  It appears it has had a long enough effect to now make you "hypo" or low thyroid.

Your TSH is elevated in both test which is consistent with Hypo.  Your FT4 level is only 14% of the range which is consistent with Hypo.  Your FT3 however is 67% of the range. This is actually surprisingly high and is generally about perfect.  And the Free T3 is the only hormone that is actually used at the cellular level.  Your symptoms are also ALL consistent with being Low thyroid (Hypo).

Your Vitamin D3 is lower than ideal  You are testing at 21 and at least 30 would be the goal. So you might want to get some more direct sunlight (no sunscreen) on your skin, and/or supplement with Vitamin D.  Just over the counter Vit D will be fine I would think as your numbers are not dismally low.

If I were you, I would talk to your Dr and see if he/she would be willing to start you with a "starter" dose of thyroid medication.  As all but your FT3 level is consistent with Hypo. The fact that you are positive for Hashi's only means your thyroid will continue to produce less and less thyroid. So sooner or later you WILL be in need of Thyroid replacement.  Since you are symptomatic, you may as well start sooner rather than later!  At least that is my opinion.

A starter dose is usually 25 to 50 mcg or a T4 medication.  This takes 4 - 6 WEEKS to build up and stabilize in your blood. So do not expect to feel better immediately as  it may take WEEKS to settle out.  In fact a good number of people even feel WORSE when they first start taking thyroid medication.  

This is about all I can offer or suggest at this point.  I am not an expert on all the other tests.

i will say that a common symptom of Hypo is high cholesterol.  So while your total cholesterol was not high, getting your Thyroid levels optimized may help your lipid profile.  And I would tend to resist any attempt to want to put you on a Statin drug until at least you've worked on the thyroid levels.

As a side note:  I have always had high cholesterol and triglycerides.  And the ONLY real change to my diet and lifestyle that I have made was limiting dairy (primarily milk as I do eat butter and cheese and sour cream) and using Coconut milk instead.  Secondly I only use olive oil and mainly the switch to Coconut oil (refined there is VERY little coconut taste).  

My triglycerides for the first time in my life significantly dropped and I'm now in the normal reference range.  I personally attribute that to the switch to exclusively coconut oil.  Nothing else has changed and unless my last test was a pure anomaly, then I can attribute it to nothing else as that is the only change.  I did not change my diet otherwise, nor my exercise nor did I lose (or gain) weight.

So As your cholesterol looks pretty good.  The only thing that is out of whack is your triglycerides. So you MIGHT want to consider giving coconut oil a try.

Vegetable oils like Canola and corn oil are TRANS fats.  and are horrible for us.  Coconut oi is a medium chain (not long chain) fat and is extremely good for us.

Olive oil is good but really should NOT be used to cook with. As heating up olive oil oxidizes it and really reduces it's health benefits. But even hot olive oil is FAR better for health than the TRANS fats of vegetable oils.

Again these are only my opinion and my experience.  Others may have different perspective.