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20882895 tn?1563606182

20 year old female,results for Tsh w/ reflex to ft4=0.43, mixed answers!!!

So recently I went to the gastroenterologist for crazy ongoing stomach issues (basically have been taking antacids for nine months, etc.,it's a long story) and he decided to do labs. For one of the tests it was called tsh w/ reflex to ft4. The range was from 0.40-4.50, and mine was 0.43. Now, I went to another doctor (I see him for ADHD issues but he has a degree in reading labs) and he said these levels indicate my thyroid levels are really low. I don't know who to believe. Also, my sinuses had been acting up since the day I got the labs on a Tuesday, I've been lethargic since high school, and my vitamin D levels were at a 10.7 (normal is 30-60). For a while I felt it was just the Vitamin D making me tired, but my head fogginess symptoms felt abnormal, even for  ADHD me.  Any advice?
2 Responses
649848 tn?1534637300
COMMUNITY LEADER
I'm not sure what the gastroenterologist told you, but I'll explain the meaning of your labs and you can decide for yourself.  

When a doctor orders TSH w/reflex to FT4, the order means that the lab should analyze TSH and if it's out of range, the lab should, then, go on to analyze Free T4.  The reference range your lab uses is 0.4o - 4.50, which means that your 0.43 was actually within the labs range, since it's greater than 0.40 and less than 4.50.  That means your results are "normal" and the lab would not analyze Free T4.  

So the way it works is that TSH is a pituitary hormone that senses the amount of thyroid hormones in your blood and when thyroid hormones get low, the pituitary gland produces TSH to stimulate the thyroid to produce more thyroid hormones.  

It's all counter-intuitive... typically (in a perfect world), when TSH is high, thyroid hormones are low and when TSH is low, thyroid hormones are high.  

In your case, there could be one of 3 things happening:  

1) Since your TSH is so low, your thyroid hormones could be really high, causing hyperthyroidism, which can cause stomach issues,  tiredness, etc but also causes things like sudden weight loss, diarrhea, heart palpitations, rapid heart rate, hand tremors, etc.  You don't mention any of those.  

2)  Your pituitary, for some reason, seems to believe that you have adequate thyroid hormones, therefore, it's not producing enough TSH, which in turn is not stimulating your thyroid.  This causes another form of hypothyroidism called Central or Secondary hypothyroidism.  This is when the thyroid works fine, but there's a malfunction in the pituitary gland.  This is still a type of hypothyroidism and needs to be treated with replacement hormones.  Common symptoms of hypothyroidism are acid reflux/GERD and other stomach issues, constipation, weight gain, hair loss, fatigue/tiredness, muscle/joint aches/pains and many others.

3) You could have the autoimmune condition called Hashimoto's  and your blood work just hasn't all caught up yet.  To determine if you have Hashimoto's, you'd need to have antibody tests - Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  

The treatment for Hashimoto's and Central hypothyroidism will be the same - replacement thyroid hormones.

If you aren't supplementing Vitamin D, you should be doing so, as Vitamin D is necessary for the  proper production and metabolism of thyroid hormones.  

If you've been tested for Vitamin B-12 and Ferritin, it would be helpful if you'd also post those results, as they, too are necessary for adequate production/metabolism of thyroid hormones.   If you haven't had them tested, I'd recommend you do so.  Deficiency either/both of these can also cause lethargy/tiredness and B-12 deficiency can cause brain fog/inability to concentrate.

Ferritin is the iron storage hormone... Iron deficiency can also cause extreme tiredness/lethargy.
3 Comments
I haven't heard from the gastroenterologist yet, I just got part of my results a from an online portal. However, when I went to the other doctor  (he deals with naturopathic medicine as well) he said otherwise. He actually just sent a message this morning and  said he meant to say hyperthyroidism. He sent me the list of symptoms as well. Honestly I'm not sure anymore because I don't have the palpitations or hand tremors but I have various stomach issues. When I called the gastro office, they said everything's "normal". My B-12 is 823, the range is 200-1100. I dont know my ferretin levels yet
I'd guess the doctor that said you're hyper is assuming that simply because your TSH is on the low side.   The fact is, TSH can't be used to determine, either hyper or hypo.  You have to have the actual thyroid hormones to determine thyroid status because it's entirely possible that my option 2 above is what's going on, or even a couple other options...

Hashimoto's, which is, associated with hypothyroidism, often begins with periods of hyper, alternating with periods of hypo or even normal before settling into permanent hypo... you could be in a period of hyper.

Or yet another option  would be Graves Disease, which is always associated with hyperthyroidism.  Graves Disease is confirmed by testing Thyroid Stimulating Immunoglobulin (TSI), whereas Hashimoto's is confirmed via the antibody tests I listed above.  

Symptoms of, both, hyper and hypo can include digestive distress, including acid reflux,/GERD, bloating, etc.  They, both, also typically, include fatigue/tiredness.  Some of us can even have palpitations when hypo even they're, typically, associated with hyper.

Free T4 and Free T3 would tell us whether or not the thyroid is over producing (hyper) or under producing (hypo).  Getting those tested  would be a priority.  If the  gastroenterologist won't do it, the naturopathic doctor should be willing since most naturopaths understand that TSH, alone is, basically, useless.

Your B-12 is adequate - most of us have to keep it at/near the top of its range in order to keep symptoms from appearing.  Do you know what tests have been ordered besides Ferritin?  
Yes, I also got the C-reactive protein test which was at 1.2 mg/L, the comprehensive metabolic panel, Celiac disease comprehensive panel test, and the Gliadin AB (IGA& IGG). I didnt get results for celiac or gliadin yet.

I should mention that when I went to another doctor in February, they just tested my TSH by itself, and it ws 1.680
649848 tn?1534637300
COMMUNITY LEADER
It's always best to post reference ranges with results for the best comparison since ranges vary from lab to lab.   Was there anything abnormal on CMP?

As noted, a TSH by itself isn't very useful because we don't know what your actual thyroid hormones were in Feb, just as we don't know what they are now.   We can see, however, that TSH is considerably lower now than it was, then... how do symptoms compare to the way you felt then?

You said you don't have palpitations or hand tremors... do you have any other symptoms of being hyper, such as weight loss, diarrhea, irritability/irrationality, rapid heart rate, etc? Or do you have any other symptoms of being hypo?  Just based on the symptoms you provided, we can't tell if you might be  hyper or hypo since they can both present with tiredness and stomach issues.

Have you, by any chance, had a thyroid ultrasound?
3 Comments
There was also a thing called  urea nitrogen (bun) that was a 6 and the normal range is 7-25. My creative level was0.65 (range is 0.50-1.10), the Bun/Creatine ratio was 9 (range is 6-22). As far as the hyperactivity I say I think I just partially deal with irritability and impatience not sure what to say about the stomach part because I wouldn’t count it as having diarrhea but loose  as far as the hyperactivity I say I think I just partially deal with irritability and impatience not sure what to say about the stomach part because I wouldn’t count it as having diarrhea but loose stools randomly. I have not had a thyroid ultrasound, looking into it though.
Also I got my celiac and Gliadin results back-
Gliadin(IGA & IGG) Range:<20
Mine:
IGA=3.  IGG=4
Celiac range=No serological evidence, but consider DQ2 or DQ8

Tissue transglutaminase AB, IGA <1

Immunoglobulin A: 145
Range 47-310
To add on to that, my eyelids feel weird, like I’ve been crying but I haven’t. Thought that was part of the cold I had, but now I’m not sure
I also have slight anemia but other than that that’s it
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