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Interpreting my lab results - new to thyroid info

Brand new and currently learning more about the thyroid.

Below are my lab results (non fasted)
after having symptoms of sluggish metabolism, constipation/GI issues, low vit D,
low Testosterone, and a tingling sensation in the neck/thyroid area.
If the labs are all normal ranges, might it be a pituitary issue causing the tingling sensation?
Also, what are your opinions on Lugol's iodine supplementation if I don't have Hashi's?

Im 29, male, 150lbs, extremely active for years now.
Thank you for any help in advance!

TSH          2.09 uiu/ml

T3 Free          3.1 pg/ml
T3 Total        100 ng/dl
T3 uptake       32
Reverse T3     16  ng/dl

T4 Free      1.3  ng/dl
T4 total       7.4 ug/dl

Thyroid antibody  <10 iu/ml
Thyroxine binding glob   19.1  meg/ml



Testosterone total    356 ng/dl
Vit D 25 Total           40 ng/ml
cortisol total             10.9ug/dl
30 Responses
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798555 tn?1292787551
Fluconazole possibly causing hypo, almost halfway down the comments on this older post.

I think I am experiencing the same issue.  Currently on Flucon for internal / systimatic Candida, felt hypo and my thyroid labs are hypo.

I have used Flucon. in the past, and if I remember correctly, I felt hypo symptoms.

The question is after Flucan use, does the thyroid return to its past med level requirements? Thats what I'm trying to figure out.
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Avatar universal
please check your inbox thanks
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Avatar universal
Just sent PM with doctor info.  Just click on your name and go to your personal page.  Then click on messages.
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First off this is all great info and I thank you for that.

I am in Islip (Long Island, NY) and I am looking for a knowledgable thyroid doctor.

My cousin recommended his endo ( Dr. Shiff in Massapequa, NY)

Very interesting about the Iron and the "anti-aging" specialist I went do didn't mention anything about it. I have since left there after not feeling comfortable with the service.

Both times with separate doctors on blood tests (non fasted), the cortisol came up "normal".

I am actually ordering the saliva testing this week as well as speaking with the doctors that administer this saliva testing.

Is there anything further downstream that could be causing the hypo or is this uncontrollable even with diet? I am a very active 30 year old male 160lbs and I don't eat terrible at all. Obviously all eating habits could be better than they are.
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Avatar universal
Your Free T4 and Free T3 are low enough that, taken with your symptoms are certainly worth a therapeutic trial of thyroid med.  A good place to start would be with a small dose of T4 med.  

However, I have another suggestion to consider before taking that step.  Looking at all your iron related tests, I think that you should review those results with a doctor that is knowledgeable about the various possible iron related issues.  I say that because when I saw your ferritin, it struck me that it was higher than we usually see.  Then when looking at the other iron related tests, I noted that your serum iron was high end and your other tests were either at high or low end of ranges.   I just think this needs to be reviewed in total by a knowledgeable doctor.  

In addition, if you are gong to delay the possible start of a therapeutic trial, I also suggest tht you should also do the diurnal saliva cortisol panel, which is 4 tests taken over a 24 hour period.  If your doctor won't do those tests you can send away for a test kit and have it done relatively inexpensively.  

If you are considering another doctor, please tell us your location and perhaps we can recommend a good thyroid doctor for you.  Just being an Endo does not guarantee a good thyroid doctor.
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Avatar universal
Wow thats an eye opener thank you.
according to your info both my ft3 and ft4 are low and points to hypothyroid.
I tested negative for antibodies , but hypo might be the cause of my low Testosterone after all.

I am going to go directly to an Endo for a consultation with this info.

In your experience, what should by my next step and what meds in your opinion are best for that? synthroid? synthetic t3/t4 ?
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Avatar universal
Lots of previous info here, and good advice from goolarra.  Just wanted to throw in some info I got from a very good thyroid doctor.

"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."
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Avatar universal
Update on Labs (bloodwork)
-----------------------------------------------
T3 uptake 27.84
(23 - 26)

Thyroxine total (T4) 6.5
(4.5 - 11.7)

TSH 1.87
(.27 - 4.2)

FTI(T7) 1.8
(1.0-4.5)

Free T4 1.13
(.80 - 1.7)

Free T3 (3.16)
(2.0 - 4.4)

Total T3 102
(80 - 200)

vitamin d 56
(30 - 100)

THYROID ANTIBODIES (TG ab/ TPO ab) & Peroxidase Ab
.4  
(<9)

antithyroglobulin Ab
.9
(<4)
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Avatar universal
Here is a VERY interesting/confusing update for you. Once again I appreciate all your help thus far.

After getting weekly testosterone shots for 1 month (1cc of Depo Test) my testosterone came in high

Testosterone Total

Before
320

After injections
1034 (160 - 853 ng/dl)

After Bi-weekly liquid Vit D 50,000 injections for 1 month, the
Vit D 25-hydroxy
is still
LOW

BEFORE
40

AFTER
24.95  ( 33 - 100 ng/ml )

In addition, the doc wants to check thyroid again in 3 weeks before prescribing a combo of t3/t4 (not synthroid).
The doctor said the antibody test didn't reveal anything but him not knowing or not discussing the fact that there is 2 different tests for thyroid antibodies concerns me. Could both  TPOab and TGab be included in the thyroid antibodies blood test?

I will do more research but the thing that gets me is if it were a GI issue (intolerance, Crohns, IBS, Celiac), how come the VIT D level hasn't come up with liquid injections if it bypassed the GI ? Could this point more to a thyroid/pituitary ?
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Avatar universal
I'd say that's pretty spot on.
I take probiotics and also try to add kimchee to most of my meals.
I also get the bulk of my food from a local organic/free range/pasture raised/grass-fed/raw Farm.
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Avatar universal
Avoiding Soy in America is nearly impossible unless you do not eat a single thing that is processed.  Sort of the same thing with High Fructose Corn Syrup (HFCS)

look onthe ingredient list and soy oil is used in almost anything creamy.  HFCS is similar and they are often paired together.

But think about this. in the USA, the governmetn subsidizes both the producation of corn and soy beans.  And we ares surprised that corn and soy appear in almost everything. And many of these processed foods are cheap. (Maybe because government subsidy's have artifically kept the prices lower).

So it is only logical that when you incent people to do something you get more of it.  So the farmers are producing more and more and more of soy and corn.

Both of them are also highly genetically modified.  Mostly to be resistent to pests and round up.  As a result the farmers use MORE chemical round up (glyphoste) which kills the weeds but does not affect the soy or corn plant.  By killing the weeds it allows the corn and soy to have higher yields.  Bottom line the farmer gets paid more and get subsidized besides.  Massive production results in people inventing ways to utililze these ingredients. And BINGO you have soy and corn in almost everything.  This should not come as a surprise.

Related back to gut bacteria.  These "roundup ready" plants which are covered repeatedly with ever increasing doses of roundup, are eaten by both humans and livestock that we humans also eat.  While round up process is not used in humans so "THEY" say it is perfectly safe, it is true. However the "good" gut bacteria in your digestive track however use the same pathway that round up disrupts. So it kills your good gut bacteria.  Compound that with the reduced immunity that results from poor gut bacteria and all of a sudden there is a need for increased antibiotics. And what does the antibiotics do? Well of course they kill bacteria.  But they also happen to kill the good gut bacteria along with the bad bacteria that is causing the illness.  And the animals taking antibiotics to both stay healthy and for no other reason other than to fatten them up right before slaughter leave residual antibiotics in the meat.  Which we humans ingest, which kills bacteria.

Botom line is that in America our gut bacteria is absolutely under seige.  Killing the good gut bacteria.  Compound that with the idea that carbs expecially simple carbs of sugar, corn syrup and breads etc are food for yeast overgrowth. This is "bad" bacteria if over populated in the gut. Yet in the USA this is EXACTLY what we are eating.  The almost perfect combination of feeding yeast, and killing good bacteria, causing leaky gut which may need antibiotics which kill gut bacteria and we stay in a constant state of poor gut bacteria health and overall health.

So in the end, we wonder why we have a huge (no pun intended) obesity and diabetes problem. When we subsidize cheap food which is super high sugar and carbs guranteeing low prices, kill off gut bacteria. And then we wonder why a large portion of our society is overweight and diabetic.  When we force low prices of foods which almost deliberately spike insulin and sugar and fat production.  This explains why the USA and other "rich" nations poorest people also have the highest obesity rates.  In every other country throughout history the poorest people can't afford food and are the skinniest.  Yet in the USA the poorest people are the most obese. Why, because the cheap food is exactly the food that produces the physiological response of diabetes abnd obesity.

We as a society are with taxpayer funded subsidy are killing ourselves with the food we produce and eat.

Just my opnion of what I see connecting some pretty seemingly to me at least obvious "dots".
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Avatar universal
I don't know anything about testosterone as a medication, but 200 ml would equal 200 cc, no?  I'm sure whatever you're getting as an injectable from your doctor is good quality; you only have to make sure the quantity is appropriate.

Most of us (thyroidians) avoid soy because it can have a negative effect on thyroid hormones.  I avoid it because until the 1960s, it was animal fodder.  Westerners didn't eat soy.  Asians have always eaten soy, but they learned millennia ago that it has to be fermented to be digestible.  

Once again, never having had any allergy testing myself, I've never explored how accurate the skin test is.  My husband was having gut problems a while ago, and he had blood tests for food allergies.  I would assume that you are probably more sensitive than allergic if your throat doesn't close up and you don't go into anaphylactic shock when you eat them.

I suppose they scratch you with the 20 most popular allergens???  Before my husband's blood test, we had to go through a questionnaire to identify what we thought were the most likely suspects, so the test was targeted.  Why test for eggs if you never eat them?  Has your doctor suggested exploring these "allergies" with a more sensitive test?  
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Avatar universal
Good point, I will definitely finish out the Rx.

Got some more info today:
The Testosterone is Depo Testosterone and I am getting 200ml (1cc) weekly
The B injection is Methylamine (sp?) B12 and  a complex of B's and a multi.
Im guessing thats a different B12 since I don't metabolize B12 ?

The last time I took antibiotics was over a year ago.

POSITIVE on the food allergy test for (in order of severity)
Soy bean
cows milk
corn
wheat
bakers yeast
cane sugar
chicken
tomato
eggs

Just to clarify, this isn't an "allergy" right? is it an intolerance? or just something your system doesn't agree with? Ive heard mixed reviews on the testing.
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Avatar universal
At this point, I'm sure it would be best to finish the course of fluconazole.  Any damage has already been done, so you might as well reap the benefits as well.

Do you know which allergy test came up positive?

If I were you, I think I'd give B-12 and D levels a bit of time to stabilize.  Things thyroid often take some time to respond.  Also, before going on meds, I'd want to put that course of fluconazole behind me for a couple of weeks (at least according to some of what I read) and retest thyroid labs to see if that was affecting results.  

You haven't recently taken antibiotics, have you?

Very few of us have a baseline level for thyroid hormones since they're not part of any regular blood work.  So, we all have to experiment to find out where we feel best.  That being said, while your FT3 and FT4 are a little on the low side, I certainly think that anywhere between 40% and 60% of range is "about midrange".  However, there's no reason you couldn't request a small trial dose to see if it makes you feel better.  I'd just give what you're already doing time to settle out first.

Selenium is a thought.  Be sure to follow label directions as selenium can be toxic if the dose is too high.  Once again, it's best to test levels first...if they're adequate, more is not going to help.  Brazil nuts are the major food source for selenium...one nut provides RDA, so don't chow down!
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Avatar universal
@goolara,

I will find out which antibody test was done and let you know.

Another thought, since I'm doing the injectable B12 and VitD, if theres no celiac issue, maybe the answer is to correct the thyroid with a prescription to get the metabolism back to normal.

@flyingfool,

that all makes sense with my years of high intensity activities (competitive motocross in my childhood, and highly competitive martial arts since 14),

the doc was going to prescribe something for the thyroid but wanted to try to correct vitamin deficiencies before doing that which I think was a good decision. I hope the thyroid wasn't overlooked though because the serum levels of thyroid didn't reveal anything.

I will look into the Selenium, thanks!
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Avatar universal
Wow taking Fluconazole doesn't seem like a good idea for me. More than halfway through the prescription already though.
It was prescribed after a Candida blood test revealed too much yeast in my blood. It makes sense because of the years being active in teaching and competitive in Brazilian Jiu-Jitsu and getting Ringworm numerous times over the years.

The overall thing that pushed me to get this bloodwork was just the overall feeling of a slower metabolism coupled with the tingling in the neck. Also the fact that fat gain is still a problem despite my activity level. Of course everyone's diet could always be better, but I'm not eating bad by any means.

The constipation, bloating, gas, and mucus in the stool over the last few years has also been a concern.

Searching for an underlying cause for all of this is my main objective, not just treating the symptoms. Wondering if its underlying undetected Celiac that is affecting everything. Thyroid, Testosterone, and poor absorption of vitamins and minerals.

Or just overworking the body over the years and exhausting the adrenals and effecting the thyroid and testosterone.

On another note, the doc had a food allergy test done (the one where they inject a small % of the food in your arm?). after about 20 of them, a lot came up positive. I've read mixed reviews on the accuracy/dependency of the food allergy test. Thoughts?
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Avatar universal
excessive excercise can also cause issues with the ability to metabolize thyroid at the cellular level.  So serum levels of thyroid may not reveal the issue and otherwise appear "normal" yet at the cellular level be starved of thyroid.

What "excessive" or actually in the article it stated "more than moderate excercise" means is still undefined.  But since you say you are extremely active that could play a role.

You could also try taking Selenium as this helps convert the T4 into T3.  And it is the T3 that is ultimately used at the cellular level.  This may not be a dramatic help, but if you are teetering on the edge this may be just enough to help you.
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Avatar universal
http://www.ehealthme.com/ds/fluconazole/low+thyroid

Take a look at that regarding fluconazole and thyroid.

The gene mutations...just did a quick google...seem to be a can of worms.  The A1298c list of symptoms impressed me.  If you consider that many of us believe that CFS is a catch all diagnosis that includes undiagnosed, untreated hypo, the list of symptoms pretty much reads like a list of hypo symptoms (except for autism).  It seems to impact the metabolism of the B vitamins in general.

Positive ANA can indicate Hashi's or celiac.  You're right that the negative "thyroid antibody" is not consistent with Hashi's.  However, there are two antibodies that are markers for Hashi's, TPOab and TGab.  Both have to be tested to rule out Hashi's.  You only had one tested, and we don't even know which one it is.  If they only tested TGab, it's virtually meaningless as most of us by far are TPOab positive.

Heart arrhythmias are pretty common, and most people don't even know they have them.  If the cardio told you it was nothing to worry about, and it doesn't bother you, I don't see any reason not to take his advice.  



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Avatar universal
great information! thank you again!

LH and FSH have not been tested.

I am on Fluconazole for 30 days for anti fungal but other than that NO meds at all.

Supplements are now injectable b-12, vit d shots from the doc, and Testosterone shots once per week. I also take probiotics , whey protein, bcaa's, and a multi.

This new info from my labwork might help:

MTHFR, DNA mutation - POSITIVE
C677T mutation
A1298c mutation

my doc said because of this I don't convert B-12 correctly? and therefore I should be taking injectable b12 2-3x per week.

Also, anti nuclear antibodies were at 1.37 High (0.00 - 0.90)

that can mean autoimmune? (IE Hashimoto's or Celiac)
I don't think the lab results for the thyroid would be Hashi's consistent?

maybe unrelated but something to throw out there as an FYI:
My previous Primary care doc noticed an irregular heartbeat on my EKG. After being monitored for 24hrs on a heart monitor and consulted with a cardiologist, the doc said its nothing to worry about just keep an eye on.
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Avatar universal
Typically, pituitary issues don't cause neck sensations unless they affect the FT3 and FT4 levels.  Your TSH, which is a pituitary hormone, looks consistent with your FT3 and FT4 levels, so I don't see any obvious sign of pituitary involvement.

The saliva test is supposed to be more accurate than the blood test.  In the 24-hour test, you spit into a cup at 4 different times of day so that you get a reading at each.  This eliminates averaging errors, where, for example, a low morning and high evening reading might cancel each other out.

The rule of thumb for FT4 is 50% of range, and for FT3, it's 50+%.  However, for people not on thyroid meds, i.e. who still have hormones on demand, my personal feeling is that there's considerably more leeway in the variation of those.  We, on meds, often have to run levels a bit higher to cover periods of peak demand, since rather than continuously producing T4 and converting T3 all day long, we gulp our whole daily allotment in one swallow.  

Vitamin D deficiency is rampant, especially in temperate climates.  They've handed us the sunblock, trading one ill for another.  B-12 depends partly on your diet (plant sources of B-12 are very limited).  Pernicious anemia, the inability to absorb B-12 through the gut, is an autoimmune disease.  If you have PA, you have to inject B-12 or use a sublingual or nasal spray (the latter two rarely used in the U.S.).  I believe your B-12 is on the low side (barely), but not low enough to signal PA.  A supplement would probably work just fine.  So, I don't think you have to look too deeply to find the possible causes of D and B-12 deficiency.

As far as the low testosterone is concerned, I don't know.  That could be a pituitary issue.  Have LH and FSH been tested?  While your FT3 and FT4 are just a little low, your testosterone is very low.  However, the whole pituitary is often not effected.  Are you on any meds or supplements that could be affecting the pituitary or hypothalamus?      
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Avatar universal
besides constipation which just might be dehydration, I would get mucus in the stool frequently ( could be IBS ?).

Celiac may make sense because generally GI issues could cause a decrease in Testosterone and Vitamin D and also effect the thyroid. Im trying to find an underlying cause so I'm not trying to correct a deficiency without addressing the root cause.

Doc didn't palpate or feel nodules or comment on thyroid size.

As far as thinking it was pituitary, it was just doing process of elimination with the tingling symptom if the thyroid labs looked normal.

Also thinking about the adrenals and cortisol maybe? but even then there has to be an underlying cause effecting all of this. The cortisol was in range but that was blood.

Should I have done a 24hour salival test?

Im very active and don't eat perfect but by no means terrible either. just feel like the hormones are off because of fat gain around just the midsection and neck area when most other areas are fine.

The years of high intensity activity might be catching up with me.

Either way I keep coming back to the Thyroid and GI issues as the root causes.

You mentioned the FT4 and FT3 as being a little low. Can that give you any clues?

Low D, Testosterone, and B12 is vague and can point to different things.

If correcting the deficiencies changes things then maybe the answer is the high activity creating the deficiencies therefore causing problems.
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Avatar universal
Technically, it doesn't rule out celiac, only a small intestine biopsy can rule out celiac.  So, if your antibodies weren't elevated, it's not conclusive, but if it doesn't walk like a duck and doesn't quack like a duck, etc., it probably isn't a duck.  Besides constipation, what other G/I issues were you having?

I was just thinking that an U/S would give you a better idea if the tingling in your neck was thyroid related.  Has the doctor palpated your thyroid, and did he comment at all on size or whether or not he felt nodules (very common)?  Typically, iodine deficiency causes a goiter (enlarged thyroid).  
I don't think I ever answered you that iodine is a simple blood test.

I also meant to ask why you thought this could be a pituitary issue.  Have other pituitary hormones, besides TSH, been tested?  
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Avatar universal
no thyroid ultrasound yet.

GI Distress Profile immunology/serology on the labwork was normal for wheat and gluten. I'm guessing that rules out celiac?

Thanks again
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Avatar universal
Celiac disease (autoimmune gluten intolerance) can inhibit absorption of nutrients in the gut.  

Have you had a thyroid ultrasound?

Ferritin looks good.

I agree with your doctor.  Those known deficiencies should be corrected before starting thyroid meds.  

There are really only three possibilities in the treatment of hypo...synthetic T4 only meds (like Synthroid, Levoxyl and generic levothyroxine), synthetic T4/T3 combos of the previous T4 meds plus synthetic T3 (Cytomel and generics) and desiccated porcine thyroid, which contains both T4 and T3 in the proportions the pig likes it in (considerably different from what our thyroids make).  Of course, all of those can be prescribed in different doses and combos can be mixed and matched.  Unfortunately, until we try each for ourselves, we really don't know how it will work for us.  Another person's experience doesn't apply.  Anyone who tells you that there is only one therapy that works for everyone is someone to be avoided.  We've all gotten well doing very different things.  

\Most often, mainstream doctors prescribe T4-only first.  
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