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[veenaelango]

Is the following Thyroid Function Test result is normal

TSH      : 4.55 mcu/ml
Free T3 :  6.1 pmol/ml
Free T4 :  14.63 pmol/ml

[GravesLady]

yes,

per AACE Guidline 2006 amended version, US Government 2004 Guidelines and  UK 2006 Guidelines

[borninquisitive]

Did you have antibodies (TPO/TgAb) tested?

[GravesLady]

what are your labs reference range and do you have a nodule.

nothing they can do about antibodies.  antibodies are not curable nor treatable. only the damages to the thyroid by the antibodies are treatable.  certain percentage of the world population with normal thyroids will have thyroid antibodies. therefore levels prevail over antibodies and levels will relate to damages i.e. thyroid condition, if any. per AACE Guideline 2006 amended version, US Government 2004 Guidelines and  UK 2006 Guidelines

[borninquisitive]

If her/his  ranges are close to this: http://www.averasacredheart.com/ash/adam/1/003684.adam or even up to 5.5...if he/she has elevated antibodies, I've seen Dr. Lupo report that he would consider treatment at 3.+

[GravesLady]

the range  most refer to is a target range for already diagnosed and treated patients.

diagnosed treatment, will depend on what type of thyroid issue per levels. there are more than just one type of hypothyroidism or hyperthyroidism.
Drug-induced hypothyroidism, but rarely causes severe hypothyroidism for an example.

hyper and hypo have different target levels and different diagnose levels, as well as nodules, cancer, etc.  not just one set range fits all -  thyroid conditions.

quote
per US Government panel guidelines set forth by U.S. Preventive Services Task Force (USPSTF) Jan 14, 2004
Subclinical Hypothyroidism  is a TSH of 10 or less with normal FTs.
Subclinical Hypothyroidism: No routine levothyroxine treatment for patients with TSH levels between 4.5 and 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level. Early levothyroxine therapy does not alter the natural history of the disease,.....
TSH of 4.5 to 10:
Subclinical Hypothyroidism With Serum TSH Higher Than 10 mIU/L
Levothyroxine therapy is reasonable.
Anti-thyroid peroxidase (TPO) antibodies:
The evidence was insufficient to recommend either for or against routine measurement of anti-thyroid peroxidase (TPO) antibodies in patients with subclinical hypothyroidism.  
...., antibody presence or absence does not change the diagnosis of subclinical hypothyroidism (which is based on serum TSH measurements) or the expected efficacy of treatment.
unquote

quote
AACE positition statement on hypo treatment - 2006 amended version.
AACE clinical practice. guidelines for the evaluation and treatment
Treatment of subclinical hypothyroidism remainscontroversial, and recent arguments for and against treat-ment have been proposed (19,21). We believe that treat-ment is indicated in patients with TSH levels >10 µIU/mLor in patients with TSH levels between 5 and 10 µIU/mLin conjunction with goiter or positive anti-thyroid peroxi-dase antibodies (or both). These patients have the highestrates of progression to overt hypothyroidism. An initialdosage of levothyroxine of 25 to 50 µg/day can be used,the serum TSH level should be measured in 6 to 8 weeks,and the levothyroxine dose should be adjusted as neces-sary. The target TSH level should be between 0.3 and 3.0µIU/mL. Once a stable TSH level is achieved, annualSubclinical hypothyriodism treatment is indicated with TSH  10
In conjunction with a goiter or positive anti-thyroid peroxidase antibodies or both TSH between 5 and 10.
The target TSH level between 0.3 and 3.0
Subclinical hyperthyroidism TSH 0.3 and 3.0
unquote

TPO Abs will rise if you've had vaccines or are being exposed to something you're allergic to, such as eating gluten when you have gluten sensitivity.

There are not really any lifestyle changes or therapies that can prevent or eliminate thyroid antibodies - labtestonline

N.B. Requests for autoantibodies should be selective and relevant to the clinical circumstances - rlbuht.nhs.uk

patients with positive levels of thyroid antibodies may never develop thyroid disease during their lifetime - pubmed.gov

Presence of these antibodies is not enough for a diagnosis......
Johns Hopkins Autoimmune Disease Research Center

Thyroid antibodies may remain positive for years, and do not provide an indication of whether the person has normal or abnormal thyroid function -
mythyroid

....antibodies are also present in lesser numbers of people with other thyroid diseases. Other autoimmune disorders such as Sjögren syndrome, lupus, rheumatoid arthritis, and pernicious anemia are sometimes positive for TPOAb. Small numbers  of people may have TPOAb show no evidence of disease. medicinenet.

A % of most populations have positive TG and TPO antibody test results(35-37) in the apparent absence of thyroid disease - thyroidmanager

According to some endo, antibody tests are neither necessary after the first testing nor terribly helpful. They cannot "do" anything about antibody levels.
not all are dr lupo.
                          

[borninquisitive]

Interesting to read that TPO elevations can result due to vaccines and allergies. First time I had heard that and good to know.

No, not every doctor is like Dr. Lupo. Do you think he is too quick to diagnose and treat somebody with elevated antibodies and a 3+ Tsh?

The gal/guys level is on the "brink." If it looks like a duck, quacks like a duck (way one feels & borderline TSH)....I'm not going to dismiss the strong possibility that person isn't suffering from a thyroid condition or soon will be.

If his/her lab range is 4.5? (I've seen them anywhere between 4+ to 5.5)
Given that there are doctors who look into antibodies-find they are elevated along with a borderline TSH test (again, some treat at 3+)...I don't know...is it better to wait until that person is feeling 5 ft. into the ground before treatment? Whether Hashi or Graves?

At the least, I think this person should have repeat testing, along with antibody testing. While there is no "cure" for antibodies (however, Selenium has been reported to reduce TPO but there is current debate as to possible problems that Selenium may pose outside antibodies), having elevations along with border-line TSH test...I'd say it'd be very hopeful for any person to think...that it'll all just "go away."

"We believe that treatment is indicated in patients..-... with TSH levels between 5 and 10 µIU/mL in conjunction with goiter or positive anti-thyroid peroxi-dase antibodies (or both)."

I heard the statement that x people have elevated antibodies, who do not go on to develop a thyroid problem but am curious to know how they know that. Obviously, it would require following these people, testing periodically and for the rest of their life...to know this? I would think, anyway.

[patient-x]

Hello Do you know if the the above guidelines etc you have quoted are the same for the UK?
Thankyou
Jen