Sure you get this a lot: Thoughts on my lab results?

[wonko]

Dear Thyroid Community,

I got a copy of recent blood work and would appreciate any one with the time to weigh in.  A brief history of myself:  I've been sick for several years with late-stage Lyme disease.  There are a lot of symptoms I experience that could be cuased by Lyme or thyroid, including extreme fatigue, heaviness in limbs, difficulty exercising, and difficulty managing weight.

A few years ago, I had a low positive for Hasimoto's, but this got little attention from my docs.  A more recent test for the antibodies (from Feb.) was negative.

My recent tests show that most of my thyroid values are in range, the only one that is out of range is the T4 Free.  Here are the details:

T4, Free, non-dialysis  0.7  (normal range 0.8-1.8)
T4, Total 7.3 (normal 4.5-12.5)
TSH 2.63 (normal 0.4-4.5)  (This moves around in me, but the higest it's ever been is 3.5  This is the lowest it's been in years.)
T3, total 108 (normal 76-181)
T3, Free 264 (normal 230-410)

Some other out-of-range results were:

DHEA Sulfate 24 (normal 40-325)
Cardio CRP 8.7 (normal 1-3)
Hemoglobin A1c 5.7 (normal <5.7, so I'm on the line with that.)

I've read that thyroid disease can be a clinical diagnosis, because some people will have fairly normal labs.  It is my understanding that some doctors will prescribe thyroid medication and see if the patient improves.  I'm just not sure if I should pursue that possibility, or just keep hoping that I'll feel more energetic with ongoing Lyme treatment.

I'm 31 years old.  I work full time again (after working part time in 2009 due to the Lyme disease), but I'm often in bed by 7:30-8 PM with crushing fatigue.  I wake up feeling tired, and need to drink a lot of coffee to get going in the AM.  I also regularly have localized sharp pains in the front of my neck where the thyroid gland is, and my doctor has commented that my thyroid feels enlarged.

Does any one have advice if I should follow up on my suspicions of thyroid disease?  If I want to pursue this, how should I go about seeking an endo who is more willing to treat even with my overall good thyroid labs?

Thanks in advance, and sorry if I sound desperate.  My issues with fatigue are very troublesome to me.

[wonko]

Thank you for the promt and helpful replies.

Barb135, I have had the TPOab test before.  In 2008, it came back high/positive, but recently in Feb. 2010 it was negative.  The 2008 test also lookded for thyroglobulin Ab, which came back negative.  So I'm not sure what that means in terms of this possibly being Hashimoto's.

I do think I should ask for an ultra sound.  I'm moving soon and will likely need to delay that request until I resettle, but this issue is going to be on my front burner as soon as possible.

As for symptoms, I have a bunch of systemic complaints:  I wait up sore with bilateral stiffness everyday, that takes a couple of hours to loosen up.  I also often wake up feeling unrested.  The bottom of my feet and shins often hurt.  I have several sensory issues and paresthesias, like tingling/prickling sensations in my face, hands, and feet (though they can turn up other places, too, or manifest differently like the feeling of water running down my skin).  I get small, hard white nodules (like pimples, but harder and more persistent) on my face, chest, forearms, and legs.  I experience head pressure that is accompanied by rosacia (basically, my face gets all red).   If I stay seated for any lenghth of time, my joints start to freeze up and I'll be stiff upon moving.  My legs and sometimes my arms feel very heavy/difficult to move.  I have roving pains in my limbs, and sometimes muscle twitching as well.  My vision blurs when I get tired or overheated, I get optical migraines, and I see flashing lights when I move my eyes.  The heat makes my sensory issues worse.  The cold makes my joints hurt.  I often have "brain fog" or difficulty concentrating.  Off and on, I get fibromyalgia-like symptoms, including painful sensations in my skin.  I also have many trigger points, which are bunched up muscles in my back and neck, that can cause discomfort.  And of course, fatigue, which is often a top complaint for me.

As I said before, I know that some of this is likely related to the Lyme disease or damage from it.  I went undiagnosed for a long time and that can cause a lot of issues.  But I'm much improved overall since when I began Lyme treatment in Dec. '08.  (While I still get a lot of symptoms, the severity is less.  I may sound like a whiner above, but I'm as active as I can be these days and really try to not let it all stop me.)  

That is why I posted here, I really wanted encouragement to, if it sounds resonable, pursue thyroid treatment.  I know it might not fix everything, but if even a subset of my symptoms improve, it would be totally worth it to me.  It sounds like I have reason to look for a good doctor.  Since I'm about to move, I'll wait until I'm relocated to start my search, but will make a post here for advice on that in the near future.

Thanks both for the replies.  I feel validated and motivated to address this aspect of my health.

[Barb135]

What symptoms do you have?  

Your FT4 is below range and your FT3 is very low in it's range, so I wouldn't be a bit surprised if you have hypo symptoms.  These are the 2 labs that we look at the most. TSH is not a good indicator because it does fluctuate a lot; AND it's a pituitary hormone, not thyroid.  

If you haven't already done so, you should ask your doctor for thyroid antibody tests (TPOab and TGab).  These will confirm or rule out Hashimoto's Thyroiditis, which is an autoimmune disease, in which antibodies slowly but surely destroy your thyroid.  You should also ask for a thyroid ultra sound to check for nodules or a goiter.

It sounds as though you might very will benefit from a low dose of thyroid med to bring you Free's up.  Would probably do a lot help alleviate that fatigue.

You should probably also, start checking your fasting blood sugars - looks like you are a prime candidate for diabetes, or at the very least, insulin resistance.  

[gimel]

You should absolutely pursue thyroid treatment.  To me the most important indicators of being hypo are symptoms such as yours, along with relatively low levels of the actual, biologically active thyroid hormones, free T3 and free T4.  Many of our members report that their FT3 had to be adjusted into the upper part of the range and their FT4 adjusted to at least midpoint in order to get symptom relief.  Your FT4 is below range and your FT3 is low in the range.  

In my opinion the best way to treat a thyroid patient is to test and adjust the levels of FT3 and FT4 with what ever medication is required to  relieve symptoms, without being constrained by resultant TSH level.  You need to find a doctor that is wiling to treat you in that manner.   The best way to find such a good thyroid doctor is to post a new message asking members if they can recommend such a doctor in your area.  If that is unsuccessful, then post again and we will try a different way.