Help with these blood test results

[pattig]

17 year old daughter has these results:
T4 (thyroxine)  11.0            5.2-10.7
TSH                  7.25          .0 - 5.0
THBR               .77              1.00
(Thyroid Hormone Binding Ratio)

Can anyone help interpret these?  Thanks.

[SusanneKonig]

I had a great doc near Boston , but as far as I know he doesn't practice any more .
There's a good one in north eastern PA
http://www.****.com/
He is specialised on hormones . So if it is a hormone problem , he should be able to help you .

Susanne
http://www.****

[pattig]

SusanneKonig,
Southern NH so not far from Boston.

[SusanneKonig]

Where are you , Pattig ? Just wondering if by any chance I knew a good doc in that area ....

[pattig]

So the new endo did another round of blood work.  All levels came back within normal range.  TSH 2.3, T4 7.0, free T4 1.0.  The only thing that was slightly low was Vitamin D, I don't have the final numbers  but endo said it was borderline low.  Prescribed Vitamin D. Suggested retesting in 4 months.  So...   no progress on the anxiety front.  We have seen 2 mental health professionals/therapists who do not think my daughter has anxiety.  She was given a prescription for ativan, which does not seem to help.

Back to square one I guess.

[kitty9309]

Wow, no follow up?

Is she on an anxiety med? Many of us have been diagnosed rightly or wrongly with anxiety.
Thyroid disorders can cause anxiety.

[pattig]

Kitty,

She did have antibodies tested earlier when they thought she might have Hashimotos and they were normal.

She was in the ER and admitted for 2 days due to severe tightness in neck, face, and head which caused her to feel like she could not breath.  After finding no medical reasons she was diagnosed with severe anxiety.  At this time, her TSH was 7.2. and she was told to follow up with an endo.

New endo has recommended accupuncture, no follow up scheduled.

[kitty9309]

Stress and illness can increase the TSH, but it is usually serious illness, like hospitalized. What was her resp. problem?

Yes, estrogen can increase the TSH.

Has she had thyroid antibodeis tested?  I would bet that the test is positive.

TSH levels that bounce around are good reason to continue following up with repeat levels.

Has the endo recommended follow up testing?

[pattig]

So an update after seeing the endo:  newest round of bloodwork shows TSH at 2.5, T4 still high, but free T4 is within normal range (and by the way has always been in the normal range).  So now my question is this:  TSH was high twice (6.8 and 7.0) while she was on the YAZ.  After stopping YAZ for 2 weeks, TSH dropped to 2.8.  But while she was in the ER for severe respiratory problems her TSH was 7.2.    Can stress/illness as well as estrogen (YAZ) cause TSH to be elevated?  Because now they are saying all is normal, there is no thyroid problem.  And she still has all these horrible symptoms, fatigure being the worst, then nausea, then head tightness/pressure.  Thanks.

[pattig]

Thanks Kitty, we go to the endo this week.

[kitty9309]

How long has she been off YAZ? I'm not sure how long it takes for the extra estrogen to be excreted.

A free t4 would really be telling in light of the previous use of YAZ, whose estrogen can cause the t4 to be elevated. I'm sure the endo will do the free t4 instead.

[pattig]

She had an MRI of the brain to check the pituitary and it was normal.  We are seeing a new endo this week.  The only meds she was taking at the last blood test was Prevacid for nausea.  Before that she was taking Yaz for irregular periods, but since being off the Yaz, the T4 has not really gone down.

Her other symptoms are:  constipation, weight loss, extreme fatigue, nausea, fluttering in chest/throat and most recently pressure in her head (squeezing feeling on top and sides).  Does this sound like anything anyone has heard/experienced.  

[kitty9309]

I just came across a reference that states that high TSH and high t4 could mean a possible TSH secreting pituitary adenoma.

Here is the source:

http://www.thyroidmanager.org/Chapter6a/chapter%206a-text.htm

Thyroid Manager is a great source.

Is your daughter taking any medication? Some can raise the t4.

I'm not familiar with the THBR. Sorry.

I would seek out an endocrinologist to explain these tests, if you haven't already.

[pattig]

This has been rechecked a few times.  The T4 has always been elevated and the TSH has gone as low as 3.5.  No estrogen being taken.  Antibodies were tested and were normal.  ANy comment on the THBR?  And that you so much.

[kitty9309]

The TSH by itself implies hypothyroidism.

The elevated t4 in this case doesn't make sense. The t4 is usually normal or low in hypothyroidism.

Ask for repeat blood tests to include a repeat TSH an a FREE T4. Free t4 is a better test than t4, as it is not affected by estrogen. Is she on any type of estrogen? (Birth control for any reason?) This can increase the t4, but not the free t4.

You may also ask for thyroid antibodies to be tested. Autoimmune thyroiditis is the most common cause of hypothyroidism.