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Avatar universal

Scared first-timer, please help look at labs?

Hello there,

Could someone please look at these lab results and give me their thoughts?  I'm not sure if I'm interpreting the data correctly, and my doctor isn't helpful.


TSH:
0.508  (ref. 0.358 - 3.740 uIU/mL)

FREE T4:
0.8  (ref. 0.8 - 1.6 ng/dL)

FREE T3:
100  (ref. 60 - 180 ng/dL)


Went to my GP for fatigue.  I'm a 26-year-old woman with a family history of primary hypothyroidism (mom) and Hashimoto's (sister).

From what I've read. I think I have secondary hypothyroidism, caused by the pituitary or hypothalmus, because my TSH AND T4 are on the low end (as opposed to an elevated TSH, which would indicate primary hypo)?  Does this sound right?  This scares me because I've read that secondary is usually caused by a tumor on the pituitary or hypothalmus.  :(

I would appreciate any's help and evaluation.  I am waiting for a referral to see an endocrinologist, but that will probably take weeks.  :(

Thanks again
23 Responses
649848 tn?1534633700
COMMUNITY LEADER
Your vitamin D is not "minor"... Optimal vitamin D should be about 55-60, so you're considerably low... Your ferritin is also way too low.  

Both vitamin D and iron are necessary for the proper metabolism of thyroid hormones.  If your doctor didn't tell you to supplement those, you should be.

What was the exact level of your vitamin B12?  Many/most of us have to have vitamin B12 high in the range - at/near the very top in order to keep symptoms at bay.  Fatigue is the number one symptom of early B12 deficiency.  Fatigue is also a symptom of low iron, so even though your iron was "fine", meaning in range, it might have been too low, also...

Thyroid-wise, your results could indicate central or secondary hypothyroidism, but that doesn't necessarily mean a tumor.  I could simply mean a malfunction in the pituitary or hypothalamus glands.  Even though your thyroid hormones are somewhat low, if that were causing your fatigue, it would be extremely unusual if that were the only symptom you'd have.  

I'd look at some of the other things first... As noted, having ferritin, B12 and vitamin just "in range" is not good enough; they must be optimal to alleviate symptoms of deficiency...
Avatar universal
Is fatigue the only real hypo symptom you have?

If so why would they not have also tested for vitamin D3 and Vitamin B-12. Both of which if deficient cause fatigue.

Finally with your family history why would the Dr not also have tested you for the two antibodies associated with Hashimoto's?

You are very rock bottom on Free T4 and below the middle of the range in Free T3.  Many, but not all people will have hypo symptoms at those levels.  But each person feels well at different levels.

Rule of thumb to feel well are BOTH of the following:

1) Feee T4 to be 50% of the range if not higher.  You are testing at ZERO percent of the range!

And- that means in addition to #1

2) Free T3 to be 50% to 67% of the range.  That is the middle to upper 1/3 of the range.  With many leaning more towards the upper 1/3 of the range. You are testing at only 33% of the range.

As you can see above compared to the rule of thumb you are low in both. And like I said it is often common for people with your levels to have many hypo symptoms.  But again it is only a rule of thumb.
Avatar universal
Is fatigue the only real hypo symptom you have?

If so why would they not have also tested for vitamin D3 and Vitamin B-12. Both of which if deficient cause fatigue.

Finally with your family history why would the Dr not also have tested you for the two antibodies associated with Hashimoto's?

You are very rock bottom on Free T4 and below the middle of the range in Free T3.  Many, but not all people will have hypo symptoms at those levels.  But each person feels well at different levels.

Rule of thumb to feel well are BOTH of the following:

1) Feee T4 to be 50% of the range if not higher.  You are testing at ZERO percent of the range!

And- that means in addition to #1

2) Free T3 to be 50% to 67% of the range.  That is the middle to upper 1/3 of the range.  With many leaning more towards the upper 1/3 of the range. You are testing at only 33% of the range.

As you can see above compared to the rule of thumb you are low in both. And like I said it is often common for people with your levels to have many hypo symptoms.  But again it is only a rule of thumb.
1 Comments
Sorry for the double post.  The first didn't show up so I resent it only to find out the first submission actualy did get posted!
Avatar universal
Hello flyingfool,

Yes, my only real symptom at this time is fatigue.  They did test for other deficiencies; I have mild vitamin D insufficiency at 25 ng/mL.  B12 and iron were fine.  Ferritin was on the low end of normal at 12 (ref. range 6 - 231).

Thank you for your detailed analysis.  So it does look like I have hypothyroidism.  :(  With my TSH and T4 being low, am I correct that it looks like secondary or tertiary instead of primary?  I am scared of having a tumor on my pituitary or hypothalmus (a common cause of secondary/tertiary, or so I've read).

Thank you again
Avatar universal
Thank you, Barb.  My vitamin B12 was 528 (ref. range 200-1000 pg/mL).
My iron was 108 (standard range 50-170 ug/dL).

I'm glad you mentioned that about my D and ferritin being so low.  I went out earlier and bought some D supplements today, so I hope that'll help.  Sounds like I should get some iron supplements too?

I'm glad to hear that a tumor isn't the only possibility.  My mother had to have a tumor removed from her pituitary (surprisingly, it was unrelated to her hypothyroidism, which was primary), and had a really rough time of it.
Avatar universal
My vitamin d levels are the same as yours. I bought supplements but it didn't help. I ended up going on prescription vitamin d 50,000 units once a week and that made my levels go up. If the supplements you buy dont do anything to the levels you may want to ask about that, I think that will help you feel better.
Avatar universal
I should say my vitamin d levels WERE the same as yours, haha
649848 tn?1534633700
COMMUNITY LEADER
I have a cousin who had pituitary tumor removed and had no trouble, whatsoever... that was years ago and she's done great ever since it was removed.  Don't be afraid of something you don't even know is there...

It does look like you might need iron supplements since your ferritin is so low.  Did you have an entire iron panel done?  If so, what was your actual iron level?
Avatar universal
Hello Barb,

My iron levels were:

IRON
108 ug/dL  (ref. range 50 - 170)

HGB
12.4 g/dL  (ref. range 12.0-14.8)

HEMATOCRIT (HCT)
38.8%  (ref. range 35-43%)


I'm a bit disenchanted with my GP right now.  I called them back to discuss my ferritin being on the low end at 12, but they said this didn't indicate anemia and I didn't need to take iron supplements.  I think they're wrong.
Avatar universal
Low ferritin is often a precursor to low iron levels.  You can get some good info on ferritin from this thread.

http://www.medhelp.org/posts/Thyroid-Disorders/The-Importance-of-Ferritin/show/2818614
Avatar universal
Thank you, Gimel.  You seem like the go-to for ferritin questions.  :)  Would you agree that my ferritin level of 12 is low and warrants iron supplements, despite my actual iron level being "normal"?  It sounds to me like my GP is wrong.
Avatar universal
See above...I think I meant to ask, "Does my ferritin level of 12 indicate anemia and warrant iron supplements, despite my 'normal' level of iron?"
:)
Avatar universal
B-12 in many countries like Japan do not even start their low end of the range at 500.  So you would be at the very bottom of that.  And as Barb stated, many people need to be towards the upper end of the range.  Many say in excess of 700 if not 900 to feel well.

By those standards your 528 level would be quite low.

Vitamin D should be 55 to 60 and Ferritin a MINIMUM of 70.  This according to a previous post by Gimel.

B-12 seems to be best absorbed with a sublingual tablet verses a pill.  These will be noted as haveing a flavor when you see it on the shelf.  They are a bit more expensive but still cheap.  Just place one under your tounge and let it dissolve.  Some of the B-12 gets absorbed directly into the blood through the skin contact under the tounge.  Any other swallowed B-12 would be similar to if you took a pill. So it seems to get better results.

large doses of iron may be needed since it is very hard to absorb.  And it can also cause constipation so be aware of that possibility.
Avatar universal
Thank you, flyingfool!!  You guys are so much more helpful (and seemingly more knowledgeable) than my doctor!!  No wonder I've been so tired....
Avatar universal
I expect that you will need to supplement with iron starting with about 25 mg and increasing every week or so until you get up to 75 mg and then re-test.  Also when you re-test I would defer your dose until after the blood draw for testing, to avoid false high results.

To avoid possible stomach related issues, the best form of iron supplement seems to be ferrous bisglycinate.   Ferrous fumarate is also a good one.  
Avatar universal
I'm really not feeling well and I don't know where to turn or what to do.

As I posted in another thread, I saw the endocrinologist yesterday.  She is part of an esteemed practice in my area and has good credentials.  She examined my results and thought they were normal because they fell within the lab standard ranges.  (She did order some additional tests for Hashimoto's but is not expecting them to come back positive.)

My vitamin D is deficient, and my ferritin levels are low at 12.  I guess this qualifies me as "pre"-anemia because my iron levels are still normal, just my stored iron is low.  She thought my B12 level was fine, although I did just start taking sublingual drops this morning anyway.

Anyway.  This past week, especially the past 2 days, I've felt significantly worse.  I've gone from mild all-day tiredness to actual fatigue and feeling weak (not in the muscles, more like a lightheadedness).  When I'm having spells of this, my heart seems to beat harder, and my hands shake a bit.  In short, I just feel crappy.  Food isn't appealing to me right now, either.

Right now, my toddler is napping, but I feel too lousy to sleep, even though I'm tired.  Honestly, I just want to cry.

I don't know what to do.  The endo thinks my thyroid levels are normal (despite symptoms).  GP says no to iron supplements, since I'm not technically anemic (I just started taking a multivitamin with iron, so hopefully that'll help).

Could vitamin D deficiency and borderline anemia cause me to feel this lousy?  I kinda feel like I've "crashed."

Thoughts appreciated...
Avatar universal
In the words of a 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."   You can read more from this doctor in this link.

http://www.hormonerestoration.com/Thyroid.html

Your Free T4 was at rock bottom, which is way too low due to the screwy reference range.   You weren't even tested for Free T33, only Total T3.  But  if your Free T3 is in the same position in its range as your Total T3, that is another indicator of being hypothyroid.  Having a low TSH in conjunction with those tests is an indication of central hypothyroidism, which was mentioned previously.  

Your doctor and the Endo are giving you the usual answers because they have the "Immaculate TSH Belief' and are using "Reference Range Endocrinology", by which they will tell you that any test result that falls anywhere within the range is adequate.  That is very wrong, due to the erroneous assumptions used in establishing the range.  A good thyroid doctor will treat you 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.  So you need thyroid medication to adequately increase your Free T4 above the middle of its range, and your Free T3 as needed to relieve symptoms, which is usually in the upper third of its range.  

In addition, your Vitamin D is less than half of what it should be.  B12 should be in the upper end of its range, so you are way too low there.  Ferritin should be 70 minimum, so you need to supplement as I mentioned previously.  You can start on these three while you find a good thyroid doctor that will treat clinically as described above.  If you will tell us your location, perhaps we can help locate one for you.  
Avatar universal
Thank you again, gimel.  I have started D and B12 supplements, and a multivitamin with iron.

I broke down and had my husband leave work early because I feel too weak to adequately care for our toddler.  I feel like I've crashed, to the point that I'm going to ask my GP to order a mono blood test, to rule it out if nothing else. (I had bad mono 10 yrs ago and felt horribly weak and tired, and have heard it can, though rarely, recur.)

I live in Pittsburgh, PA.
649848 tn?1534633700
COMMUNITY LEADER
Avatar universal
A multivitamin with iron is nowhere near what you need to adequately raise your ferritin.  How much D are you taking?

I have a few prospects for you.  What insurance do you have?
Avatar universal
I am taking 2000 (I think it's IU) of D daily, plus the 400 in the multivitamin.

I have Highmark BCBS insurance, so most UPMC docs are now out of network, unfortunately.

Thank you again, everyone, for your time.
Avatar universal
Also, I just took a look at the script the endo ordered yesterday, and she ordered a retest of TSH, T4, and T3 in addition to the Hashimoto's test.  I am actually crossing my fingers that my values come back low enough that she'll treat me for hypo because, while I don't wish to have hypothyroidism, I do think that's what I have, and I just want to get treated so I can feel better.

I'm going to get the additional blood tests done tomorrow.  Crossing my fingers.

Your detailed responses on this forum have really helped to outline what my issues are.  Again, truly appreciated.  All of you.
Avatar universal
Just make sure the T4 and T3 tests are for Free T4 and Free T3 not Total T4 and Total T3.  I'd even make sure to ask the lab attendant which tests are going to be done, just to confirm the right tests.  You'd be surprised how often they operate on auto pilot and do the usual, which may not be what you want.

You are supplementing for D and B12.  Don't forget supplementing with iron for the very low ferritin, as I outlined above.  
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