thyroid

[kazza31]

in feb2011 my thyroid tsh results were tsh 3.0 , t4 14.8 and antibodies 157 ; then in , nov 2011, t4 14.6 , tsh 3.5 i have all thyroid symptoms and gran and mam suffer with thyroid are these normal results please help thanks kazza x

[kazza31]

Thankyou , you are right i need to take charge of my health and make my doctor listen .

[gimel]

Has anything really changed since prior posts?  Have you requested the additional tests, as recommended?  Have you gotten your doctor's attention and requested meds/supplements that could help you?  We explained that TSH is totally inadequate as the main diagnostic for thyroid, and the need for additional tests.  Your prior testing did show thyroid antibodies.  The effect of that will only get worse with time, if you do nothing more.

As I heard somewhere, "If you do what you did, you'll get what you got".  Meaning that unless you take charge of your health and either push your current doctor to do the testing and treatment you need, or find a new doctor that will treat you clinically for symptoms, by testing and adjusting Free T3 and Free T4, it's unlikely things are going to get any better for you.   We have supplied you with the info necessary for you to get started, but at this point it's really up to you to do so.

[kazza31]

so surprised my results have come back 2.5 tsh and t4 12.5 ,i am feeling so bad vertigo ,sickness been in bed 4 days head so heavy i have slept every afternoon for 2 month, why has these results got better so unwell ! thanks kazza x

[Barb135]

Will look forward to seeing them.

[kazza31]

thanks very much , will post my results when i get them done .

[Barb135]

I apologize for this thread having gone off in a direction, other than addressing your issues.  If you have further questions, please feel free to ask them; we will be most happy to help in any way we can.

Also, when you get further blood work done, please post the results and we will explain what they mean.

[kazza31]

thanks for all your help and advice

[Barb135]

Most thyroid treatment is for life anyway, so if you can get on treatment and have your symptoms alleviated, why not do so?  

While we like to think that our doctors know best, we know our body much better than any doctor could possibly know it.  If FT3 and FT4 levels are not where WE need them to be, we aren't going to feel well, no matter what the TSH is.  

I have not read the entire article linked above, but this jumped out at me, from page 1:  "Fundamental questions such as whom to screen and when to initiate treatment remain largely unanswered. Based on the available data, withholding treatment for individuals with serum TSH values that are slightly above or below the reference range (4.5-10 or 0.1-0.45 mIU/L) likely poses no harm, and initiating treatment likely poses no clear gains. Individuals with serum TSH concentrations lower than 0.1 or higher than 10 mIU/L are more likely to benefit from treatment, though some uncertainty remains. Initiating treatment for subclinical hypothyroidism
does not alter the natural history of the disease but may prevent symptoms
and signs of overt disease.

In disorders for which the definition of the condition is imprecise and the benefits and risks of treatment are not clearly established, patient preferences play a critical role in treatment decisions."

If a person has clear symptoms of hypothyroidism with TSH levels above the reference range, why would anyone want to withhold treatment, if symptoms can be alleviated?  

Aside from that, TSH is a pituitary hormone and is not always indicative of actual thyroid status.  I'm proof of that!!  

[kazza31]

thanks for f all your help and advice .

[sceptic266]

I know how confusing blood results can be.  Your TSH was raised, but you appeared to have normal circulating levels of fT3 and fT4.  This has classically been described as subclinical hypothyroidism - i.e. the pituitary is having to release more than usual amounts of a hormone (TSH - thyroid stimultating hormone) to get the thyroid to release its hormones (T3 and T4).  

Now, below a TSH of 10, with a normal fT4 most mainstream (i.e.published and respected endocrinologists - unlike the link to the good Doctors information sheet above) would advocate not starting treatment and monitoring - yearly if you were antibody positive (because the chance of progression is much greater) or 3-5 yearly if you were antibody negative.  HOWEVER, it sounds like you had some thyroid-related symptoms so a trial of treatment is fine at this stage.

Chances are once started, the treatment would be for life.  Its important to note however, that there remains insufficient evidence to link starting treatment in subclinical hypothyroidism with any improved health outcomes - including symptoms.  .We'll have to wait and see what happens in your individual case with regards the symptoms.

Please see:

http://jama.ama-assn.org/content/291/2/239.full.pdf

for a good review - although it is written for the medically qualified.

I would advise: trust your qualified doctor, eat well, exercise, don't smoke, avoid fishing for medical problems with dubious blood tests and get on with your life whilst awaiting your next thyroid blood test.  Many symptoms are likely unrelated to the results you have presented above - thats not to say they are very real.  It may just be a case of life-style and diet adaptions rather than blood tests and medications that may help the most once the MD has excluded any other causes that may need medical treatment (which it sounds like he may have already).

All the best

[kazza31]

i do appriciate all the advice gimel has given me and would like to say thankyou .

[Barb135]

AACE stands for American Association of Clinical Endocrinologists and it's just fine for you to seek information from this forum.  We have some very knowledgeable members; gimel happens to do tons of research and is giving you sound advice.

You are not doing wrong to ask your doctor to do adequate testing.  You need the proper tests in order to get adequate treatment.

[kazza31]

im i doing the wrong thing by asking my doc 2 do more blood tsest ! do you think it will do me any good or do you think i am just wasting my time ,i do not understand all these blood results arrrrrrrrrrhhhhhhhhh. i just want to be right again , what do i do . ?? x

[kazza31]

what is AACE mean ? where would you advise me to get the best imformation ?

[kazza31]

or just 1 more thing , when is the best tiime of day to get your blood tests done ???kazza x

[kazza31]

thanks so much for your help , my doc says i am just depressed and its all in my head and if my gran and mum didnt have it i wouldnt know about thyroid !!!! i have been suffering years now i really want to get my life back on track ,thanks again i will go back to docs and ask for my free t3 and free t4 testing , i will let you know how i get on xx

[gimel]

Over 8 years ago the AACE recommended that the reference range for TSH should be revised downward to .3 - 3.0 from .5 - 5.0.  Unfortunately most labs and doctors have still not adopted the change.  So your TSH tests are right at and slightly above the upper end of that new range, and thus a slight indicator of being hypo.  I say this because TSH is a pituitary hormone is affected by many variables.  

At best TSH is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T3 and Free T4.  Of these, Free T3 is the most important, because it largely regulates metabolism and many other body functions.   Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.

The many symptoms you have described, and the TPO ab test result clearly indicate Hashimoto's Thyroiditis.  Even though your Free T4 (I think) is around the midpoint of its range, this does not mean that everything is okay.  You really need to be tested for Free T3 and Reverse T3, along with the Free T4 and TSH.  I would also suggest testing for Vitamin A, D, B12, ferritin, a full iron test panel, zinc and selenium.  I'm sure that such a request will throw your doctor into shock, but hypothyroid patients frequently are low in some of those areas as well.  so it is a good idea to do those tests.  If the doctor resists, you should at least insit on the Free T3, Reverse T3, Free T4 and TSH tests.  The others can wait for a while, if need be to make your doctor happy.

I am curious as to your doctor's response on all your testing so far.  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.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is then sent to the PCP of the patient to help guide treatment.  

http://hormonerestoration.com/files/ThyroidPMD.pdf

When new lab results are available, please post results and their reference ranges shown on the lab report and members will be glad to help interpret and advise further.

[kazza31]

it just says t4 on my results , yes my thyroid peroxidose antibodies  157 if thats how you spell it lol . my symptoms are depression, falling asleep in afternoon , dry hair ,puffy eyes , psoriasis, dieted 3 months cant loose any weight, boils spots on face, pmt, ibs, hoarse voice every so often, always cold,bloated tummy, back pain,weakness ,panic attacks, brain fog and confusion , not sure if all these are thyroid symptoms , is my tsh right at 3.5 ? thanks

[gimel]

Those results all together don't appear normal, but we need more info.   I assume that was a test for Free T4, and that the reference range is around 10 - 19 p mol/L.  Please confirm that.  Also, please confirm that the antibodies test was 157 and  also post the reference range shown on the lab report.  What hypo symptoms do you have?