Hypo symptoms but normal tests?

[TBKB18]

I have all the symptoms of hypothyroidism. If you look up the top 16, I can pick out 14 or 15 I have..plus some such as tingling fingertips, severe fatigue, thinning hair. But I also have PCOS. I decided to have a full thyroid panel ran, just to see if perhaps I did have a thyroid issue. The results basically show normal. My doctor called, but I missed his call. Thankful for long voicemails. He was only slightly concerned about one test (TGAb), said to recheck after some time and refer me to a Endocrinologist to talk about that antibody test. Also waiting for the ReverseT3 to come in as it has not yet. He said could be Hashimoto's but with everything else normal, he wasn't really thinking that direction. If the RT3 comes back abnormal OR normal, with the high TGAb...what would that mean?
Here are my results with normal range in parentheses.

TSH.       1.64 (.35-5)
FreeT3.    2.75 (1.71-3.71)
ReverseT3  ?
FreeT4.    1.0 (.7-1.9)
TotalT3.   .96 (.58-1.59)
TGAb.      11.2 (.1-4.1)
TPOAb.     1.8 (.0-5.6)

[gimel]

In trying to diagnose hypothyroidism the most important indicator is symptoms.  You reported having many hypo symptoms.  The next most important indicators are Free T4 and Free T3 levels.  Your Free T4 is lower than many of us have found to be optimal.  It is usually best if at least mid-range.  Your Free T3 is about mid-range, and it may be that the reason is that your body is converting extra T4 to T3 in an effort to maintain body functions as best possible.  It will also be revealing to see what your Free T3 to Reverse T3 ratio is when RT3 result is available.  

Doctors have been taught and like to believe that TSH tells them all they need to know about thyroid status.  This is incorrect.  If TSH is over 10 it is classified as overt and will be treated.  If between 5 and 10 it is classified as subclinical and many doctors will not treat, even if the patient has many hypothyroid symptoms.  Your TSH is still within range, even though your TG ab result indicates Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously identifies the thyroid gland as foreign and produces antibodies to attack and eventually destroy the gland.  As this proceeds, less thyroid hormone can be produced and the TSH rises in a attempt to stimulate more thyroid hormone production.  Your test results indicate you are likely in the early stages of Hashi's, even though you have multiple hypo symptoms.  

A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  You can confirm all this by reading at least the first two pages of the following link, and read more if you want to get into the discussion and scientific evidence of all that is recommended.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
  
Don't expect that being an Endo automatically means a good thyroid doctor, because many specialize in diabetes, not thyroid.  Also many of them have the "Immaculate TSH Belief", and use "Reference Range Endocrinology", by which they would say you are okay and don't need treatment.  Any doctor that you see that  is unwilling to treat clinically, as described, is very unlikely to treat you adequately, if at all.  If you want, we can possibly suggest a good thyroid doctor in your area if you will tell us your location.  

Finally for now, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  If not tested for those, you should do so and then supplement as needed to optimize.  D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 70, and some say 100.  Note that adequate ferritin is needed for good hair growth.  

[TBKB18]

I very much appreciate your response. Much of what you wrote, I have read about, but you put it into a context I could better understand. Though I'm still slightly confused as to how it all works. The more I research, the more I'll learn. I will add I do take B12 sublingual drops and a multivitamin, though I'm not certain it has ferritin. Biotin and D, yes.
My RT3 came back, and he also ran T3 Uptake. The results are:

T3 Uptake%  - 34 (28-41)
Rt3         - 17.2 (9-27)

I believe my doctor thinks Hashimoto's, but not sure he wants to be the one to diagnose it. He's my family doctor.
I am in the North/Northeast Oklahoma area. I've been researching Endo doctors, but I just don't know who to choose. My dr hasn't recommended one yet, but likely will be one in the Tulsa. Distance isn't a factor so long as I find one who will help me combat these symptoms. Kind of ***** being miserable day after day and not knowing how to fix it.

[Rustyempire]

Hi . Gimel gave a great answer there! (I'm actually going to bookmark this just to keep it as reference). I am also Hashimotos with labs that show nothing untoward according to most Drs. There is so much misinformation out there and seriously misinformed MDs as well. Good luck with the Endo though as many of them are backwards thinking with regard to Treating with Dessicated Thyroid etc. That's my next plan of attack as standard T3 is doing nothing. I found Stop the Throid Madness site a good source to get more info, as well as Pinterest even! Good luck!

[gimel]

Sorry I thought I had sent you info previously, but it does not show up, so I just sent a PM.  To access, just click on your name and then from your personal page, click on messages.  

[gimel]

We all know how frustrating it is to try to find a good thyroid doctor.  If you will tell us your location, perhaps someone can give you a doctor that has been recommended by other thyroid patients.  

[TBKB18]

Tulsa area

[gimel]

I hate to rain on your parade, but I know of no information showing  you can reverse the effect of Hashi's.  Even one of the biggest proponents of the theory of leaky gut causing Hashi's ( not verified with conclusive scientific evidence) says that prior damage to the thyroid is not reversible, and will require thyroid medication.   So I think you need to find that good thyroid doctor that will treat you clinically, as described.  If natural ways,/supplements are ineffective, and your Hashi's causes additional deterioration of the thyroid gland function, then your med dosage will need to be increased accordingly.  Also, don't overlook the importance of Vitamin D, B12 and ferritin.  

[TBKB18]

Reverse may have been the wrong term. Perhaps just finding ways to improve the symptoms I have, fatigue being The biggest. The dr told me my thyroid is functioning fine because my labs are fine. The elevated tgab of 11 isn't that high. If it was 20+, he said then it would likely be dysfunctional. But like I said, he was focused on the TSH number. Since it was normal, 'I'm fine'. My diagnosis of Hashis is probably in the early stages, and 'symptoms are likely from stress'..his words. I am self pay, across the board, or I would do everything in my power to go to Endo after Endo. But I cant do that. Not back to back. I'm sort of stuck and it sucks.

[gimel]

When you think you know ways to reverse your symptoms, please let us assess them before you try.

[TBKB18]

Diet and exercise more so than anything else. I've read a lot about the AIP diet, healing the gut helps, cutting out sugar, etc. I found a book, waiting on it to be delivered this week. Maybe it will shed more light on other natural ways/supplements.

[TBKB18]

Ok, so my Endo said it's likely I have Hashimotos but because my TSH, T3, and T4 were within range he will not treat me. Which is fine. I've been researching ways to reverse my symptoms on my own. Not easy, but I'm trying. He also said to recheck just the TSH once a year. If it goes out of range, he'll treat me. So, basically, he's one of those doctors. I liked him, and the office, but the fact that he was so focused on the TSH as the main test bothered me.I went in looking for confirmation that I had what I assumed I did. I'm certain I got it.

[TBKB18]

Not sure what's up with all the added stuff in there.. if you can see it like I can, apologies

[Red_Star]

Hi. I had insulin resistance (but not PCOS) and it caused  numerous hypothyroid symptoms but no abnormal standard lab results. It was only when I also developed Hashimoto's that my existing hypothyroid symptoms worsened and I developed even more symptoms. I found two articles you might be interested in and posted an excerpt from each.


Lara Briden - "Treatment for 4 Types of PCOS. Treat the Cause."...

4 Types of PCOS

1) Insulin-Resistant PCOS

This is the classic type of PCOS and by far the most common. High insulin and leptin impede ovulation and stimulate the ovaries to make testosterone. Insulin resistance is caused by sugar, obesity, smoking, trans fat, and environmental toxins.

Is this you? You have been told that you are borderline diabetic, or you had an abnormal glucose tolerance test. You probably have elevated insulin, and you may also have elevated LH (luteinizing hormone). You are probably overweight, although you may be normal weight. Normal-weight insulin resistance can occur in the years following dieting or eating disorder.

Treatment ideas: The first step is to quit sugar.  Please also consider gentle intermittent fasting, which works well to improve insulin sensitivity. Best supplements for insulin resistance are magnesium, lipoic acid, inositol, and berberine. The Pill is not a treatment for this type (or any type) of PCOS because it impairs insulin sensitivity. Improvement for Type 1 PCOS  is slow and gradual over 6-9 months. Please see my Insulin Resistance post."


National Academy of Hypothyroidism - "Understanding Local Control of Thyroid Hormones: (Deiodinases Function and Activity)"...

"Insulin resistance/diabetes/metabolic syndrome/obesity

As with leptin resistance, it has been shown in numerous studies that insulin resistance, diabetes, or metabolic syndrome have associated significant reduction in T4 to T3 conversion, an intracellular deficiency of T3, and an increased conversion of T4 to reverse T3, further reducing intracellular T3 levels (91,100,92,94,147,184-193,235). Additionally, the elevated insulin will increase D2 activity and suppress TSH levels, further decreasing thyroid levels and making it inappropriate to use the TSH as a reliable marker for tissue thyroid levels in the presence of elevated insulin levels as occurs with obesity, insulin resistance, or type II diabetes (91-99,233)."

[gimel]

Don't forget to get your primary to test for ferritin also.  Very important.

[gimel]

With those symptoms and lab test results there is no doubt that Hashi's is the source of your problems.  If you cannot get in to see the new doctor any time soon, you might consider getting your current doctor to go ahead and test for Vitamin D, B12, and ferritin, so that you can supplement to optimize to the levels I gave you above..  It would also be a god idea to test for cortisol.  

Please keep us posted on your progress.

[TBKB18]

I can't get into the specialist until May, which is (actually) exciting. I was anticipating July. I've asked my primary to do a VitD and B12. For now. I do take a supplement of B12 and a multivitamin, but in reality they're obviously not doing much for me if my levels are really low. I'll let you know what they reveal when they come in.

[gimel]

Instead of spending your money on an online book, as you mentioned in another link, I think you will find most anything you need in the link I gave above.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

[gimel]

In preparation for any further doctor visit, I highly recommend the link I gave you above.  Unfortunately right now it is not accessible, but is being worked on.  I have sent you a PM with some doctor info.  To access, just click on your name and then from your personal page, click on messages.  

[TBKB18]

I have found a Dr, and did a bit of 'research' on them before I picked the one I did. He was on the list you provided me. Again, much appreciated. The amount of fatigue I'm feeling right now is the biggest obstacle, so I'm hopeful this dr will listen to me and not base diagnosis (or lack of) off the TSH. The article also is very informative, but I've had to read it several times. I have a lot to learn, but I'm certain Hashimoto's is what's kicking me down.