Avatar universal

Help with understanding lab work

I need help figuring out what is going on with my thyroid...I am suffering from typical hypothyroid symptoms weight gain, exhaustion, etc. but tests still showing within ranges. Doctor had mentioned Hashimotos but then she left the practice and the next doctor told me I was fine and then told me she didn't need to see me anymore....I'm starting from scratch with a new doctor and I need to have some help with understanding these labs before I  go back to see her...thanks in advance for your time!

Current tests from 7/7/15
TSH                                                   1.030    (0.450 - 4.500).
(Previous tests 1/14 - was 1.1)
(Previous test 7/14 - was 1.23)

Thyroid Peroxidase (TPO) Ab.         26           (0 - 34)
(Previous test 1/14 - was 14)

Triiodothyronine,Free,Serum             3.9         (2.0 - 4.4)
(Previous test 7/14 - was 3.3)

Thyroxine (T4) Free, Direct, S.           1.19      (0.82-1.77)
(Previous test 7/14 - was 1.36)

Vitamin B12                                    347           (211 - 946)
Vitamin D, 25-Hydroxy                     25.1        (30.0 - 100.0)

Doctor has called me and put me on D2 weekly 50,000 tablets and weekly b12 injections but has not reviewed the other lab results with me yet and I do not go back for follow up appointment until 3 more weeks.
3 Responses
Avatar universal
There is nothing in those results that really point to Hashi's.  If anything they point toward central hypothyroidism.  Central hypothyroidism is a dysfunction in the hypothalamus/pituitary system resulting in relatively low TSH and resultant low Free T4 and Free T3.  I know your latest Free T3 is not low in the range, which made me think of this quote from a good thyroid doctor.  

"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

In addition hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  I expect that the new doctor will want to re-test for Free T4, free T3, and TSH.  You should also request to be tested for ferritin.  D needs to be about 55-60, B12 in the very upper end of its range, and ferritin about 70 minimum.  You should supplement to optimize all three.  Low levels can cause symptoms that mimic hypothyroidism.  Low D and ferritin can adversely affect metabolism of thyroid hormone.  

When you see the new doctor you should emphasize symptoms very strongly as being typical of hypothyroidism.  Unless the doctor is a good thyroid doctor I expect that you are going to have difficulty convincing that you are hypothyroid.  Keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  You can get some good insight from this link and perhaps use it with your doctor to push for what you need.  


Avatar universal
Thank you so much for your reply.

Can you please explain what the Thyroid Peroxidase (TPO) Ab results mean...I'm concerned with the results almost doubling in the past year.
Avatar universal
Nothing there so far to be concerned about.  TPO ab results are vary variable. If TPO ab results exceed the upper range limit and you are having hypo symptoms and your TSH is high and increasing, then it is easy to conclude that the underlying cause is Hashimoto's Thyroiditis; however, as I mentioned your results point more toward central hypothyroidism  
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