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Avatar universal

Am I hypothyroid? Help me understand lab test results...

I have had over 50 hypothyroid symptoms (low body temp, high cholesterol, weight gain, dry skin, bloating, etc.) and have had quite a few blood tests and have been told that I am normal. It's really hard to find anyone in Nebraska to even look at test results combined with symptoms. The following are recent test results:'
TSH - 1.080 (range 0.55-4.78 uIU/ml)
FT4 - 1.2 (range 0.9-1.8 ng/dL)
FT3 - 3.17 (range 2.3-4.2 pg/ml)
RT3 - 18.3 (range 9-27 ng/dL)
Thyroid Micorsoml Ab - 0.8 (range 0.0-9.0 IU/ml)
Thyrglobuln Pro Qnt - 21.3 (range 1.0-47 ng/mL)
Anti Throglob Ab - <20  (range <20 IU/ml)
Sodium, Blood 144 (range 135-148 mEq/L)
Potassium, Blood 3.9 (range 3.5-5.1 mEq/L)
Chloride, Blood 113 (range 98-112 mEq/L)
Calcium 9.6 (range 8.3-10.6 mg/dL)
Creatinine 1.1 (range 0.0-1.0 mg/dL)
B12 335 (range 211-911 pg/mL)
Vit D 32 (range none)
Magnesium 2.1 (range 1.6o-2.6 mg/dl)
Zinc 71 (range 60-120 ug/dL)
Iron 89 (range 65-175 mcg/dl
Aldosterone 4.9 ng/dL (range none)
Renin Acitivity 1.1 ng/mL/hr (range none)
Folate 9 (range 3.1-17.5 ng/mL)
ACTH 12 (range 0-46 pg/mL

If anyone can help me to understand these results I'd really appreciate it, I have a nurse practitioner that will listen and try to help, but she doesn't understand what the optimal ranges for these tests should be. My endo is worthless and dismissed me just by looking at me when she walked in the room, stating there was nothing wrong with me nor my test results. HELP
6 Responses
Avatar universal
Your Endo has it backwards.  Thyroid related tests alone cannot reliably determine if a person is hypothyroid or not.   Hypothyroidism is not just "inadequate thyroid hormone".  A comprehensive definition for hypothyroidism is "insufficient thyroid hormone effect in tissue throughout the body due to inadequate supply of, or response to, the hormone".    So it is both your thyroid hormone level and the response to it that determines your tissue thyroid status.  

TSH is not a reliable indicator  since it has a negligible correlation with tissue thyroid status.  Also, levels of thyroid hormone have only a weak correlation with tissue thyroid status.  There are also  numerous variables that affect the response to thyroid hormone.   So there is no biochemical test that can reliably determine tissue thyroid status.  Also each person can can have different requirements for thyroid hormone, at which they feel best.  

So the best way to diagnose for hypothyroidism is a full medical history, along with an evaluation for symptoms that occur more frequently with hypothyroidism than otherwise, supplemented with expanded testing.  Tests should include  Free T4, Free T3, TSH, Reverse T3, TPO ab (and TG ab if TSH is high and TPO ab is negative), cortisol, Vitamin D, B12 and ferritin.    You have had all those tests except cortisol and ferritin.   You did have an iron test but ferritin is a storage form of iron that is readily available for use by the body and it is considered a precursor to iron levels.   So you should try to get tested for cortisol and ferritin when possible.   Your Vitamin D is too low.  It should be at least 50 ng/mL.  Your B12 is also lower than optimal.  It should be in the upper part of its range.  You can supplement with OTC D3 and B12 to optimize.  

You have mentioned a number of symptoms that you said were hypothyroid related.  Along with that your Free T4 of 1.2 is  33% of its range, your Free T3 of 3.17 is only 46% of its range.   Your Free T3 being higher in range than Free T4 may be an indication that your body is converting more T4 to T3 in an effort to maintain body function as best possible.    Another indicator that your Free T3 is less than optimal is that your Free T3 to RT3 ratio is only 1.7.  Depending on the source, recommendation is that it should be more like 1.8 - 2.0.  

Symptom relief is strongly associated with Free T3, but not with Free T4 and TSH.   So you are going to need thyroid medication adequate to raise your Free T3 into the upper half of its range and adjusted from there as needed to relieve hypo symptoms.    For this purpose I suggest that you request desiccated thyroid med containing both T4 and T3, like Armour Thyroid, Naturethroid, or NP Thyroid.    But before starting on any thyroid med, I suggest that you get tested for cortisol and ferritin, since both have such an effect on thyroid.  

Do you think the NP will be willing to do these additional tests and then prescribe one of the meds mentioned?  
2 Comments
I am sure I can get her to run the ferritin, my serum cortisol at 4 pm was 4.0 mcg/dL with a range of <20 mcg/dL.
ACTH at 4pm was 12.4 pg/ml (range betw 7 -10 am 7.2-63.3 pg/ml)
24 hr creatinine 1.68 (range .5-2.5 g/24 hr)
Cortisol saliva at 11 pm for 3 days - .04, .059 & .020 (no range)
24hr Cortisol free - 4 (no range)
Urine random 24 hr - 40 mg/dL (30 - 125 mg/dL)
As a side note, I typically drink almost 1 gallon of tea during the day???
Avatar universal
Between the ranges shown and the times of day when tested, I am not sure what to make of those cortisol tests.   If you want the best assessment I suggest a diurnal saliva cortisol panel of 4 tests during the whole day, starting at about 7-8 a.m.    If the NP can't  get that done you can order a kit from ZRT that costs about $135.   Saliva cortisol (free cortisol) is much more revealing that a serum cortisol (total cortisol).  
Avatar universal
That is a lot of tea.  What kind of tea?  The reason I ask is the following info.  

"Catechins are flavonoids found in abundance in green tea, have elicited high interest due to their beneficial effects on health. Though flavonoids have been reported to have an antithyroid effect and also to be goitrogenic there have been no reports about the effect of green tea on rat thyroid. The present study was designed to examine whether high doses of green tea has any harmful effect on thyroid physiology. For this purpose green tea extract was administered orally to male albino rats for 30 days at doses of 1.25 g%, 2.5 g% and 5.0 g%, respectively. Similarly, pure catechin was administered at doses of 25, 50 and 100mg/kg body weight which is equivalent to above doses of green tea extract. Lower body weight gain associated with marked hypertrophy and/or hyperplasia of the follicles was noted in the high dose of green tea and catechin treated groups. Decreased activity of thyroid peroxidase and 5'-deiodinase I and substantially elevated thyroidal Na,K+ATPase activity have been observed. Moreover, serum T3 and T4 levels were found to reduce followed by significant elevation of serum TSH. Taken together, these results suggest that catechin present in green tea extract might behave as antithyroid agent and possibly the consumption of green tea at high dose could alter thyroid function adversely."
Avatar universal
One of the problems with hypothyroidism is that the symptoms are "non-specific". That is, some symptoms of hypothyroidism are also symptoms of other medical conditions. Fatigue and weight gain are good examples that can occur in various medical problems.

Looking at your labs alone, they do not confirm that you are hypothyroid. In fact they would be described as optimal by some doctors. For example if you look here:
https://www.nihadc.com/assessments/thyroid-scale.html
they quote optimal FT4 is 1.2 - 1.3 and yours is 1.2
they quote optimal FT3 is 3.2 - 3.3 and yours is 3.17

Because of the non-specific nature of hypo symptoms, your next step (and your doctor's) should be to make every effort to look for other possible causes of your symptoms. You are already doing that with cortisol and others. I would suggest looking at the hormone tests offered by Precision Analytical in the form of the DUTCH urine tests. They are expensive, but cover a lot of tests including cortisol.

If these test do not reveal that you have some other condition, you can come back to hypothyroidism, because as Gimel has pointed out, even though your lab tests do not indicate hypothyroidism, it is still possible the you may be hypothyroid, and further testing can be done.
Avatar universal
telus is correct about symptoms.  Individual symptoms can be non-specific; however if there are a number of those  symptoms that occur more frequently with hypothyroidism than otherwise, then that is the best evidence of hypothyroidism, which then needs to be supported with expanded tests as mentioned.    I disagree about optimal levels of Free T4 and Free T3, recommended by the doctors.  The levels they recommended are just mid-points of the ranges.  Every person can have different setpoints for FT4 and FT3 at which they feel best.   Also, studies have shown that on average,  symptom relief  required FT3  in the upper half of its range.   Dependent on other variables FT3 may even need to be in the upper end of its range for a specific person.    For treatment a patient's FT4 and FT3 levels need to be increased enough to relieve signs/symptoms of hypothyroidism without creating signs/symptoms of hyperthyroidism.  

rperdqh  Please post all the symptoms you have, so we are aware of them all.  
1 Comments
Chronic fatigue
Less stamina than others
Long recovery period after any activity
Snoring
Insomnia
Need naps in the afternoon
Weakness
Wake feeling tired
Frequently oversleep
Weight gain
Cold extremities
Night sweats
Cold intolerance
Cold feet
Low basal body temperature (below 97.8 degrees Fahrenheit)
Frequent colds
Frequent flus
Susceptibility to bronchitis
Hard time recovering from infections
Recurrent sinus infections
Salt cravings
Low, husky, hoarse voice
Dry mouth
Oversensitive hearing
Brittle ridged nails
Dry skin
Cracked heals
Rashes
Premature gray hair
Finer hair
Hair loss
Easily bruising, takes long time to go away
Chronic headaches
Joint pain and stiffness
Chronic back pain
Osteoarthritis
High cholesterol
Hysterectomy due to difficult periods - heavy bleeding, non-stop bleeding, PCOS
Low blood pressure
Bilateral carpal tunnel

Probably more, but its all I can list right now.

PS - I don't drink green tea, regular black tea.


Avatar universal
You certainly have numerous symptoms that occur more frequently with hypothyroidism.  There are also some symptoms that are often related to low cortisol.   If you need to get the  saliva cortisol testing done on your own, this is a link to order a kit.

https://livewelltesting.com/healthconfirm-zrt-stress-hormone-plus-full-day-cortisol-saliva-home-test-kit/
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