new thyroid lab results what do they mean

I just got back my lab results. I ordered them myself and now i need to know what they mean.
TSH 0.227  .45-4.5

T4 5.2        4.5--12.0

T3 uptake 36     24-39

Free Thyroxine**** 1.9   1.2--4.9

T4 free direct 1.03      .82---1.77

Reverse T3    69      71-180

TPO 111         0-34

TAAab  <20        0-40

Triodethroxine free  2.3    2.0-4.4

When I started medicine my TSH was 5.62 and my Free T3 was 3.1.
This time I was taking 2 grains of Nature-thyroid but still having a lot symptoms.

[gimel]

What symptoms are you having?

[tracker59]

low energy especially in the afternoon, still losing my hair, brain fog, again especially in the afternoon. Having difficulty reading so I have to reread the whole section again, (I do most of my reading at night). Just got back from helping my mom and dad and it took me 4 days to feel good again.
Was in a sauna today for 22 minutes and when I got out my feet were still cold!!
Hang nails on fingernails (this stopped when I was taking 3 grains)
alternating Constipation/ Diarrhea
and my ears still ring and itch.
My morning body temp is 96.5 to 97.2

[tracker59]

tracker59  
less than a minute
low energy especially in the afternoon, still losing my hair, brain fog, again especially in the afternoon. Having difficulty reading so I have to reread the whole section again, (I do most of my reading at night). Just got back from helping my mom and dad and it took me 4 days to feel good again.
Was in a sauna today for 22 minutes and when I got out my feet were still cold!!
Hang nails on fingernails (this stopped when I was taking 3 grains)
alternating Constipation/ Diarrhea
and my ears still ring and itch.
My morning body temp is 96.5 to 97.2
My blood pressure is still very low and my pulse rate has come up to about 70 to 75

[gimel]

No wonder you have all those hypo symptoms.  Free T3 is the most revealing thyroid test and yours is below the range, and your free T4 is too low in the range.  In addition, the ranges for both are far too broad to be functional for most hypo patients.   Many members, myself included, report symptom relief required Free T3 in the upper third of the range and Free T4 around the middle of the range.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free e and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results and especially not just TSH results.

So you need to work with your doctor if amenable to raise your meds as necessary to relieve symptoms.  If not, you will need to find a good thyroid doctor that will do so.  Also, I suggest that you request to be tested for Vitamin D, B12 and ferritin, as well as a full iron test panel.  

[tracker59]

Thank you. I am going to a new doctor on the 25 so I hope she will help me. My vit D was low (22) but I have been taking 10,000 iu's for about six months.  Last test it was up to 50 (november 2012)
. My vit B12 was 1999 (range 254 to 950). I was not taking a supplement at the time. Dr. thinks it was a mistake
My ferritin level was 75 (range 13-150)
My iron panel:
Iron Bind. Cap 272  250-450
UIBC 197   150-375
Iron Serum 75  35-155
iron saturation 28  15-55

Something is going on. My free T4 started at 1.54, then dropped to 1.42 and now is 1.03.
My free T3 started at 3.1, dropped to 2.4 and now is 2.3. all done at the same lab so ranges have not changed.
Any suggestions on how I approach my next doctor appointment?

[gimel]

Sorry, I should have asked for confirmation that the TPO test you listed was for  thyroid antibodies (TPO ab) associated with Hashimoto's, correct?   Also, what is the TAA ab test you listed?

[tracker59]

Thyroid Antithyroglobulin Antibody (TAA) is the name of the test that Direct Labs had in their thyroid panel special for January. This is Listed with the TPO antibody test.
This is what Direct Lab has on their site.
Includes: TAA - This test helps to detect possible thyroid problems. Thyroglobulin is a protein that is normally confined to the thyroid gland. It is the source of the thyroxine and triiodothyronine hormones in the body. The presence of autoantibodies to thyroglobulin can lead to the destruction of the thyroid gland. Such antibodies are more likely to appear after trauma to, or inflammation of, the thyroid gland.

TPO - The TPO gene provides instructions for making an enzyme called thyroid peroxidase. This enzyme plays a central role in the function of the thyroid gland. Thyroid peroxidase assists the chemical reaction that adds iodine to a protein called thyroglobulin, a critical step in generating thyroid hormones. Thyroid hormones play an important role in regulating growth, brain development, and the rate of chemical reactions in the body (metabolism).

[gimel]

I find it very strange that they would test for Thyroglobulin antibodies and Thyroid Peroxidase, but not Thyroid Peroxidase antibodies.  I have sent Direct Labs an email asking them to clarify which test was done.

[tracker59]

Thank you, I didn't know there was a difference.
I was reading about splitting doses and one dr wrote we should be taking part of our dose at night before bed so I have done that three times (not in a row) and I am sleeping better and longer on those nights but I have to give up part of the afternoon dose to do it and that only works on my days off.  Also I don't take my multivit because it has calcium in it. What do you think? Thank you

[gimel]

Got a response from Direct Labs.  

"Thanks again for choosing Direct Labs.  In response to your email, the Thyroid Antibodies test do include the TPO (Thyroid Peroxidase (TPO) Antibody) and TAA (Thyroid Antithyroglobulin Antibody (TAA) for $88.00"

When I click on a description for the antibodies tests, it reads just like what you posted above, so I have to assume that they just didn't describe very well the TPO ab test, and that it is for the antibodies, not TPO.

So, from your test results, you would be diagnosed as having Hashimoto's Thyroiditis.  With Hashi's your body erroneously identifies the thyroid gland as foreign, and produces antibodies to attack and destroy.  Over an extended period, the gland's function is diminished, requiring increasing amounts of thyroid meds.

Your current test results show that your Free T3 and Free T4 are too low in the range to relieve hypo symptoms.  The ranges are far too broad to be functional for many hypo patients.  Many members, myself included, say that symptom relief required Free T3 in the upper third of the range and Free T4 around the middle of its range.   Depending on how your doctor treats hypothyroidism, he may not want to increase your meds because of your TSH level.  If so, that is wrong because TSH is frequently suppressed below range when taking adequate thyroid meds to relieve symptoms.  there are many scientific studies that confirm this.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  symptom relief should be all important, not just test results, and especially not just TSH results.  You can get some good insight from this link written by a good thyroid doctor.

http://hormonerestoration.com/Thyroid.html

  

[tracker59]

thank You so much. I have been reading all the information on the website. I think I should order a saliva test kit tonight. And I think I need to make a phone appointment with the Dr. but I don't think for one minute that any of the doctors I have gone to would go along with his treatment. I might just have to make a trip to PA. I am printing out all the information on that site and taking it with me to the new Dr. on the 25th. My old Dr. will not give me any more than 2 grains no matter the TSH, FT3, or FT4 levels. She stated that the thyroid can not use anymore than 2 grains.
Again, thank you for helping me.