Aa
How accurate are lab tests?
I am a 20 year old female. Two weeks ago, I finally told my mom I wanted to get some tests done. I haven't felt like myself for a while. A year ago, I went through some anxiety/depression but have since been off the meds for quite a few months. My memory within the last year or so has been really bad. Recently, I woke up one morning and could not remember who I was for several minutes. I have gained weight within the last year (my sophomore year of college) and have always felt tired during the day. I would much rather sleep all day than do anything else. My appetite has been increased, I have seemed to be more irritable, and I am always hot. The machine was down at the lab, so I did not get all my results that day, but all of my results: red blood cell count, iron, B12, blood pressure, was all normal. I found out about a week later that the results had shown a TSH of 6.9, which they said was high so they put me on Synthroid for hypothyroidism. That day, before I started the medicine, they did another TSH test and tested my t4 (but not my t3?). I called them and basically pestered them for my results (this was about a week or more later than the first test). The nurse finally called me back and told me my TSH level was normal (after no meds) and that my t4 was low (she didn't give me the actual numbers). My mom remembered I got blood work done last year, and got them to check what my tsh was last year (maybe it was high then, and they never told me). She once again gave no numbers but said it was normal. I know my grandmother and her sister both have thyroid problems (her sister had a goiter(s) removed). My questions: could the blood that gave the high tsh have rendered wrong results since they tested it a day or two later, could the machine not be accurate, could the abnormal TSH test be abnormal because I was going to start my period that week? They are now sending off my most recent blood (with the normal TSH) off to another lab to be tested, but if it is normal, what does that tell me? Out of the past year, one of three showed me to be hypothyroid, but the others were normal. What is your take on this? If I wanted to go to another doctor for a blood test, how long do I have to be off the Synthroid to get an accurate reading not affected by the medicine? Should I even keep taking the Synthroid since I don't even know that I have hypothyroidism? Thank you for any answers or advice. Our heads are swimming right now.
COMMUNITY LEADER
It takes 4-6 weeks for the medicine to reach full potential in your blood, so stopping after a month will completely defeat your purpose.
As for the TSH and FT4 --- it's not unusual for symptoms to appear before lab tests are out of range and many people have horrible symptoms, even with labs in range.
TSH fluctuates greatly, even intraday, so the fact that 2 out 3 came back "normal" means nothing. TSH, alone is totally inadequate to diagnose or treat a thyroid condition. And don't forget that your lab is using an outdated range, so if you replace their range with the recommended one of 0.3-3.0, your level is definitely out of range.
When you go to the new doctor, don't just assume that he knows what to test for....... ASK for what you need or you may not get it.
As far as vitamin deficiencies -- you could have some, because a lot of people with hypothyroidism are lacking in some vitamins/minerals. Vitamins B12 and D are 2 that are often deficient in hypothyroidism and can cause similar symptoms, so you should get those tested, as well.
I wouldn't want to come between you and your mother or other relatives/friends, but it appears that they don't understand how hypothyroidism works and how horrible it can make you feel.
Your TSH is too high in the range and your FT4 is way too low in its range. Your body doesn't use FT4; it must be converted to the active FT3, and since you haven't had an FT3, we don't know if that's happening.
Being on the med for 2 weeks isn't long enough for it reach full potential, but some people do start feeling minor improvement in a short time. The first thing I noticed when I started on med, was that the puffy bags under my eyes went away and I didn't even know they were hypo symptoms....
The person who said she didn't know if you need the med or not, should be fired from her job........... if the doctor prescribed the med, it's not up to a nurse to second guess...... if you choose not to take the medicine that's your prerogative, no one else should be telling you, you don't need it, because only you know how you feel and if you think some of your symptoms might be getting better after only 2 weeks, why would you even think about stopping?
As for the TSH and FT4 --- it's not unusual for symptoms to appear before lab tests are out of range and many people have horrible symptoms, even with labs in range.
TSH fluctuates greatly, even intraday, so the fact that 2 out 3 came back "normal" means nothing. TSH, alone is totally inadequate to diagnose or treat a thyroid condition. And don't forget that your lab is using an outdated range, so if you replace their range with the recommended one of 0.3-3.0, your level is definitely out of range.
When you go to the new doctor, don't just assume that he knows what to test for....... ASK for what you need or you may not get it.
As far as vitamin deficiencies -- you could have some, because a lot of people with hypothyroidism are lacking in some vitamins/minerals. Vitamins B12 and D are 2 that are often deficient in hypothyroidism and can cause similar symptoms, so you should get those tested, as well.
I wouldn't want to come between you and your mother or other relatives/friends, but it appears that they don't understand how hypothyroidism works and how horrible it can make you feel.
Your TSH is too high in the range and your FT4 is way too low in its range. Your body doesn't use FT4; it must be converted to the active FT3, and since you haven't had an FT3, we don't know if that's happening.
Being on the med for 2 weeks isn't long enough for it reach full potential, but some people do start feeling minor improvement in a short time. The first thing I noticed when I started on med, was that the puffy bags under my eyes went away and I didn't even know they were hypo symptoms....
The person who said she didn't know if you need the med or not, should be fired from her job........... if the doctor prescribed the med, it's not up to a nurse to second guess...... if you choose not to take the medicine that's your prerogative, no one else should be telling you, you don't need it, because only you know how you feel and if you think some of your symptoms might be getting better after only 2 weeks, why would you even think about stopping?
From what I had read before, I thought that is how it would work with Synthroid - my results would be hyper if I did not need the meds and "normal" if I did need them. She is concerned because of the three labs the office themselves took, only the one looked to be abnormal.
After sleeping on and off for two days straight, I do feel that I am feeling a bit better -maybe a bit more clear-headed. Sometimes, I am not quite as unbearably hot as I was - maybe even kind of cool. I cannot quite tell if it is helping my energy level yet, and sometimes I still get super hungry (especially at night).
From what I can tell, the range is the same as with the other labs, but who knows. She was not going to tell me any of the numbers but was just going to say it came back normal. TSH Range is 0.340-4.820 mIU/mL and mine was 4.1, but like you and many others I have seen online say, it has actually been changed to 0.3-3.0. My free T4 was 0.9 ng/dL, which is in range (0.59-1.17).
I have not had FT3 or antibodies checked (no test for Hashimoto's), but I am hoping maybe this new doctor would test these (hopefully it won't cost a ton more or maybe he will just know to do so).
Basically, I think my mom thinks this is all test result error and since 2 out of 3 said my TSH was fine, she thinks I am fine, but I know it goes a lot deeper than that. I just wish she would understand that I do not feel good, and this is my last bit of hope - that maybe this is what is causing me to feel the way I do.
Needless to say, I am really hoping this doctor knows what he is doing. My mom told me to take them for the month's dosage, and then if I don't see a difference to stop, but I don't know if that would leave a small part of it in my system. I want it all in my system, so if my test turns out good, I can say it is from the medicine, whereas if I stopped it a week or two before (maybe even three), I feel it is a bit unclear that if my results came back it was because I am not hypothyroid or because some of the Synthroid was still helping me.
Some family friends are trying to say it is basically just gluten or maybe vitamin deficiencies. They think if it was a serious problem at my age, I would be really big. I think the meds might be helping or potentially help, so I just wish I could take them without so much fuss. Also, how unprofessional that was to basically say, "I don't know if you need the meds or not - that is your call", but still have a six weeks check-up.
After sleeping on and off for two days straight, I do feel that I am feeling a bit better -maybe a bit more clear-headed. Sometimes, I am not quite as unbearably hot as I was - maybe even kind of cool. I cannot quite tell if it is helping my energy level yet, and sometimes I still get super hungry (especially at night).
From what I can tell, the range is the same as with the other labs, but who knows. She was not going to tell me any of the numbers but was just going to say it came back normal. TSH Range is 0.340-4.820 mIU/mL and mine was 4.1, but like you and many others I have seen online say, it has actually been changed to 0.3-3.0. My free T4 was 0.9 ng/dL, which is in range (0.59-1.17).
I have not had FT3 or antibodies checked (no test for Hashimoto's), but I am hoping maybe this new doctor would test these (hopefully it won't cost a ton more or maybe he will just know to do so).
Basically, I think my mom thinks this is all test result error and since 2 out of 3 said my TSH was fine, she thinks I am fine, but I know it goes a lot deeper than that. I just wish she would understand that I do not feel good, and this is my last bit of hope - that maybe this is what is causing me to feel the way I do.
Needless to say, I am really hoping this doctor knows what he is doing. My mom told me to take them for the month's dosage, and then if I don't see a difference to stop, but I don't know if that would leave a small part of it in my system. I want it all in my system, so if my test turns out good, I can say it is from the medicine, whereas if I stopped it a week or two before (maybe even three), I feel it is a bit unclear that if my results came back it was because I am not hypothyroid or because some of the Synthroid was still helping me.
Some family friends are trying to say it is basically just gluten or maybe vitamin deficiencies. They think if it was a serious problem at my age, I would be really big. I think the meds might be helping or potentially help, so I just wish I could take them without so much fuss. Also, how unprofessional that was to basically say, "I don't know if you need the meds or not - that is your call", but still have a six weeks check-up.
COMMUNITY LEADER
What's the lab range for the FT4? Ranges vary lab to lab and have to be posted with results.
I think, both, you and your mom are misunderstanding things. If the synthroid does anything to alleviate your symptoms, then it's a pretty sure bet that you need it.. But even if your dose isn't high enough to alleviate symptoms, that doesn't mean you don't need it; it simply means your dose isn't high enough........ I don't want to get between you and your mother about this.... I just have to question if your mother is informed enough to decide whether or not you need the med.
With a TSH of 4.1 and an FT4 of 0.9, even without ranges, I'd say you need the med, because even if the FT4 is "in range" it's quite likely to very low in the range.
I am totally appalled that a medical professional would leave it up to your mother to decide whether or not you need the med.... that's totally absurd.
My question to you is - have you seen even the slightest bit of improvement since you started on Synthroid? If not, with your labs, you might need a higher dose.
I'm sorry, I don't understand the reasoning behind not taking the Synthroid. If you really don't need it, between your own thyroid production and the med, you will go hyper.
Let's look at the issue of whether or not your new doctor can tell what's going on if you have labs while on the synthroid........ you already have labs showing that you're hypo (I assume you will take those lab results with your), so if your levels are "normal" when you get tested again, it's logical to think that the med (Synthroid) is what's making them normal....
I'm sorry, I just don't understand anyone (even your mother) wanting you to stop medication when it seems obvious that you need it. I'm not a doctor, so I'm not going to try to fight your mother... I'm only going to suggest that she may not understand the whole issue........ I'm not sure why she's so opposed to your taking replacement hormones, when it's clear that you need them.
Yes, if your appointment is 5 weeks away and you stop the synthroid now, it will be out of your system..... so what's that going to prove? Nothing, other than that you're hypo and need to be on med...... If you continue to take them and your symptoms are somewhat alleviated that would indicate that you really do need them in order to feel better... your mother wouldn't deny that would she?
The pills can "fix" you, but it might take a while to find the right dosage, depending on what's causing your hypothyroidism...... Have you been tested for Hashimoto's?
I think, both, you and your mom are misunderstanding things. If the synthroid does anything to alleviate your symptoms, then it's a pretty sure bet that you need it.. But even if your dose isn't high enough to alleviate symptoms, that doesn't mean you don't need it; it simply means your dose isn't high enough........ I don't want to get between you and your mother about this.... I just have to question if your mother is informed enough to decide whether or not you need the med.
With a TSH of 4.1 and an FT4 of 0.9, even without ranges, I'd say you need the med, because even if the FT4 is "in range" it's quite likely to very low in the range.
I am totally appalled that a medical professional would leave it up to your mother to decide whether or not you need the med.... that's totally absurd.
My question to you is - have you seen even the slightest bit of improvement since you started on Synthroid? If not, with your labs, you might need a higher dose.
I'm sorry, I don't understand the reasoning behind not taking the Synthroid. If you really don't need it, between your own thyroid production and the med, you will go hyper.
Let's look at the issue of whether or not your new doctor can tell what's going on if you have labs while on the synthroid........ you already have labs showing that you're hypo (I assume you will take those lab results with your), so if your levels are "normal" when you get tested again, it's logical to think that the med (Synthroid) is what's making them normal....
I'm sorry, I just don't understand anyone (even your mother) wanting you to stop medication when it seems obvious that you need it. I'm not a doctor, so I'm not going to try to fight your mother... I'm only going to suggest that she may not understand the whole issue........ I'm not sure why she's so opposed to your taking replacement hormones, when it's clear that you need them.
Yes, if your appointment is 5 weeks away and you stop the synthroid now, it will be out of your system..... so what's that going to prove? Nothing, other than that you're hypo and need to be on med...... If you continue to take them and your symptoms are somewhat alleviated that would indicate that you really do need them in order to feel better... your mother wouldn't deny that would she?
The pills can "fix" you, but it might take a while to find the right dosage, depending on what's causing your hypothyroidism...... Have you been tested for Hashimoto's?
So, I am sorry to be back so soon, but I was hoping you could help me with some insight. The outside lab tests came back. My TSH was 4.1 and my FT4 was 0.9, both of which are normal in their scales. I just don't know why my results are so different every time. :(
Anyway, my mom asked if I should continue taking my Synthroid and the nurse practitioner said that was up to what my mom thought (really? a medical professional?). We have cancelled my six week lab tests with that office, and I am instead going to go to a doctor that has a specialty in thyroid disorders. My appointment is on the 12th of August (I have been taking this medicine for roughly two weeks).
My question is can the doctor get an accurate reading of everything if I continue taking my Synthroid since he won't have a baseline. I thought if it was working, my results would be in range, and if I was not actually hypothyroid, that my results would be those of someone with hypothyroid.
My mom keeps telling me to stop taking them because she is afraid it could give me damage if I do not have hypothyroidism. Also, she was asking if the doctor could even get that accurate reading and know whether it was from the Synthroid or not.
My appointment is about five weeks away. If I stopped now (25 mcg), would the Synthroid be completely out of my system? Would it throw things off if I continued using it? I guess I was just holding out hope that maybe the pills would fix me, so that is why I keep taking them.
Thank you for any insight.
Anyway, my mom asked if I should continue taking my Synthroid and the nurse practitioner said that was up to what my mom thought (really? a medical professional?). We have cancelled my six week lab tests with that office, and I am instead going to go to a doctor that has a specialty in thyroid disorders. My appointment is on the 12th of August (I have been taking this medicine for roughly two weeks).
My question is can the doctor get an accurate reading of everything if I continue taking my Synthroid since he won't have a baseline. I thought if it was working, my results would be in range, and if I was not actually hypothyroid, that my results would be those of someone with hypothyroid.
My mom keeps telling me to stop taking them because she is afraid it could give me damage if I do not have hypothyroidism. Also, she was asking if the doctor could even get that accurate reading and know whether it was from the Synthroid or not.
My appointment is about five weeks away. If I stopped now (25 mcg), would the Synthroid be completely out of my system? Would it throw things off if I continued using it? I guess I was just holding out hope that maybe the pills would fix me, so that is why I keep taking them.
Thank you for any insight.
COMMUNITY LEADER
Okay, so your folate, then is greater than 24, with the high end being greater than 5.4. Odd - I wonder what they consider too high!!
I'm glad you have a lead on a different doctor; sounds like Dr McDreamy. It may be overkill, but I can't stress enough - when you're talking about testing for T3 and T4, "always" be sure to specify "FREE", because if you don't you may not get what you want, because simple T4, without the Free will get you total, which you don't want...... same goes for T3.
Keep us posted on how things go. Best of luck.
I'm glad you have a lead on a different doctor; sounds like Dr McDreamy. It may be overkill, but I can't stress enough - when you're talking about testing for T3 and T4, "always" be sure to specify "FREE", because if you don't you may not get what you want, because simple T4, without the Free will get you total, which you don't want...... same goes for T3.
Keep us posted on how things go. Best of luck.
I see what you mean. So it still did not type right. Low is less than 3.4. Borderline is 3.4 to 5.4 and Normal is anything greater than 5.4.
We are now looking at other options. It turns out there is actually a doctor not too far away that is supposed to be really good and works both naturally and medically. A friend who I just found out has a thyroid condition said that this person checks both T3 and T4 and runs full panels and things. She also said that someone with a thyroid condition should watch their gluten intake.
I guess now it is about figuring out the next step doctor-wise. I cannot thank you enough! I really can't. And thank you for the questions I could ask. If I can ever officially find an email, that would be good!
We are now looking at other options. It turns out there is actually a doctor not too far away that is supposed to be really good and works both naturally and medically. A friend who I just found out has a thyroid condition said that this person checks both T3 and T4 and runs full panels and things. She also said that someone with a thyroid condition should watch their gluten intake.
I guess now it is about figuring out the next step doctor-wise. I cannot thank you enough! I really can't. And thank you for the questions I could ask. If I can ever officially find an email, that would be good!
COMMUNITY LEADER
Okay, let's focus on the folate for a minute........ do no I now understand that your result is > 24, and the lab considers 5.4 as being the low end of the range, so anything above that would be in the normal range? Sometimes the "less than/greater than" signs don't post properly so things end up kind of jumbled. We often resort to just typing it out.
The doctors don't come up with these ranges, the labs do, based on the people for whom they do these tests. The problem is that the way they set the ranges is flawed, because not all the data comes from people with "normal" levels. For instance in Japan, a vitamin B12 under about 500 is considered to be deficient. Doctors simply look at the range the lab sets and if your result is somewhere within it, they say your result is normal.
MCHC measures the average amount of hemoglobin inside red blood cells. Low levels may indicate an iron deficiency.
RDW measures the size of red blood cells. It's often quite high, with B12 deficiency; yours is not, but then your B12 isn't really horribly low, according to the range, either. Even though yours is in range, it may not be a functional level for you. If my B12 were at 478, I'd not be able to navigate.
Some doctors' offices have only certain people allowed to answer specific questions about treatment. Many times it involves either going through a nurse or office manager, or even someone such as the liaison, you mentioned. Some of our members have faxed questionnaires to potential doctors, others have e-mailed. You might try that, with your set of questions - when questioning about thyroid treatment, always be sure to include the questions I listed above. You may find a great doctor who does everything else right, but won't treat thyroid adequately. Doctors who don't bother to respond, would, of course, not be considered. If a doctor (or someone in her/his office) won't give you straight answers, you probably don't want to go there, anyway.
You definitely need to have the thyroid antibodies I listed above tested, along with Free T3, Free T4 and TSH and a thyroid ultra sound to determine whether or not you have nodules. Would be a good idea to repeat the B12 test and since your MCHC is so close to the bottom of the range, I'd add ferritin. Some of us who are hypo are also deficient in vitamin D, so you might as well add that to the list.
The doctors don't come up with these ranges, the labs do, based on the people for whom they do these tests. The problem is that the way they set the ranges is flawed, because not all the data comes from people with "normal" levels. For instance in Japan, a vitamin B12 under about 500 is considered to be deficient. Doctors simply look at the range the lab sets and if your result is somewhere within it, they say your result is normal.
MCHC measures the average amount of hemoglobin inside red blood cells. Low levels may indicate an iron deficiency.
RDW measures the size of red blood cells. It's often quite high, with B12 deficiency; yours is not, but then your B12 isn't really horribly low, according to the range, either. Even though yours is in range, it may not be a functional level for you. If my B12 were at 478, I'd not be able to navigate.
Some doctors' offices have only certain people allowed to answer specific questions about treatment. Many times it involves either going through a nurse or office manager, or even someone such as the liaison, you mentioned. Some of our members have faxed questionnaires to potential doctors, others have e-mailed. You might try that, with your set of questions - when questioning about thyroid treatment, always be sure to include the questions I listed above. You may find a great doctor who does everything else right, but won't treat thyroid adequately. Doctors who don't bother to respond, would, of course, not be considered. If a doctor (or someone in her/his office) won't give you straight answers, you probably don't want to go there, anyway.
You definitely need to have the thyroid antibodies I listed above tested, along with Free T3, Free T4 and TSH and a thyroid ultra sound to determine whether or not you have nodules. Would be a good idea to repeat the B12 test and since your MCHC is so close to the bottom of the range, I'd add ferritin. Some of us who are hypo are also deficient in vitamin D, so you might as well add that to the list.
I cannot keep telling you enough how thankful I am for your insight. My goodness I am sorry you have so many things going on. :/ I hope you have found a good doctor to help you with all this stuff.
About interviewing potential doctors, they are not like that here at all. We talk to the receptionist and are lucky to ever get to talk to a nurse. My mom called a recommended doctor and had her own set of questions, but they said they weren't even sure they were taking patients and that we had to wait til Tuesday of next week to talk to some kind of liaison-type assistant. No matter where we go, we don't get any straight-forward answers.
Upon further investigation, the range somehow got posted wrong. I remember typing all the less than and greater than signs, but that did not transfer right because I put so many spaces or something, so I will write it on without long spaces. My numbers are showing right, but the reference range isn't.
Here is the correct Reference Range:
Low: 5.4
Do my results now look more normal? hehe Sorry that got typed so weirdly the first time. Oh and she did tell me my T4 was a bit low, but that my TSH was normal. Hmmm I have been sluggish, forgetful, and have been told I have been more irritable.
I find it comical that doctors use a generic range for everyone on these things, especially because of your experience with B12.
I don't seem to have any of the Lipid Panel or LDL/HDL tests, unfortunately.
My 6/18/13 CBC:
MCV: 88.0 fL Expected: 85.0-99.0
MCH: 29.6 PG Expected: 27.0-31.0
RDW: 12.5% Expected: 11.5-14.5
I also found something similar to the second one called MCHC: 33.6 g/dL where the expected is 33.0-37.0.
I noticed that all of these numbers are just a bit lower than last year's. There are a couple of things on my paperwork that are out of range or close, but I guess they were not considered important because I was not told about it. haha
You are just an angel! I hope you get magnificent sleep! I definitely feel like I am being helped!
About interviewing potential doctors, they are not like that here at all. We talk to the receptionist and are lucky to ever get to talk to a nurse. My mom called a recommended doctor and had her own set of questions, but they said they weren't even sure they were taking patients and that we had to wait til Tuesday of next week to talk to some kind of liaison-type assistant. No matter where we go, we don't get any straight-forward answers.
Upon further investigation, the range somehow got posted wrong. I remember typing all the less than and greater than signs, but that did not transfer right because I put so many spaces or something, so I will write it on without long spaces. My numbers are showing right, but the reference range isn't.
Here is the correct Reference Range:
Low: 5.4
Do my results now look more normal? hehe Sorry that got typed so weirdly the first time. Oh and she did tell me my T4 was a bit low, but that my TSH was normal. Hmmm I have been sluggish, forgetful, and have been told I have been more irritable.
I find it comical that doctors use a generic range for everyone on these things, especially because of your experience with B12.
I don't seem to have any of the Lipid Panel or LDL/HDL tests, unfortunately.
My 6/18/13 CBC:
MCV: 88.0 fL Expected: 85.0-99.0
MCH: 29.6 PG Expected: 27.0-31.0
RDW: 12.5% Expected: 11.5-14.5
I also found something similar to the second one called MCHC: 33.6 g/dL where the expected is 33.0-37.0.
I noticed that all of these numbers are just a bit lower than last year's. There are a couple of things on my paperwork that are out of range or close, but I guess they were not considered important because I was not told about it. haha
You are just an angel! I hope you get magnificent sleep! I definitely feel like I am being helped!
COMMUNITY LEADER
"Expected Ranges" is the same as reference ranges; they "expect" everyone to fall into these ranges... and if you don't, apparently, your doctor feels justified in ignoring it. Wow!!!!
Here's what jumps out at me: Your lab is using an outdated reference range for TSH (as do most labs). The recommended reference range for TSH was established about 10 yrs ago by AACE, to be 0.3-3.0. As you can see, your 6/26/13 level was just below the top of the range. Most labs, hence, doctors, have resisted the change to the recommended range.
Then take a look at your 6/26/13 FT4 --gracious, at 0.58, it was actually below the reference range of 0.59, and they told you it was "normal"?. Somebody doesn't know how to read labs.
Then, take a look at your vitamin B12.... at 458, you're well within the range, but still too low...... The range my lab uses is the same as yours (might be the same lab......lol) and I have to keep my level right at the very top or even a bit over, in order to stave off the fatigue and other symptoms caused by Pernicious Anemia (B12 deficiency). Many lab ranges are flawed and we can almost discount the bottom 1/2 of the ranges.
Please take another look at the folate result and confirm that you typed it correctly; I'm sure you did, but yours is lower than low, so needs to be verified. Folate is a B vitamin and is necessary to help produce red blood cells. Without enough healthy red blood cells, you will have symptoms of anemia, which include fatigue, light headedness, forgetfulness, grouchy, etc. Add that to less than optimal B12 levels and you have a problem.
Please check on your CBC and look for tests called RDW, MCV, MCH. If they are there, please post results and reference (or expected) ranges... These results will help pin point an anemia. Again, don't worry if they are in the range, but be sure to post the range, with result.
In my opinion, you may have more than one thing going on here; hypothyroidism for one, anemia for another. You should try to get ferritin tested to make sure that's good. Ferritin is a storage form of iron, so if ferritin levels are low, that would indicate that iron levels might also be low, in which case, you would need to get a full iron panel. If iron stores are low, you may have more than one type of anemia.
By the way - to answer your previous question - yes, I know this stuff because of my own experience, which is hypo/Hashimoto's, Pernicious Anemia (B12 deficiency), as well as tons of research to help myself and others with similar issues.
Most labs list cholesterol under a "Lipid Panel" and you'd see things like "Total Cholesterol, Triglycerides and some more "3-letter names", such as LDL, HDL, ".... because of your age and their conviction that there's nothing wrong with you, they may not have done that.
At any rate, I'm convinced that you have some valid issues and I really think you need to find a different doctor asap. You can call potential doctors and interview them over the phone, often via a nurse. You need to ask if they routinely test both FT3 and FT4, as well as TSH (answer should be yes). You need to know if they are willing to prescribe both T4 and T3 medications, including cytomel T3) and desiccated hormones (T3/T4 combo), (answer should be yes). You also need to know if they are willing to treat by symptoms, which might mean a trial dose of thyroid hormone to see if it helps (answer should be yes). If the answers to any of these questions is no, you shouldn't waste time on them, because they will keep you just as sick as your current doctor is keeping you.
"I guess the few things I provided don't say much. :/ " Oh, don't sell yourself short, my dear, you did great...... we'll just keep digging and get you an entire list of tests to ask for, to confirm/rule out certain issues.
I'll be off, soon, for tonight, but will check back in the morning. Be optimistic; we're here to help you.
Here's what jumps out at me: Your lab is using an outdated reference range for TSH (as do most labs). The recommended reference range for TSH was established about 10 yrs ago by AACE, to be 0.3-3.0. As you can see, your 6/26/13 level was just below the top of the range. Most labs, hence, doctors, have resisted the change to the recommended range.
Then take a look at your 6/26/13 FT4 --gracious, at 0.58, it was actually below the reference range of 0.59, and they told you it was "normal"?. Somebody doesn't know how to read labs.
Then, take a look at your vitamin B12.... at 458, you're well within the range, but still too low...... The range my lab uses is the same as yours (might be the same lab......lol) and I have to keep my level right at the very top or even a bit over, in order to stave off the fatigue and other symptoms caused by Pernicious Anemia (B12 deficiency). Many lab ranges are flawed and we can almost discount the bottom 1/2 of the ranges.
Please take another look at the folate result and confirm that you typed it correctly; I'm sure you did, but yours is lower than low, so needs to be verified. Folate is a B vitamin and is necessary to help produce red blood cells. Without enough healthy red blood cells, you will have symptoms of anemia, which include fatigue, light headedness, forgetfulness, grouchy, etc. Add that to less than optimal B12 levels and you have a problem.
Please check on your CBC and look for tests called RDW, MCV, MCH. If they are there, please post results and reference (or expected) ranges... These results will help pin point an anemia. Again, don't worry if they are in the range, but be sure to post the range, with result.
In my opinion, you may have more than one thing going on here; hypothyroidism for one, anemia for another. You should try to get ferritin tested to make sure that's good. Ferritin is a storage form of iron, so if ferritin levels are low, that would indicate that iron levels might also be low, in which case, you would need to get a full iron panel. If iron stores are low, you may have more than one type of anemia.
By the way - to answer your previous question - yes, I know this stuff because of my own experience, which is hypo/Hashimoto's, Pernicious Anemia (B12 deficiency), as well as tons of research to help myself and others with similar issues.
Most labs list cholesterol under a "Lipid Panel" and you'd see things like "Total Cholesterol, Triglycerides and some more "3-letter names", such as LDL, HDL, ".... because of your age and their conviction that there's nothing wrong with you, they may not have done that.
At any rate, I'm convinced that you have some valid issues and I really think you need to find a different doctor asap. You can call potential doctors and interview them over the phone, often via a nurse. You need to ask if they routinely test both FT3 and FT4, as well as TSH (answer should be yes). You need to know if they are willing to prescribe both T4 and T3 medications, including cytomel T3) and desiccated hormones (T3/T4 combo), (answer should be yes). You also need to know if they are willing to treat by symptoms, which might mean a trial dose of thyroid hormone to see if it helps (answer should be yes). If the answers to any of these questions is no, you shouldn't waste time on them, because they will keep you just as sick as your current doctor is keeping you.
"I guess the few things I provided don't say much. :/ " Oh, don't sell yourself short, my dear, you did great...... we'll just keep digging and get you an entire list of tests to ask for, to confirm/rule out certain issues.
I'll be off, soon, for tonight, but will check back in the morning. Be optimistic; we're here to help you.
2012 TSH: 1.120 mIU/mL | Expected: 0.340 - 4.820
6/26/2013 TSH: 2.950 mIU/mL | Expected: 0.340 - 4.820
2012 FT4: 0.60 ng/dL | Expected: 0.59 - 1.17
6/26/2013 FT4: 0.58 ng/dL | Expected: 0.59 - 1.17
6/18/13 (typed it exactly because it was confusing)
Test Name: In Range: Reference Range: Lab:
Vitamin B12/Folate, AT
Serum Panel
Vitamin B12 458 200 - 1100 pg/mL
Folate, Serum >24.0 Reference Range
Low: 5.4
There weren't Reference Ranges on the TSH or FT4, only the 'Expected', which may be the same thing. As for the cholesterol and iron, I am almost certain those were of the things they said were 'normal', but I cannot find either of them on my lab work unless they are listed in some weird 3-letter name, so I guess the few things I provided don't say much. :/
6/26/2013 TSH: 2.950 mIU/mL | Expected: 0.340 - 4.820
2012 FT4: 0.60 ng/dL | Expected: 0.59 - 1.17
6/26/2013 FT4: 0.58 ng/dL | Expected: 0.59 - 1.17
6/18/13 (typed it exactly because it was confusing)
Test Name: In Range: Reference Range: Lab:
Vitamin B12/Folate, AT
Serum Panel
Vitamin B12 458 200 - 1100 pg/mL
Folate, Serum >24.0 Reference Range
Low: 5.4
There weren't Reference Ranges on the TSH or FT4, only the 'Expected', which may be the same thing. As for the cholesterol and iron, I am almost certain those were of the things they said were 'normal', but I cannot find either of them on my lab work unless they are listed in some weird 3-letter name, so I guess the few things I provided don't say much. :/
COMMUNITY LEADER
Please post the TSH and FT4 results from 6/26/13, as well as the ones from last year. Be sure to include reference ranges, as they vary lab to lab and have to be posted with labs. Not surprised they didn't do any T3, many doctors don't and if they do, they order total T3, which is not nearly as useful as Free T3.
Also post the B12 result from 6/18/13.
Do you see anything listed for either iron or ferritin, as well as anything to do with cholesterol? If so, please post those, as well.
Again, please be sure to post all reference ranges from your lab reports.
Also post the B12 result from 6/18/13.
Do you see anything listed for either iron or ferritin, as well as anything to do with cholesterol? If so, please post those, as well.
Again, please be sure to post all reference ranges from your lab reports.
Goodness me you are so helpful! So you know all of this stuff from previous experiences and such? That really helps give me a better understanding of what the 'free' means and what t4 and t3 kind of do.
I just got back from the doctor's office. Apparently, it was FT4 they tested but for some reason they do not test T3 at all. I have a lab from a little over a year ago that has CMP, TSH, FT4, CBC, Gran#, Lymph #, Mono#, Gran%, Mono%, Lymph%.
I also have the one from 6/18/13 which has B12, UACOMP (Urinalysis?), CBC, CMP, TSH, and a paper with CO2, NA, Calcium, etc.
Lastly, I have my FT4 and TSH as of 6/26/13.
I cannot begin to thank you for giving me helpful insight on what these things mean. We are talking about trying to find another doctor who seems to be better at this stuff. Please tell me what of an of these things, would be helpful. Also, is there any way to make things like that private? My mom doesn't like the idea of the whole world seeing lab results. Thank you!
I just got back from the doctor's office. Apparently, it was FT4 they tested but for some reason they do not test T3 at all. I have a lab from a little over a year ago that has CMP, TSH, FT4, CBC, Gran#, Lymph #, Mono#, Gran%, Mono%, Lymph%.
I also have the one from 6/18/13 which has B12, UACOMP (Urinalysis?), CBC, CMP, TSH, and a paper with CO2, NA, Calcium, etc.
Lastly, I have my FT4 and TSH as of 6/26/13.
I cannot begin to thank you for giving me helpful insight on what these things mean. We are talking about trying to find another doctor who seems to be better at this stuff. Please tell me what of an of these things, would be helpful. Also, is there any way to make things like that private? My mom doesn't like the idea of the whole world seeing lab results. Thank you!
COMMUNITY LEADER
Synthroid has a long 1/2 life so it takes a while to get out of your system, but it also takes a while (4-6 weeks) to build to maximum potential in your blood when you first start taking it. If you've only been on it a week, it won't have built much in your blood, so you could, either go ahead and have another blood test now, before it builds anymore, or simply stop taking it for a few days, then get another test.
You said the nurse told you your T4 was low........ with a higher than normal TSH, low T4, even if it was total, not free, indicates that you are hypo and really do need the medication.
Thyroid 101......... Your thyroid produces the hormones T4 and T3, but mostly T4 and very little T3. The cells don't use T4 directly; it has to be converted to T3. The pituitary constantly monitors for adequate levels of T3 and T4. If it senses that levels are low, it puts out Thyroid Stimulating Hormone (TSH) to stimulate the thyroid into producing more hormones. If the thyroid doesn't respond, the pituitary continues to crank out more and more TSH. The lower thyroid hormone levels (T3 and T4) go, the higher TSH will go.
Of the T4 produced by the thyroid, some of it will be attached to a protein. The T4 attached to the protein is not available for conversion. The only T4 that can be converted is FREE T4, which is that portion not attached to the protein. When Total T4 is tested, the result contains both the amount attached to protein and the amount that free....... since the free is what's available for conversion, that's the main thing we need to know.
T3 works the same way........ a portion is attached to a protein and that portion is not usable by the individual cells. The usable portion is the FREE T3, which is the portion not attached to protein. Again, testing Total T3 includes both bound and unbound T3; we're concerned, mostly, with the unbound, because that's what's available for our cells to use.
With Hashimoto's, the body sees the thyroid as foreign and produces antibodies to destroy it. Many of us here, on the forum, have Hashimoto's. The destruction process can take years, but as the antibodies destroy healthy thyroid tissue, the thyroid makes less and less hormones, until eventually, it produces nothing and the patient is totally dependent on the replacement hormones - some of us are at that point. Along the way, replacement hormones have to be adjusted periodically, to account for the decreased thyroid hormone production.
The antibody tests you need to diagnose Hashi's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab). You need them both, because some of us have one or the other, some have both, so not testing them both, could result in misdiagnosis. While Hashimoto's is most often associated with hypo, early stages can be characterized by periods of hyper alternating with hypo. Symptoms of hyper and hypo can "overlap", such as the tired, forgetful.
Being hot is often a hyper symptom, so you could have Thyroid Stimulating Immunoglobulin (TSI), which is the definitive test for Graves, though, it's probably an unnecessary expense, since your high TSH and low T4 would pretty much rule that out.
In my opinion, it's always worth the effort to get copies of previous labs, but that's up to you. Our labs are our "medical history", that show where we've been. Mine have become a running record of my disease, because I note on each one, the medication(s)/dosage(s) I was on at the time of the blood draw and what, if any, symptoms I was experiencing. That lets me know what levels I need to target.
You DO need a different doctor asap........Is there any way you can go to your mother's doctor? Sounds like you might have better luck, there, getting tests you need. But then if she doesn't have a thyroid condition, it's hard to say, because many doctors are reluctant/refuse to test both FT levels, since they're taught that TSH is the "be all, end all" of thyroid treatment.
It's best to call a potential doctor and ask questions, often via a nurse or office manager, about how that doctor tests/treats thyroid patients. Questions should be 1) what tests are routinely ordered (should be TSH, FT3 and FT4 - antibodies, typically, only need to be done once). 2) Is the doctor willing to prescribe medication with both T4 and T3, as needed, including desiccated? Answer should be yes.. 3) Is the doctor willing to treat by symptoms, rather than simply looking at labs and saying "anything in range" is good enough. For many of us, that's not true.
With your symptoms, I'd also like to see a current B-12 result, so you should try to get that retested.
You should also ask for cholesterol testing, since high cholesterol and hypothyroidism go hand in hand.
You said the nurse told you your T4 was low........ with a higher than normal TSH, low T4, even if it was total, not free, indicates that you are hypo and really do need the medication.
Thyroid 101......... Your thyroid produces the hormones T4 and T3, but mostly T4 and very little T3. The cells don't use T4 directly; it has to be converted to T3. The pituitary constantly monitors for adequate levels of T3 and T4. If it senses that levels are low, it puts out Thyroid Stimulating Hormone (TSH) to stimulate the thyroid into producing more hormones. If the thyroid doesn't respond, the pituitary continues to crank out more and more TSH. The lower thyroid hormone levels (T3 and T4) go, the higher TSH will go.
Of the T4 produced by the thyroid, some of it will be attached to a protein. The T4 attached to the protein is not available for conversion. The only T4 that can be converted is FREE T4, which is that portion not attached to the protein. When Total T4 is tested, the result contains both the amount attached to protein and the amount that free....... since the free is what's available for conversion, that's the main thing we need to know.
T3 works the same way........ a portion is attached to a protein and that portion is not usable by the individual cells. The usable portion is the FREE T3, which is the portion not attached to protein. Again, testing Total T3 includes both bound and unbound T3; we're concerned, mostly, with the unbound, because that's what's available for our cells to use.
With Hashimoto's, the body sees the thyroid as foreign and produces antibodies to destroy it. Many of us here, on the forum, have Hashimoto's. The destruction process can take years, but as the antibodies destroy healthy thyroid tissue, the thyroid makes less and less hormones, until eventually, it produces nothing and the patient is totally dependent on the replacement hormones - some of us are at that point. Along the way, replacement hormones have to be adjusted periodically, to account for the decreased thyroid hormone production.
The antibody tests you need to diagnose Hashi's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab). You need them both, because some of us have one or the other, some have both, so not testing them both, could result in misdiagnosis. While Hashimoto's is most often associated with hypo, early stages can be characterized by periods of hyper alternating with hypo. Symptoms of hyper and hypo can "overlap", such as the tired, forgetful.
Being hot is often a hyper symptom, so you could have Thyroid Stimulating Immunoglobulin (TSI), which is the definitive test for Graves, though, it's probably an unnecessary expense, since your high TSH and low T4 would pretty much rule that out.
In my opinion, it's always worth the effort to get copies of previous labs, but that's up to you. Our labs are our "medical history", that show where we've been. Mine have become a running record of my disease, because I note on each one, the medication(s)/dosage(s) I was on at the time of the blood draw and what, if any, symptoms I was experiencing. That lets me know what levels I need to target.
You DO need a different doctor asap........Is there any way you can go to your mother's doctor? Sounds like you might have better luck, there, getting tests you need. But then if she doesn't have a thyroid condition, it's hard to say, because many doctors are reluctant/refuse to test both FT levels, since they're taught that TSH is the "be all, end all" of thyroid treatment.
It's best to call a potential doctor and ask questions, often via a nurse or office manager, about how that doctor tests/treats thyroid patients. Questions should be 1) what tests are routinely ordered (should be TSH, FT3 and FT4 - antibodies, typically, only need to be done once). 2) Is the doctor willing to prescribe medication with both T4 and T3, as needed, including desiccated? Answer should be yes.. 3) Is the doctor willing to treat by symptoms, rather than simply looking at labs and saying "anything in range" is good enough. For many of us, that's not true.
With your symptoms, I'd also like to see a current B-12 result, so you should try to get that retested.
You should also ask for cholesterol testing, since high cholesterol and hypothyroidism go hand in hand.
Thank you SO much for being so helpful in your reply! I am so new to blood tests and this site. This doctor's office never calls me like they say they will, and even when I call and ask my results, I am lucky if they call back that day. Today, after waiting 7 hours, I pestered them again just enough to get her to send off the rest of my blood and to tell me my t4 was low and my TSH was normal. I asked about t3, and she said they didn't test that. We had to basically force them to even test my thyroid with my first blood test.
Because of all of that, I doubt what they tested was the free t4, and I know they didn't test the free t3. Unlike my mom's doctor, which is so nice to post all her tests online for her, they don't tell me any numbers, nor do they give me any of the paperwork. I will try to get them to mail it to me or have it at the font desk for me if I can make someone get on it. I did not even know about the antibodies testing until today, so they haven't tested that at all.
At this point, my best bet may be to go to a new doctor. I have never had an unltrasound, and I just learned of the history of thyroid conditions on my dad's side today from my grandmother who probably does not really understand what a goiter is, which I didn't either, so I guess throw my lack of knowledge and goiters out of that post of mine.
So, if I had another doctor test me while I am on Synthroid and the results are good, it is from the Synthroid for sure or could it still have been my natural levels? I have currently not been on the Synthroid long enough for me to even tell anything (only one week), but my mom thinks I should stop taking it.
I just want to know why I am always hot, tired, forgetful, and started gaining weight just within the past year or so and even worse within the last few months. :/ I wish there was a blood test that could just test everything because I know my symptoms are pretty generic.
Should I request my other blood test and last year's blood test results if they have them?
Because of all of that, I doubt what they tested was the free t4, and I know they didn't test the free t3. Unlike my mom's doctor, which is so nice to post all her tests online for her, they don't tell me any numbers, nor do they give me any of the paperwork. I will try to get them to mail it to me or have it at the font desk for me if I can make someone get on it. I did not even know about the antibodies testing until today, so they haven't tested that at all.
At this point, my best bet may be to go to a new doctor. I have never had an unltrasound, and I just learned of the history of thyroid conditions on my dad's side today from my grandmother who probably does not really understand what a goiter is, which I didn't either, so I guess throw my lack of knowledge and goiters out of that post of mine.
So, if I had another doctor test me while I am on Synthroid and the results are good, it is from the Synthroid for sure or could it still have been my natural levels? I have currently not been on the Synthroid long enough for me to even tell anything (only one week), but my mom thinks I should stop taking it.
I just want to know why I am always hot, tired, forgetful, and started gaining weight just within the past year or so and even worse within the last few months. :/ I wish there was a blood test that could just test everything because I know my symptoms are pretty generic.
Should I request my other blood test and last year's blood test results if they have them?
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You need to have Free T3 and Free T4 (make sure you specify FREE or you will get total, which is not the same test), in order to know what's going on. Your doctor is required, by law, to provide you with copies of your lab results, free of charge.
If you can get a copy, please post the actual results here, along with reference ranges that vary lab to lab and have to be posted with results.
I'd also like to see the results of your B-12 test. Even though it might have been in range, it might not have been high enough for you. Many doctors think that results "in range" are good enough, and that's just not true - that goes for thyroid, as well.
You should get in the habit of getting copies of all blood work and other lab tests and keep a copy for your records, note medications and symptoms on each lab report. That will become your running record, that you can always look back and see where you felt best/worst.
Have you been tested for thyroid antibodies to determine whether or not you have thyroid antibodies, which would result in a diagnosis of Hashimoto's Thyroiditis. Hashimoto's is the number 1 cause of hypothyroidism in the developed world.
Have you had an ultra sound to determine whether or not you have nodules on your thyroid? Nodules are very common and usually nothing to worry about, but it's nice to know if you have them.
"I know my grandmother and her sister both have thyroid problems (her sister had a goiter(s) removed)." Can you please explain this? A goiter is simply a swollen thyroid and you only have one thyroid that consists of 2 lobes and an isthmus. Did she have her thyroid removed?
We can't tell you whether or not to continue with the Synthroid. If you decide to go to another doctor, you don't have to go off the Synthroid, first. If your labs come back good, and you feel good, that would indicate the Synthroid is helping.
What, if any, symptoms do you currently have? Has the Synthroid done anything to alleviate symptoms you previously had?