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what do my test results for TSH mean?
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what do my test results for TSH mean?

I'm 25. And I'm extremely overweight and have been all my life. I am also the only overwieight person in my family. Over the past few months I've been extremely tired even when I get 8 to 10hrs of sleep. And have NO energy what-so-ever. Just recently my toenails have been becoming very brittle and breaking off at the slightest bump.  Anyway, I have NO idea what my test results mean. The TSH came back as 3.35 and my T4, Free was 1.1 the bariatric doctor didn't explain any of this to me. If you could help explain this to me I would appreciate it. Thanks.
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Avatar_m_tn
TSH is a pituitary hormone that is affected by so  many variables that it is inadequate as a sole diagnostic for possible thyroid problems.  At best it is an indicator to be considered along with more important indicators such as symptoms, and also the levels of the biologically active thyroid hormones, Free T3 and Free T4 (not the same as total T3 and total T4).  Whenever you go for thyroid testing you should always insist on being tested for Free T3 and Free T4, along with the TSH.

Your symptoms sound like hypothyroid symptoms.  Your TSH, even as poor an indicator as it is, is also an indicator of being hypothyroid.  

Before going any further, please tell us if you have had bariatric surgery.

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2031081_tn?1329279520
No. I have not had any bariatric surgery. I just recently started going to a bariatric clinic where they give you an appetite supressant called adipex and they help you to try and find the right diet and exercise for the individual. They do just an overall blood work on you so they know generally how healthy you are and tsh and t4 was one of the things they tested.
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1947387_tn?1325644930
"Over the past few months I've been extremely tired even when I get 8 to 10hrs of sleep. And have NO energy what-so-ever. Just recently my toenails have been becoming very brittle and breaking off at the slightest bump."

I am 25 also and was diagnosed this summer. Starting in May, my toenails began falling off!! I can relate to the exhaustion too! I hope you will seek out a doctor who is willing to treat you - you probably have other symptoms too, but just don't realize it because you've gotten used to it.
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Avatar_m_tn
First thing needed is to get tested for Free T3 and Free T4.  I would also make sure of your status by testing for Reverse T3 as well.  To determine if Hashimoto's Thyroiditis is the cause of your being hypo, you should also test for the thyroid antibodies.  Those tests are TPO ab and TG ab.  Since hypo patients are frequently low in other areas as well, you should test for Vitamin d, B12, and a full test panel for iron anemia.  

If you will take whatever steps are necessary to get these tests done, and then post results and reference ranges shown on the lab report, members will be glad to help interpret results and advise further.  If the doctor resists all those tests, just insist on it and don't take no for an answer.  In view of your symptoms, those tests are vital to understand your thyroid status.

There may be a few additional tests that are advisable, but we can discuss those later.  

Just for information, I am very dubious about bariatric surgery.  I say this based on seeing several people go through it and then go back to gaining a lot of weight afterward.  I always suspected that they were hypothyroid, but never had a chance to discuss the possibility before surgery.  After surgery they also have a lot of trouble having to take lots of vitamins and minerals because their stomach does not absorb very well.  One of them has had trouble with twisted bowels.  Anyway, food for thought.
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2031081_tn?1329279520
Thanks rach7612. My next step is to go to an actual doctor and see what they will do for me. I don't think the bariatric doctor really knows that much about thyroid issues. My pinky toenail has fallen off one time. I stumped my toe on my lil boys toy. I cut the nail where it split and thought nothing of it and a few days later it fell off completely. I'm sure there is other symptoms but this energy drain is killing me. I need to figure out what's going on asap.
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1947387_tn?1325644930
Sorry, I should clarify - you might have a hard time getting some doctors to see that your thyroid levels are a problem (obviously they are if you're battling weight, tiredness, nails breaking). My now former doctor told me that at 5.4 my TSH was "fine". The range most of the population falls into is between .3 and 3.0. Above that is considered hypothyroid, but I think for young people, it should really be around 1.0. A lot of doctors follow outdated recommendations that TSH is healthy up to 5 or 6. Even still, current research shows it's possible for a person to be hypothyroid at almost any TSH. Most doctors aren't up to date on that, so if you're feeling sick but a doctor says you're healthy, you should really keep seeking treatment.
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2031081_tn?1329279520
Thanks Gimel. I will request all of those. Cuz there is definitely something going on somewhere. I don't think I would ever get bariatric surgery Unless it was life or death situation. I'm not one for surgery and I know if I try hard enough I can lose the weight it just takes a much much longer time than most. Thank you again for your input. I will try and get these tests done soon. I need too
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Avatar_m_tn
I totally agree that you are going to need a good thyroid doctor.  By that I mean one that will treat you 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.  

I think you will 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 sent to the PCP of the patient to help guide treatment.





"For Physicians of Patients Taking Thyroid Hormones
Mild-moderate thyroid insufficiency is quite common and is an unrecognized cause of depression, obesity, high cholesterol, cold intolerance, atherosclerosis, chronic fatigue, and fibromyalgia. It is often secondary, so the TSH is normal, but the FT4 and FT3 levels are low in the reference ranged. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels. I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long-term health. If they showed clear improvements, I kept them on the thyroid supplementation. The final dose we decided upon was based on symptoms and signs first, and on free T3 and free T4 levels second. As the TSH was usually normal initially, it is frequently suppressed when thyroid levels are optimized clinically. FT3 and FT4 are usually within the ranges, ruling out significant thyrotoxicosis.
We were all taught that the TSH perfectly portrays a person’s thyroid hormone status, supplemented or unsupplemented, and we need only obtain a “normal” TSH to know that our patient had no excess or deficiency of thyroid hormones. In fact, there is no reason to believe that the hypothalamic-pituitary axis is always perfect, and lots of evidence that it is not. TSH-based thyroidology is an unjustified faith in the infallibility of the hypothalamic-pituitary axis. One must instead base the diagnosis and dosing on symptoms first, and on the free T4 and free T3 levels second. Even here, “normal” is not good enough. The labs’ reference ranges for FT4 and FT3 are not optimal ranges; they are statistics: 95%-inclusive population ranges. They are excessively broad (2 to 3x from bottom to top) and define only the bottom 2.5% of the population studied as “low”. The prevalence of hypothyroidism is much greater than 2.5%.
T4-only therapy (Synthroid®, Levoxyl®), to merely “normalize” the TSH is frequently inadequate treatment as the H-P axis overreacts to once-daily oral thyroid hormone peaks, compared to the gland’s steady 24-hr glandular secretion. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, Nat. Acad. of Clinical Biochemistry guidelines call giving enough T4 to keep the TSH near the bottom of its RR (<1) and the FT4 at or just above its RR. But this is not sufficient; the ultimate criterion for dose adjustment must always be the clinical response of the patient. I have prescribed natural dessicated thyroid for your patient (Armour, Nature-Throid) because it contains both T4 and T3 (40mcg and 9mcg respectively per 60mg). This assures sufficient T3 levels and thyroid effects in the body. Since NDT has more T3 than the human thyroid gland produces, the well- replaced patient’s FT4 will be below the middle of its range, and the FT3 will be high “normal” or slightly high before the next AM dose.
Excessive thyroid dosing causes many negative symptoms, and such patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, etc.. Atrial fibrillation can unfortunately occur in susceptible patients with any increase in their thyroid levels. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolism and therefore the rate of the current bone formation or loss. Most older women are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism, but the correction of their other deficiencies."      





If you will please tell us your location, perhaps a member may be able to recommend a good thyroid doctor in your area.
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2031081_tn?1329279520
I'm here in the Greenville/Spartanburg area of South Carolina.
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Avatar_m_tn
I don't have a member recommended doctor for that area.  The best I can offer is this listing of Top Thyroid Doctors for South Carolina.  If you look through the list there are several in your area.  The one in Travelers Rest looks like a very good prospect for you.

http://www.thyroid-info.com/topdrs/southcarolina.htm
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2031081_tn?1329279520
Ok. Thank you so much.
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