Interpretations of blood results from lab.

[lenza77]

Hi. I’m new to the world of thyroid dysfunction. Until recently I didn’t even know that we all have this butterfly shaped organ in our neck. Anyways, I’m a 39 year old male I got some blood results back and I hope you guys could shed your light upon these results as I have been reading some contradicting interpretations of these same results on the web. High TSH according to the parameters of the lab 4,58 (0,27 – 4,20), low Free T4 according to the parameters of the lab 0,87 (0,93 – 1,70) and normal  Free T3 according to the parameters of the lab 2,80 (1,95 – 6,04). I do experience quite some hypothyroid systems. Thank you guys for your feedback.

[gimel]

Have you read the link I gave you above?  From that link probably the first thing to recognize is that hypothyroidism is best defined as "inadequate supply of, or response to, thyroid hormones throughout the body".  Note in the link that serum thyroid levels may not accurately reflect tissue thyroid levels.   Next is to recognize is that there is no test that will positively identify hypothyroidism.  You can get a mental image of this from Fig. 1 on page 6 of the link.  There are so many processes and variables that affect tissue thyroid effects, that no single test will reliably diagnose hypothyroidism.  There are numerous signs/symptoms that are indicative of hypothyroidism.  There are also a number of tests that can indicate possible hypothyroidism; however, every diagnosis of hypothyroidism is a probability theory that must be confirmed with a trial of thyroid med adequate to raise the Free T4 and Free T3 to optimal levels and evaluate the effect on signs/symptoms.  If they improve, the tentative diagnosis is confirmed.  

You have said you have numerous symptoms that are frequently related to hypothyroidism.  Your Free T4 and Free T3 results are low in their flawed  ranges, consistent with the possibility of hypothyroidism.  Your TSH is high enough to warrant tests for possible Hashimoto's Thyroiditis.  Two tests are required, Thyroid Peroxidase antibodies and Thyroglobulin antibodies.  (TPO ab and TG ab).  You should push the doctor to do those and if positive, perhaps that might be enough to get him to start treatment with thyroid med.  If not, then you will need to convince the doctor to treat you clinically by prescribing thyroid med adequate to optimize your Free T4 and free T3 levels.  If the doctor refuses, then you will need to find a good thyroid doctor that will do so.

Your iron and ferritin results are adequate.  If fatigue is one of your symptoms, you can raise your B12 level to upper part of the range to help with that.  

[lenza77]

Hi Gimel, thanks for your input. Well appreciated. I just don’t know what to think anymore. I’m just reading so many things on the web and even the doctors don’t follow uniform procedures.  My latest test results showed the below values.

Hierro 114,0 μg/dL (59.0 - 158.0) AUTO
Ferritina 179,7 ng/mL (30.0 - 400.0) JBP
Vitamina B12 431,5 pg/mL (191.0 - 663.0)

I don’t know why but I haven’t been tested for Vitamin D. What could you get from this data?

Thanks!

[gimel]

Just noticed that I previously stated, "Your FT4 is higher in range than your FT3 likely due to your body trying to maintain thyroid function as well as possible."  That was a mistake,  Should be just the reverse.  "Your Free T3 is higher in range than your FT4 likely due to your body trying to maintain thyroid function as well as possible."  

[gimel]

I really don't know what your doctor is waiting for.  You still have symptoms that are typical of hypothyroidism.  Your TSH is even farther above range.  Your Free T4 went from below range to now at 12% of its range, and your Free T3 went from 21% to 27% of its range.  When a person has all those symptoms, Free T4 and free T3 being in the lower part of the ranges is a strong indication of hypothyroidism.  Your FT4 is higher in range than your FT3 likely due to your body trying to maintain thyroid function as well as possible.  

A good thyroid doctor would be treating you with thyroid med as needed to relieve symptoms, without being influenced by test results.  We have found that FT4 needs to be at least mid-range, and FT3 in the upper third of its range, and adjusted from there as required to relieve symptoms.   In addition Vitamin D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 100.  So what are your test results for those?

If it were me I would not wait around for 3 more months of the same problems.  I would give the doctor a copy of the link I gave you and ask to be treated clinically, as described.  The paper provides extensive scientific evidence for clinical treatment.  If the doctor disagrees, then you are wasting your time there and need to find a doctor that will treat clinically, and also prescribe T3 type meds, if needed to get your FT3 optimal.

[lenza77]

Well, six months have passed and recently I have had my blood tested again as my doctor suggested. I’m still experiencing the same systems, although I’m feeling a bit more anxious than I did a couple months ago. My results are as follows;

TSH 6,43 versus 4,58 back in March
T3l 3,07 versus 2,80 back in March
T4l 1,02 versus 0,87 back in March

Conclusion my TSH has risen considerably and my free T3 and T4 have gone up slightly.

B12, cholesterol, Iron and ferritin are all well within range.

Once again my doctor told me that hormones are affected by so many things, especially anxiety. He stressed that in order to start a life-long treatment we have to be very sure that indeed there is something wrong with my thyroid and that it is not something temporarily caused by my anxiety (I’m still taking Paxil for this reason). Nevertheless he seemed to take it a bit more seriously than last time and told me that my TSH level was at its upper limit now. (Although the range limits on my test go from 0,27 to 4,20). He wants me to take another blood test within three months (not six) in order to see the different values once again.

I would really like to know what you all think of these new results and especially about my doctor’s advice.

[jmidlife]

Also, the loss of the outer part of your eyebrow is a classic symptom of hypothyroidism.

[gimel]

Not sure if you need a second opinion, but you clearly need a good thyroid  doctor that will treat you clinically (for symptoms) by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not TSH results when taking thyroid med.  

Barb and I both said you were hypothyroid, due to the symptoms you have plus the low levels of Free T4 and Free T3.   The doctor said you were fine, even though your TSH, FT4 were out of range, and your FT3 is way too low in the range.  Your doctor is wrong.  If you want to confirm what I say, make sure to read the link I gave you above.  

Just going to another doctor may or may not work for you.  It all depends on whether the doctor is willing to treat clinically, as described, rather than based on just lab results compared to reference ranges that are too broad.  In trying to get a doctor to treat clinically, you might be able to use the link by giving the doctor a copy and asking him to review and consider clinical treatment.  

You are also going to need to be tested for Vitamin D, B12 and ferritin, since hypothyroid patients are frequently deficient in those as well.  You need to test 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 sources say 100.

[gimel]

Yes, symptoms can be related to different causes; however, there are some symptoms that occur much more frequently with hypothyroidism.  You mentioned having a number of those.   Having those symptoms, in conjunction with your lab results, clearly indicates hypothyroidism and the need for thyroid medication to raise your Free T4 and Free T3 levels adequately to relieve your hypo symptoms.

[lenza77]

Well, I went to my Endo yesterday and he said that my TSH, Free T4/T3 are just fine. He said that these hormones are quite sensible to emotional stress and the fact that I’m on Paxil might as well have affected the results. Conclusion is that he thinks that any thyroid medication would only do me more harm than good. He just advised me to monitor my blood values and have them checked again within six months and that’s it.

I’m not really sure what to think. I might go for a second opinion. Any suggestions?

[gimel]

TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator (not a diagnostic), to be considered along with much more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  The main value for TSH is to distinguish overt hypothyroidism (TSH > 10) from central hypothyroidism.  

You have numerous symptoms that are frequently related to being hypothyroid.  In addition your Free T4 was below range, while your Free T3 was only at 21% of the range.  These results indicate that your body is converting more T4 to T3 in an effort to maintain body functions as best possible.   Having both Free T4 and Free T3 in the lower end of their ranges or below is a strong indicator of hypothyroidism.  This is because the ranges are far too broad to the low end due to the erroneous assumptions used in collecting the data base used to calculate the ranges.  You can read about all this in Item no. 4 on page 5 of the following link.   This also will explain why test results vary from lab to lab and must be compared to reference ranges from the same lab, not ranges from other sources.  

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

I highly recommend reading at least the first two pages of the link and more if you want to get into the discussion and scientific evidence for all that is recommended.  That will help you prepare for the appointment with your Endo, at which you should request to be treated clinically (for symptoms) with thyroid med to raise your Free T4 and Free T3 levels as needed to relieve symptoms.  Symptom relief should be all important, not just test reuslts, and especially not resultant TSH levels.

Since hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin, you need to also get those tested and then supplement as needed to optimize.  D should be at least 50, B12 in the upper end of the range and ferritin should be at least 70, and some sources say 100.

[lenza77]

Thanks for your reply. What I’m concluding from you explanation though is that symptoms are a much more important indicator than TSH or FT4 levels. But at the same time, hypothyroidism symptoms are so common and non-specific. Isn’t this a bit contradicting? During my first appointment with my Endo, he already explained to me that my symptoms not necessarily are related to my thyroids. As a matter of fact, since last December I’m taking a small doses of the anti-depressant Paxil for anxiety which could explain the thinning of my hair and hair loss of my eye-brows. This could also explain that I’m always exhausted. My muscle pain, weakness and twitching could be related to my anxiety and my depressed mood because  I’m always anxious. Wouldn’t it be risky then to be diagnosed primarily on symptoms?

I do not have more specific hypothyroidism symptoms, like high cholesterol, glucose or obesity (BMI). But then again, I’m a keen runner (although lately it’s very hard to go out because I’m lacking energy) and I love to exercise to clear my mind, I’m always careful what I eat, lots of vegetables, fruit, fresh fish and do not abuse alcohol. So no wonder that I’m not overweight I suppose. What I’m trying to say that it is so hard to only interpret by symptoms.

Fortunately I have been able to schedule an appointment for today with my Endo; I’m very curious what he thinks of my test results in combination with my symptoms.

If I’m going to start with some medication, I would like to know if I have to take these for the rest of my life. I would like to see if they would improve my hypothyroidism symptoms, if not they might be related to something else.

[Barb135]

Not everyone gets every symptom of every condition they have.  Doctors are very quick to hand out anti-depressants when one really needs thyroid hormones.  I was once prescribed Paxil for exhaustion, when I really needed vitamin B-12, but my doctor didn't bother to test my B-12 level; he simply diagnosed me with depression... shame on him!!

You are right that symptoms can overlap i.e. apply to more than one condition, but we know that anxiety is a prime symptom of hypothyroidism, as well as a "stand alone" condition.  You are a self professed hypochondriac, but you also have, obviously, low thyroid hormone levels, since your Free T4 is lower than the low reference range and your TSH is higher than the high reference range, which, in my opinion, take precedence over everything else, at this point.  

Your thyroid controls several body functions and you have to get your thyroid hormone levels to an optimal point, before you can determine that anything else is causing your symptoms.

If your endocrinologist is preferring to keep you on Paxil over prescribing thyroid hormones, I'd advise a different endocrinologist.  Paxil will do your body much more harm in the long run than thyroid hormones will.  If you feel the Paxil helps your anxiety, at this point, there's no reason you can't stay on a low dose until your thyroid hormone levels are optimal.  I, too, was on an anti-anxiety medication for a while, but was able to go off it, when my thyroid hormones got to where I needed them.

Thyroid hormones are, typically, a life-long medication, but taking a thyroid pill is no different (and much better for you) than taking a lot of other medications...

[Barb135]

Hi... If you had a pituitary issue, it's unlikely that your TSH would be as high as it is... Typically, when one has Secondary hypothyroidism, there's really nothing wrong with the thyroid, it's the pituitary gland that doesn't produce TSH, so it will be quite low and there isn't enough to stimulate the thyroid.  There are transient types of hypothyroidism that may resolve on their own or it's possible that antibodies simply haven't ramped up yet.

Did the ultrasound show any nodules on your thyroid?

Your symptoms correlate with hypothyroidism and with Free T4 below range, that's not a surprise.  

What happens when we don't have enough thyroid hormones is that our adrenal glands kick in to help take up the slack, so your feeling of adrenaline could be accurate, though with the anxiety, it may be greatly exaggerated.

Just so you know - anxiety can be a hypo symptom, but we can also make it worse by worrying too much.  

If it helps any, you can rest assured that if your heart work up came back normal, you don't have heart issues and there's apparently no reason to think you have cancer any place, besides your symptoms don't match with cancer (or MS)...

We're here to talk to and/or answer questions, so feel free.

[lenza77]

Hi. Thank you very much for your explanation. It’s all clear to me but as far as I can conclude from your comments, it is not common that my TSH is high and free T4 low but at the same time that my antibodies are within range. There must be a some kind explanation why the results of my TSH and free T4 are not within range and that my thyroid is not working as it should. My ultrasound was excellent, no nodules or anything like that.

Do you really think that my free T4 is out of range? I’m reading some contradicting interpretations on the web. Some labs maintain a minimal range of 0,8 even 0,7??

[Barb135]

Has anyone explained the workings of this wondrous little butterfly shaped organ we all have?  It's helpful to know a bit about how it works, so I'll add an explanation as I go and hope I don't bore you...   :-)

According to your lab results, your TSH (Thyroid Stimulating Hormone) is higher than it should be. TSH is a hormone, produced by the pituitary gland in the brain that's meant to stimulate the thyroid gland when the pituitary senses that your body doesn't have enough thyroid hormones.  If the thyroid doesn't produce an adequate amount of hormones in response to the TSH, the pituitary gland continues to crank out TSH and will continue to do so until adequate thyroid hormones are produced, whether they come from the thyroid or from outside as in the form of medication...

The hormones produced by the thyroid are T4 and T3, but mostly T4.  Most of the T4 produced is bound by protein and not available for us, which is why we test the "Free" (unbound) T4.  Free T4 isn't used directly; it's considered a "storage" hormone and must be converted by the body to T3.

Like T4, most of the T3 in our body is bound by protein and can't be used, so again, we test the "Free" (unbound) T3.  Free T3 is the hormone that's used by nearly every cell in our body, so that's the important one.

Moving on to your Free T4, as you can see, it's actually lower than the bottom of the reference range, which means your thyroid is not listening to your pituitary gland when it calls for thyroid hormones.  Your Free T3 is still within the range, but Free T3 often goes out of range last.  

With your levels as low as they are, it's no wonder you have symptoms of hypothyroidism.  What symptoms do you have and did your doctor start you on a replacement thyroid medication?  

Typically, the target for Free T4 is mid range and Free T3 is upper half to upper third of its range.

You might also ask your doctor to test thyroid antibodies to determine if you have the autoimmune condition called Hashimoto's Thyroiditis.  Hashimoto's is the most common cause of hypothyroidism in the developed world.  It attacks and destroys the thyroid, so, eventually, it will produce no thyroid hormones at all.

The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  Ask for both of them, because they are both markers for Hashimoto's and some of us have one or the other, while some have them both.

[lenza77]

Hi Barb135, thank you for your thorough reply, well appreciated. Indeed I have been tested for TPOab and TgAb as well. The results came back fine, 10,57 (< 34) and 17,05 (< 115) respectively. I’m not really sure what this means though. I also had an echo of my thyroids and these results were fine as well. Not even an enlargement or anything similar. My best guess would be the pituitary gland itself. I have been reading that stress could affect your thyroids as well. I have been under a lot of stress for the last decade, including health anxiety. I always have had the feeling that my body was pumping adrenaline into my body 24/7. Maybe this is now affecting my thyroid function?

I haven’t discussed the results yet with my endocrinologist so right now I’m not on any medication. But I do have various symptoms and as a true hypochondriac, they really freak me out.

- Dry skin, eyes and throat.
- Thinner hair and hair loss of my eyebrows in particular (outer part)
- Very tired
- Waking up feeling exhausted
- Poor sleep
- Cold sensitive
- Chest pains (which I associated with heart problems but all tests came out fine)
- Depressed mood
- Anxiety (not sure if this is a hypothyroid symptom)
- Muscle pain, weakness, twitching

Just to name a few, haha.

My appointment is still some weeks away, I’m just trying to avoid associating the symptoms with some other more serious illness (cancer, MS, heart issues)

Anyway, thanks for reading!!