Help with thyroid blood test

[Davis609]

TSH during annual blood work came back above normal reference range at 5.51 ( ) so Dr. Ordered more test and these are the results and would love some advise on interpreting them...
TSH - 4.60 (0.35-4.00)
T4, Free - 1.02 (0.89-1.76)
TPO AutoAb - 623 (<35)
Thyroglobulin AutoAb - <20 (<40)

My symptoms are achy bones, muscles and joints, insomnia, weight gain and lack of energy.

Thank you in advance for any input....

[Barb135]

Davis609... Ah, the disc doesn't really do us a lot of good when we don't know what we're looking at, does it?  LOL  There's a good chance you're right, though that those measurements could be nodules.  

As I said, both swelling, inflammation and nodules are very common with Hashimoto's, which you definitely have, according to your labs.  There's really nothing to worry about with them.  I've got quite a few nodules on my thyroid, as well as swelling/inflammation...  

I guess we'll just have to wait for the actual report to go much further.  

[Davis609]

Ok I picked up my US report today and this is what the impression says:

Enlarged, diffusely heterogeneous thyroid gland with several subcentimeter benign-appearing nodules. Surveillance recommended.

[Davis609]

i have not gotten the report from the radiologist yet. So not sure about nodules. But on the disc of my ultra sound there were small areas of measurements that may have looked like nodules. I'm definitely no expert but out of curiosity I looked at the disc and these were the measurements that were on there.

[Barb135]

I'm definitely not an expert on reading thyroid ultrasounds, but those are the dimensions of your thyroid gland... They put them in rather strange terminology, because they make it sound like you have more than one gland and you don't.  You have one gland with 2 lobes...

That said, it does look like your thyroid may be swollen (goiter).  Does the report say anything about nodules?  Is there anything that might indicate characteristics of the gland?  Goiter, which is a swollen, inflamed thyroid gland is very common with Hashimoto's.

Often, at the end of the report, the radiologist will put an "impression", which is a recommendation for follow-up, if any... Do you see anything like that?

[Davis609]

Ok I have not heard from my Dr. On these results as I just had the Ultra sound yesterday but I took a CD of the US home and these are my measurements

ISTHMUS - 0.11 cm
Rt thyroid L - 4.50 cm
Rt Thyroid H - 2.22 cm
Rt thyroid W - 1.80 cm
Rt thyroid Vol - 8.59 ml
Lt. thyroid L - 4.77 cm
Lt. thyroid H - 2.15 cm
Lt. thyroid W - 1.89 fm
Lt. thyroid Vol 9.26 ml

Any idea what these #'s mean??

[Barb135]

Yes, as I mentioned, you definitely need FT3, since that's the hormone that's used by the individual cells in your body, whereas FT4 is a storage hormone and must be converted to FT3 prior to being used.

Certainly, if your vitamin D came back at only 25, it's too low and you should be supplementing.  What dosage are taking every day?

Some people with hypothyroidism are also low in B12, so it doesn't hurt to have it tested.  As long as you're at it, you might as well go ahead and ask to get Ferritin tested as well.  Ferritin is the iron storage hormone.  Adequate iron is necessary for the conversion of FT4 to FT3.

I'll look forward to seeing the results of your ultrasound.

[Barb135]

Davis609... Your symptoms correspond with hypothyroidism, as does your Free T4.  It's unfortunate that your doctor didn't order a Free T3 test, since Free T3 is the hormone that's actually used by individual cells in the body and correlates best with symptoms.  

Rule of thumb (where many/most of us tend to feel best) is for Free T4 to be about mid range and Free T3 to be in the upper half to upper third of its range.  Your Free T4 is only at 15% of its range.  The pituitary produces TSH to stimulate the thyroid and when the thyroid doesn't respond, the pituitary continues to produce TSH, which means your TSH will keep getting higher, as your FT4 goes lower.

Your TPOab is elevated, which is the basis for a diagnosis of Hashimoto's Thyroiditis, which is an autoimmune thyroid disorder in which the body determines that the thyroid is foreign and produces antibodies to destroy it.  The destruction, typically, takes place over a period of years and as it takes place, the thyroid produces less hormones until, eventually, it produces none at all.

If your doctor hasn't already started you on replacement thyroid hormone medication, s/he should.  The ultimate goal is to relieve symptoms.

[Davis609]

My Dr won't even return my phone calls. I do see a lump on the right side of my neck right below my Adam's apple when I swallow. I have a script for an ultra sound on thyroid that I am going to schedule on Monday. Thanks for your reply and I will post my ultra sound results when I get them. After reading posts on this forum I am also going to ask that my Vitamin B12 & FT3 be checked. My vitamin D in my initial blood work came back low at 25 so I am currently taking a vitamin D3 supplement daily.