Newbie with questions.

[pattiecakes1]

Hi everyone. I am new to the boards and am looking for help! I have my yearly physical next week and am trying to put together a list of tests that might be useful in obtaining a diagnosis. This post is long, but I am desperate for answers!

Last year I was diagnosed with high blood pressure (taking a prescription for that) and high cholesterol (241 total) (no prescription yet). I don’t understand why either of these are high! Nothing has changed in my diet to lead to this. Uggggh!

My symptoms are - Low Vit D, constant fatigue. No real energy. No libido.  Restless sleep.. My hair and eyebrows are thinning.  Skin is seriously dry, crusty heels and elbows. Cold one minute, hot the next.. My tongue is swollen and has these little indentations on the sides of it, cant seem to kick my seasonal allergies, my throat feels fat and thick (sorry, can’t think of any other way to describe it). Fibrocystic breast disease, brain foggy. Joint and muscle pain.

I have a family history of Hypothyroidism, so I have had my numbers tested for the last few years.

2010 –

TSH – 3.110 (0.270 – 4.200 ulU/ml)

2011 –

TSH – 3.300 (0.270 – 4.200 ulU/ml)

T3 UPTAKE (T3UP) – 27.0 (27.8 – 40.7 %)

T4, TOTAL (T4) – 8.0 (5.0 – 12.0 mcg/dl)

FREE THYROXINE INDEX (FTI) – 2.2 (1.2 – 4.3)

2012 –

TSH – 2.430 (0.270 – 4.200 ulU/ml)

T3 UPTAKE (T3UP) – 1.09 (.80-1.30 CD:110657894)

T4, TOTAL (T4) – 9.7 (4.5-11.7 mcg/dl)

FREE THYROXINE INDEX (FTI) – 8.9 (4.8-12.7 MCG/DL)

If you made it this far, thank you! Does it look like I have a thyroid problem? I have my next physical done next week and I would love to know what tests that I could ask her for besides the above that might help me determine if my thyroid is an issue or if I am way off base.

Thank you!

[gimel]

From those test results and your symptoms, I'd say that you need to get your doctor to put you on a therapeutic trial of thyroid meds.  I say it that way because most doctors you run across would tell you that everything is "within normal range" and symptoms aren't thyroid related.  They would fail to accept that some patients need to have their Free T3 and Free T4 higher in the range to relieve symptoms.  This is because the ranges are far too broad for most people, due to the erroneous way they were established.  

Perhaps you can use this link, written by a good thyroid doctor, to help influence your doctor to prescribe a trial of thyroid med.  

http://hormonerestoration.com/Thyroid.html

You might also make good use of the  scientific study in this link.  Note the statement that "Our data indicate that each individual had a unique thyroid function. The individual reference ranges for test results were narrow, compared with group reference ranges used to develop laboratory reference ranges. Accordingly, a test result within laboratory reference limits is not necessarily normal for an individual."

Andersen S, Pedersen KM, Bruun NH, Laurberg P. Narrow individual variations in serum T(4) and T(3) in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab. 2002 Mar;87(3):1068-72.

In addition you mentioned low Vitamin D.  You need to raise D to around the middle of its range.  Your B12 is much too low.  It needs to be in the upper part of its range.  And ferritin also is a bit low.  Would be better around 70 - 80 for women.

Also, keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free tT and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not just TSH results.  If you doctor is not willing to treat clinically in this manner, then you will need to find a doctor that will do so.

[pattiecakes1]

I finally received my newest lab tests back and hope that someone can take a look at these and let me know what you think.  My doctor feels that the tests are all normal.

I put the reference range in parentheses.

ANTI THYROID PEROXIDASE -  10     (0-34 IU/ML)

ANTI THYROGLOBULIN ANTIBODIES  -   11.5      (0.0 - 115.0 IU/ML)


FERRITIN  -   50.6      (15.0-150.0 NG/ML)

FREE T3 -    3.340       (2.000 - 4.400 PG/ML)

FREE T4 -     1.200      (0.900 - 1.900 NG/DL)

TSH  -    3.470     (0.270 - 4.200  UIU/ML)

T3 UPTAKE  -    1.03     (.80-1.30  CD:110657894)

T4 (THYROXINE) -      8.8      (4.5 - 11.7 MCG/DL)

FTI - 8.5  (4.8 - 12.7  MCG/DL)

B-12  -   292.7       (243.0 - 894.0  PG/ML)


Thanks so much for taking a look and sharing your opinion,  

[gimel]

Please notice that I previously said, " If the doctor resists doing these tests, you should insist on them and don't take no for an answer."  It is that important that you need to persist in getting the tests done, especially Free T3 and Free T4.   Don't let the doctor talk you out of it.  Tell him you have done your background reading and know that those tests are necessary to verify what is causing your symptoms.  

[pattiecakes1]

Thank you so much for the response.  I will ask for all of those tests to be run.  Fingers crossed that my Dr. will be agreeable!

[gimel]

TSH is a pituitary hormone that is affected by so many things that at bet it is only an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T3 and Free T4.

Your list of symptoms certainly suggests hypothyroidism.  The tests done for you are inadequate to confirm that.  The key tests you are missing are free T3 and Free T4 (not the same as Total T3 and T4).  Free T3 is the most revealing because scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T3 and Free T4 did not correlate at all.  The other tests for Free Thyroxine Index and T3 uptake are way outdated and not worth the  effort.  

Since Hashimoto's Thyroiditis is the most common cause for diagnosed hypothyroidism, you should also test for the thyroid antibodies indicative of Hashi's.  Those are Thyroid Peroxidase and Thyroglobulin antibodies tests.  Commonly shown as TPO ab and TG ab.

Also, since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you should also get those done.  If the doctor resists doing these tests, you should insist on them and don't take no for an answer.  

When results are available, please get a copy of the lab report and post results and their reference ranges and members will be glad to help interpret and advise further.  The ability to compare results to ranges is important, because the range are far too broad to be functional for many patients.  Having Free T3 and Free T4 results in the low end of their ranges is frequently associated with having hypo symptoms.