High total T3--Is this a problem?

[mariedc]

For 20 year old daughter.  Posted below but didn't do a good job following lab posting protocol.  Her total T3 came back high this week at 326 (80-210).  Doctor didn't know what to make of it.  Is this a problem?  Note she had high testosterone in March, when her total T3 was 93, and was put on low dose oral contraceptives to treat.  Could the O/C have caused the large increase in T3 or should we be checking for something else going on?  She is somewhat anemic and deficient in Vitamin D, although not badly so.  Physically she is kind of wreck with constant muscle and joint pain, fatigue, insomnia, shortness of breath, recent resurgence of epilepsy after four year hiaturs, neurological symptoms like hyperreflexia, etc. but is not overweight.  Don't want to have to worry about thyroid if don't have too as so many other issues.

Thanks for any help

Here are labs from this year--they go back further on earlier post.

3/13  
TSH 1.9  ( 0.4-4.5)      
Total T3  93  (76-181)  
Free T4 1.1 (0,8-1.8)

11/13  
TSH 2.54  (0,7-5.7)    
Total T3 326  (80-210)  
Total T4 10.6 (4.5-12)

3/13
Total testosterone  105 (2-45)
Free testosterone   14.4 (0,1-6.4)

9/13
B12 453 (200-1100)
Folic Acid 14.7  (5.38-24)
Homocysteine 15.4 (4-15) (Note:Increases w/ age and male sex--over 9 or 10 high in young female)

11/13
Hemoglobin 11.1 (11.5-15.6)
Hematocrit 33.3 (34.5-46.5)
Ferritin 24 (10-291)
Serum Iron 56 (30-160)
Vitamin D 26 (32-80)

[mariedc]

I figure the high homocysteine is due to B12 so I am supplementing.  Her serum B12 is considered too high for injections, (One doctor said it had nothing to do with B12 and was probably genetic and in any case not a specific test so nothing to do.) I am hoping supplementation works. Your success is encouraging, though I wished we could have had injections for a quicker boost.

I know the most common cause of high testosterone is PCOS and that is what the OBGYN called her symptoms before doing any tests. She doesn't have cystic ovaries and she is not overweight--just high testosterone, acne and amenorrhea and the former can cause the latter two.  Spironalactone has finally cleared her acne after three Accutane failures.

I find a PCOS dx very confusing--seems more like a name for the sign of high testosterone.  So why not just say high testosterone? But maybe that just begs the reason why the testosterone is high.  If one says the reason is PCOS then that's the end of that, but it seems very circular.

[Red_Star]

My homocysteine levels dropped into the healthy 6 range after B12 injections. That is where I like it. :) Oral contraceptives raise total T3. Increased testosterone levels in women are most often caused by polycystic ovary syndrome (PCOS).

[mariedc]

Thanks for the kind offer.  Baltimore is an hour drive away.  I'd consider if this was her only problem, but unfortunately we are already averaging around three doctor's appointments a week between neurology, dental, eye, psychiatry, sleep (just found out she has moderate central sleep apnea), GI, gynecology, allergy/asthma, ENT etc.  Every doctor refers her to another and I am exhausted from scheduling appointments and tests,keeping prescriptions filled, and taking her there.  (Seizures=no driving for her.)

[gimel]

I have been collecting a list of member recommended doctors for well over 4 years now.  The closest Endo that I have on my list is in Baltimore.  Is that close enough to consider?

[mariedc]

Gimel,

Thanks for your input.  We see PCP again in two weeks as testosterone needs to be followed up.  Will ask for Free T3 and T4, and TSH as well so they are also tested at the same time.

We live in Washington DC--I took her brother to an endo when pediatrician found a nodule on his throat.  After two separate tests endo concluded he had Hashi's but said there was no point in treating until the ups and downs burned the thyroid out(!) Doesn't inspire confidence.  Endo also said his weight gain wouldn't have anything to do with thyroid.  On the third test endo said the results looked less like Hashi's and his antibodies weren't positive so just do annual testing.  Have to take him in for that and will try to get test results.

[mariedc]

Bedhead,

Thanks for the response.  We just got back Vitamin D and Ferritin.  Have started D supplements and will look for iron this weekend.  I have also begun supplementing B12.  She gets episodes of shortness of breath with heart racing--she has severe anxiety, but these are nothing like her anxiety attacks (believe me--both she and I I know the difference).  She also has asthma, but the episodes don't include wheezing.

They did not do frees for some reason--I always thought those were more indicative.  I am wondering if I should get the doctor to do these to be sure they are okay.

Here is earlier thyroid test history:

7/11  
TSH 0.6, (0.5-4.3)      
Free T4 1.0(0.8-1.8)

2/12  
TSH 2.0  (0.5-4.3)      
Free T3 3.1  (2.3-4.2)    
Free T4 0,9 (0.8-1.8)

7/12  
TSH 0.9 (0.4- 4.7)      
Free T4 0.8 (0.6-1.8)

8/12  
TSH 0.4  (0.5-4.3)      
Free T3 3.8 (2.3-4.2)    
Free T4  0.9 (0.8-1.8)

[gimel]

Some of those test results are beyond my understanding.  I will say that she seems to have symptoms that frequently relate to being hypothyroid.  That would be easy to conclude from the March test results, if we were able to assume that her Free T3 would reflect the Total T3 result, which was very low in the range.  It is unfortunate that she is not being tested for Free T3 and Free T4 each time she goes in for tests.  The Total T3 and T4 are somewhat outdated and not nearly as revealing as the Frees.  So I suggest that you request Free T3 and Free T4 each time she goes in for tests.  If the doctor resists, just insist on it and don't take no for an answer.  Free T3 is most important because it has been shown to correlate best with hypo symptoms, while Free T4 and TSH did not correlate at all.

As for the high Total T3 in November, I don't really know what to make of that.  Could it be an error in the testing or reporting?  Don't know.  I think at this point I would go back and request the Free T3 and Free T4 just to get the better info and to be sure of the T3 level.

Her Vitamin D is much too low.  Should be around the middle of the range.  B12 should be in the upper part of its range.  Her serum iron is low in the range, but her ferritin level is much too low.  Ferritin is said to be a precursor to iron levels.  For women ferritin is best at 70-80.  It is very important for proper metabolism of thyroid hormone and low ferritin can cause unwanted symptoms as well.  So it appears that supplementing with D3, B12 and ferritin is in order.  For ferritin supplementation, ferrous fumarate and ferrous glycinate are good forms, to be taken with some Vitamin C to prevent constipation.

So, that is all I can suggest at this point.  If you will get those Free T3 and Free T4 tests done, it will help a lot to understand her thyroid status better.  I'd like to see her go to an Endocrinologist that is also a good thyroid doctor.  There are not very many of those around anywhere.  If you will tell us your location, perhaps a member might be able to recommend such a doctor, based on personal experience.    

[bedheadblonde]

Does she take any sort of Vitamin D? It's somewhat low, a lack of it can cause muscle aches and weakness. Her ferritin is within range, but still a bit low, which can also cause the weakness, the shortness of breath, etc. Is she on anything for that?

Estrogen can affect thyroid levels, yes. I went off a higher dose birth control and ended up needing a lot less thyroid replacement hormone. Did they do the Free's this last blood draw, or just the totals?

[mariedc]

Anyone?