Your opinion please.

[redheadaussie]

Ok here is a patient who has these as their results.
  Free T4 17.0              Ref  range  10.0 -19.0
   TSH       0.62            "  "    " "     0.50 - 4.00
  Free T3  5.3               "  "    " "       3.5 - 6.5

What would you say is happening here?

[Justin1967]

I can't be too sure but the results look fine but maybe you could lower your dosage of levothyroxine..

[stella5349]

The patient  has too much T4 and it not moving into the needed Free T3 - so even through the labs are in range the paitient is still very symptomatic with hypo issues.

They- he/she - needs to increase the T3 to balance the T4 - OR figure out a way to release the T4 into T3.

I would assume if the Free T4 could go around a 12 - 12.5 and the Free T3 would go closer to a 6.0 - then the issues may be managed.

only my opinion here.....

[Smilerdeb]

Stella...my FT4 has always been around 17.--19 after RAI...it was up as far as 29.0 before RAI and FT3 was up to 12.0 before RAI.

Ok..these reference ranges are the same as aussie ones so here goes.....

The FT4 is ok...not too high
The FT3 is good too..near top of the range
BUT......
The TSH shows borderline hyper.

Personally I would say something is going on that is NOT the thyroid but the pituitory Gland....basically Cortisol may be very high.
One reason for high cortisol would be severe anxiety.


I think the TSH has to come up a fraction more although that depends on the person themselves and what their comfort zone is.

[laura1967]

I think the main question is what type of symptoms is the person having??? Are they having hyper symptoms?
If patient is feeling good then the levels look great! Free T4 should be mid range and Free T3 should be mid to high normal range.
Also if the patient is on T3 meds as well as T4, then it is normal to have a supressed TSH.
Need more info! LOL

PS- If patient has Hashimoto's, then most of issues are probably due to high antibody count instead of actual hypo symptoms.

[Smilerdeb]

I disagree that FT4 should be mid range in this case....everybody is different.
That would make the FT4 around 10.0 and that would be he// for me.
My usual levels are
FT4 17.0
TSH 2.3
FT3 4.7

This persons Ft3 is higher but some tolerate a high FT3. If I had an FT3 of 5.3, I would feel extremely hyper.

I guess everyone is different.

[redheadaussie]

Would love to hear others comments before I reveal the answer!

[Barb135]

It was assumed that the person is on thyroid med, but you don't actually SAY that in your original post ------ ????  

I would say the person might be a bit hyper....... has the person been dx'd with anything yet?  Are there any symptoms?  

MY last TSH was only 0.14 and I still have hypo symptoms.........

[redheadaussie]

No the person is NOT on any medication. This is their first time for thyroid levels.
Patient has severe fatigue, short term memory loss, heart palpitations, and anxiety. No weight gain, no goitre, no hair loss.

[Smilerdeb]

T3 toxycosis with possibly Graves Disease.
Thats my opinion.

[Super_sally888]

I would want to see some other tests, given the symptoms.  

Superficially these results look ok (in my opinion, considering the person is unmedicated).

Maybe some issue with T4 conversion to T3, but still results are upper range of normal.

I would want to test for thyroid antibodies, iron, b12m vitD, and inflammation markers.  There may be something other than thyroid going on.

Interested to see the answer.


  

[shellyme33]

This patient is very similar to me... I would bet this person has Hashimoto's in the early stages... Borderline Hyper... I bet if labs were obtained frequently that you would find this person bounces between hyper and euthyroid.

[rvaughn]

Being a phlebotomist, I'd say everything is right in normal range where it should be.

[Barb135]

Given that the person has symptoms like s/he does, I'd agree with Sally - more tests are in order, specifically B12, thyroid antibodies and inflammation markers.  

Even though the *numbers* look "normal", we all know it's NOT "normal" to have those kinds of symptoms.........and they fit right in with some of the ones most of us have suffered through.  I'd recommend that this person's thyroid levels be checked often as they may be "swinging" from "normal" to either hypo or hyper, maybe both.  

[Barb135]

When do we get an answer?

[redheadaussie]

You'll all have to be patient and wait till I get to USA. It's now 12.45am Aussie East Coast time.  7.45 am  USA West Coast. I am knackered, buggered and tired! I leave tomorrow morning to catch a 21 hour flight, then a drive of 3 and half hours...bleurgh!
  I'll be off line for a few days. So be patient! No pun intended!

[Barb135]

Well, we ARE all "patients", what else can we be????  lol

[shellyme33]

Bump

[Barb135]

I'd almost forgotten about this one - I'll "bump" again.....

[redheadaussie]

Hi Guys! Sorry took me so long to get back to this post! Been here 4 days now.
  Ok those results were from my 21 year old daughter who has always just been tested for TSH.  I think the winner in this is Smilerdeb!
My daughter is highly strung and suffers from anxiety. Her Free T3's and 4's are actually quite good. It's pretty much her anxiety causing her to suppress her TSH.
  After having done much research I can safely say, she needs Vit D. Yes! basic Vit D!
I am strongly of the opinion that once her anxiety is reduced and her depression lifted she will find that her symptoms are not really thyroid related at all!
  I must look up the youtube video of the Vit D interview and post it here for you. I think you will all be rather pleasantly surprised at how Vit D can help you too.
  I have upped my dose from 1000iu daily to 2000iu daily and have seen a dramatic effect in my depression lifting. Sadly for me I still have Free T3 issues, which my daughter luckily does not.
I have started her on 1000ius daily for a couple of weeks. She will report back to me and tell me how she feels. I am also getting her tested again in about 3 weeks for her thyroid levels.
It may well be in the future she may get Graves or Hashis. Her levels are not consistent with either at the moment. Her main issues are stress related and how she copes with stress, which is; badly! Her symptoms mimic being a thyroid disease/ So you can see how difficult it is for doctors to know what to do. She is my own daughter and now I have the tests results back, I can safely say she is unable to deal with her anxiety because of stress. I am confident the Vit D will help.(Plus the fact she is now going to a psychologist to help give her strategies on how to deal with her workload etc.)
   It was very interesting to get so many varied answers on this. Thanks so much to you all for your insight. I will repost her levels when I get them, and we can follow her journey as well as mine!
Cheers!