Your symptoms, coupled with blood test results indicate hypothyroidism. For the future, you should always insist on being tested for both Free T4 and Free T3. Free T3 is the thyroid hormone that correlates best with hypo symptoms. I expect that you will find it in the low end of the range as well.
Your TPO ab test is indicative of Hashimoto's Thyroiditis. With Hashi's the autoimmune system erroneously sees the thyroid gland as foreign and produces antibodies to attack and eventually destroy the gland. As this proceeds, levels of the thyroid hormones gradually fall, and the TSH increases as the pituitary signals for more thyroid hormone. Your TSH tested as lower than expected so you should ask the doctor if he has an explanation for the TPO test result, in consideration of the normal TSH. I think the first thing would be to re-test the TSH and Free T4, and add in the Free T3 test. Regardless of that open question, your Free T4 is very low in the range, and with your symptoms, point directly to hypothyroidism.
The doctor probably ran Vitamin D because a deficiency can cause symptoms that mimic some hypothyroid symptoms. Also, D is important to metabolizing thyroid hormone, as is ferritin, which is another test I recommend for you, along with B12. When you get these additional tests done, please post results and reference ranges and members will be glad to help interpret and advise further.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by TSH levels. Symptom relief should be the main concern, not just test results.
So you should request your doctor to prescribe a starter dose of thyroid med and re-test and adjust about every 4 weeks to get your Free T3 and free T4 levels high enough to relieve symptoms. You can supplement your Vitamin D as necessary to get to about 55-60. When you find out your ferritin and B12, you will likely need to supplement those as well to raise your ferritin to about 60 minimum and B12 in the upper part of its range. If your doctor is not willing to treat clinically as described, then you will need to find a good thyroid doctor that will do so.
I've suffered with dopamine deficiency my whole life. I was voted most unorganised at school. smh lol. I rarely yawn which I only just found out was a symptom of dopamine deficiency. My father has Parkinson's which is depleted dopamine so I think something is going on with genetics perhapss since I have corrected a long list of causes of dopamine deficiency and still have symptoms although thankfully a bit better.
I did find a good article about dopamine symptoms but they didn't list all the symptoms...
"Here is a list of symptoms of dopamine deficiency (with my emphasis added on symptoms I identify with):
1. Physically fatigued easily (Sometimes.)
2. Sleep too much and trouble getting out of bed (Yes on trouble getting out of bed!)
3. Reduced ability to feel pleasure
4. Flat, bored, apathetic (Yes on feeling flat)
5. Low drive, motivation & enthusiasm (Yes, and yes.)
7. Difficulty getting through a task even when interesting to me (HELL yes!)
8. Procrastinator/little urgency (Mmmm-hmmm!)
9. Shy/introvert (Yes.)
10. Mentally fatigued easily (Yes.)
11.Difficulty paying attention and concentrating (A little bit!)
12.Slow thinker and/or slow to learn new ideas
13.Put on weight easily
14.Crave uppers (e.g. caffeine/sugar/nicotine/diet soft drinks/cocaine/amphetamines)
15.Use these improve energy/motivation/mood
16.Prone to addictions (e.g. alcohol)/addictive personality
18.Reduced libido and/or impotence (sometimes on the libido)
19.Family history of depression/alcoholism/ADD
Factors which reduce dopamine levels (with my emphasis added on factors I have):
1. Chronic stress
2. Inadequate sleep (Like, DUH!)
3. Hypothyroidism (Bingo! Hashimoto's!)
4. Lead, arsenic and cadmium exposure
5. Under-methylation (Possibly- I suspect my dad's family under-methylates their B12. They have a strong history of Alzheimer's and dementia.)
6. Tyrosine (precursor) deficiency
7. Magnesium, iron, zinc & vitamins B3/B6/C/D deficiency
8. Excess copper levels (I have melasma and used to be vegetarian, so copper might be a factor.)
9. Genetic dopamine receptor abnormalities
10.Chronic opioid, alcohol & marijuana use
11.Adrenal insufficiency (Definitely!!)
15.Estrogen deficiency (Yes.)
16.Human growth hormone deficiency"
Your vitamin D is extremely low. And my understanding is that a low vit D can mimic hypothyroid symptoms. It can also cause hair loss. So you will most likely be put on a good supplement.
Your TPOab is also too high which can indicate Hashimotos. The problem with that is that some doctors don't really care or o anything about it especially if your thyroid panel is within the range.
Your free T4 is within the range but low. A lot of people don't feel good until it's about 50% within the range.
Hopefully your doctor is listening to your clinical symptoms and take your antibodies serious. But I think you will feel much, much better if you can get your Vit D levels up.
I forgot to add, that 92% with Hashimoto's thyroiditis have vitamin D deficiency.
Sorry gimel, I have to disagree with vitamin D needed to metabolism thyroid hormone since over a billion people in the world are deficient and you can be also be asymptomatic with vitamin D deficiency.
I'm super tired right now but no yawing. *sigh* I forgot to add that article about dopamine is from Pretty In Primal - Dopamine Deficiency (or, I'm Not Lazy After All!).
I'll let you wrangle that one with this well known thyroid doctor. LOL
Richard Shames, MD: "Last month I was coaching a very careful and conscientious low thyroid patient. She was taking optimal amounts of the minerals just mentioned; and in addition, was taking herbal medicines to promote her thyroid health, as well as the pro-hormone pregnenolone (to increase availability of cortisol). Moreover, she was also taking prescription thyroid medicine, consisting of a T4 / T3 combination, with a small amount of natural desiccated thyroid for completeness. Even with all of this effort, she was not getting good results in terms of symptom relief. After checking her Vitamin D level, I found it to be in the low-normal range, and we boostied it up to mid-to-high normal range. Only then did she begin to do well.
Thyroid treatment isn't optimal -- and may not work -- if you do not have adequate Vitamin D for the crucial final metabolic step, which takes place at the site where thyroid hormone actually works. This happens inside the nucleus of the cell. Vitamin D needs to be present at sufficient levels in the cell in order for the thyroid hormone to actually affect that cell. That is why vitamin D is so crucial.
These days people are using sunblocks, and staying inside at their computers much more frequently. Therefore we are getting less Vitamin D from the sun. In addition, multivitamins typically have about 400 IU of Vitamin D, which was the RDA standard from research done in the 1940s and 1950s. Today, this research is being questioned, with many researchers now recommending a minimum of 1000-2000 IU daily, an amount that exceeds most multivitamins. In the case above, for example, my patient needed 4000 IU daily to achieve her good results.
I believe that a blood test for Vitamin D is essential for anyone dealing with hypothyroidism. The typical normal range for Vitamin D levels is from around 30 to 100. Keep in mind in mind that just being in the low end of normal range will not do an adequate job for someone with an underactive thyroid person. Thyroid patients need to be "replete" -- and that means alevel of at least 50 - 60 level, or greater."
Where did your 92% come from. I'd like to have that link for my bookmarks. Send by PM please.
Here's my blood work so far, I am getting more blood work at the end of the week.
TSH 0.931 Range 0.358-3.74 uIU/ml
Free T3 3.0 Range 2.3-4.2 pg/ml
Free T4 Range 1.2 Range 0.8-1.8 ng/dL
I can see that in the eyes of most doctors we encounter, you would be told that your thyroid test results were within the "normal' range and that any symptoms you have are due to something else. However, your Free T4 is at only 40% of the range and your Free T3 is at about 37 % of the range. Those can be associated with being hypothyroid.
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."
Of course weight gain can be associated with a number of things, but low metabolism associated with low thyroid hormone levels is a common problem. So, based on all that, you at least deserve a therapeutic trial to raise your Free T3 into the upper part of its range and your Free T4 to at least the middle of its range. Free T3 has been shown to correlate best with hypo symptoms.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief is the most important consideration, not just test results. So when you see your doctor next to discuss all this with him I also suggest you should find out if he is going to be willing to treat clinically as described. If not then you will need to find a good thyroid doctor that will do so.
Finally, please tell us about the additional blood work to be done. And also are you having any other symptoms besides the ones mentioned in prior posts?
Thank you gimel for your comments. Since I just signed into this website, please understand all this is new to me. Do you have a clinical/medical background? You certainly sound very clinical and knowledgeable and I appreciate your responses. Are there specific symptoms you are referring to? Having thyroid issues i.e. Goiter is something pretty recent and new for me. Since my hysterectomy 1 year ago I was diagnosed with multinodular goiter. Being thrown into surgical menopause is a whole new world for me as well. Hot flashes, night sweats, insomnia, menopause muffin top (weight gain) has not been easy getting use to. I think the surgery had a direct effect on my thyroid, obviously, so those symptoms are either menopause related or thyroid related or both. I just feel like my body took a dive post surgery-lots of changes-hard to adjust.
If you have an iodine or selenium deficiency you will be hypothyroid. There won't any asymptomatic cases. The same doesn't apply to vitamin D which is why it seems a bit dodgy lol.
But thinking about this further, it's possible there might be something to do with reverse T3 since that is the closest test that have found to measure thyroid hormone at a cellular level. Perhaps for some people this deficiency does affect reverse T3 levels. Other things to consider is vitamin D is needed for the immune system and some of the vitamin D symptoms are the same as hypothyroidism.
My background is partly that I suffered with hypothyroidism for about 35 years. At first the doctors refused to accept that I was hypo since my TSH was slightly below 5. Then I finally coerced a doctor into a trial of Synthroid. That helped, and over the years the dose was gradually increased up to 200 mcg daily, and I still had lingering hypo symptoms. Six years ago I found this Forum and learned from the members about the importance of Free T3. Got mine tested for the first time and confirmed it as low in the range. Convinced my doctor to switch me to Armour Thyroid, because I was obviously not converting the T4 to T3 adequately. After some tweaking of meds and dosages, my Free T3 is now in the upper end of the range and my Free T4 right around the middle of the range, and I supplement Vitamin D, B12 and iron, and I feel the best that I can even remember.
I mention all that just to acknowledge what I have learned on the Forum that has helped me so much. Also, since I am retired, I have time for extensive research into scientific studies related to hypothyroidism. So, I try to learn more every day from scientific studies as well as from the knowledgeable and experienced members here. Then as a way of paying back to the Forum I try to use that info to help other members.
When will you have the additional blood test results? When will you be seeing your doctor next?
Hi Everyone, I am the original poster to this thread and wanted to thank you so much for the advice. I have copius notes to take to my endo (we are meeting tomorrow morning). I will report back. I pray that she doesn't dismiss treatement based on the TSH levels, she sounds like a very progressive doctor who treats symptoms to optimal not "normal" so we will see. It sounds like there is finally an explanation for why my body acts as it does and I feel relieved of the guilt I've felt because I thought I was just lazy.
Will report back soon. Thanks again!
Glad we did not hijack your thread totally. LOL Please make sure they test you for those mentioned previously. I'd even confirm with the person in the lab, to make sure they don't get mixed up.
Update: Just back from the doctor. I have been crying. I feel upset, because she was insistent that I did not need Thryoid meds based on those numbers. I asked why my hair is falling out, why I sit in a coma all weeked, why why why...and she had no answers. She said we could try a low dose of meds but strongly, strongly suggested against it and made me feel like a freaking doctor shopper. It's not like I was asking for narcotics for goodness sake.
And since I feel the need to defend myself, I haven't seen a doctor in nearly 10 years except for two walk-in clinic visits for bronchitis and an eye infection...
Anyway, she prescibed a prescription dose of Vitamin D. More blood tests:
Free T3 (only because I asked)
I have my first appointment with a PCP tomorrow for a physical and will be asking for a CBC, I assume I should also discuss this with her?
Not a lot changed on the ultrasound, nodules have grown slightly not they didnt seem alarmed. They are still subcentimeter. Thyroid measured slightly smaller than the one from 10 years ago which she attributed to different machines.
You really need a good thyroid doctor that will treat clinically, by testing and adjusting free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Since you are meeting with a PCP tomorrow, I'd suggest that you plan on relating all about your symptoms, and that they are often related to being hypothyroid, and that you haven't yet been tested for Free T3, but your Free T4 was much too low in the range, and that you would like to have a therapeutic trial of thyroid meds to evaluate the effect on your symptoms. Giving the doctor a copy of this link might also help.
If the PCP wants to run tests also, your symptoms also suggest that it would be a good idea to test for Vitamin B12 and ferritin, along with the D that you previously confirmed as way low. I would also inquire if the PCP will be willing to treat clinically as described. If not, then you will need to find a good thyroid doctor that will do so. We may be able to help with that if you want.
The same thing happened to my mother just today. And yes she was upset as well. The pain from the fluid in her legs (hypo symptom!) are so bad she'll be in a wheelchair soon! And she had her labs done in the afternoon which is why her TSH was lower in the "normal" range. She ordered more labs and will fast overnight and do them between 7 and 9 am. Quite ridiculous frankly that a number means more than a patient's symptoms.
Although she wasn't offered medication which was why she was so upset. The doctors more than happy to give out anti depressants etc. but thyroid medication. *gasp*
Just wanted to give an update. I am feeling very good about my new PCP. I was quite nervous when I walked in so I forgot half the reason I was there (another reason to write things down!) but she was very intuitive and thorough and ordered quite a few tests to rule out other issues given an extensive family medical history of auto-immune disorders.
I didn't get the feeling she agreed with my endo based on my bloodwork results and symptoms, however, I really appreciated the way she handled everything -- putting me at ease without bad mouthing or second guessing anyone.
I have an appoointment to have blood drawn on the 17th for the following:
Complete Blood Count w/Platelet
Comprehensive Metabolic Panel
Iron and TIBC
Lipid Panel with LDL
Rheumatoid Factor (my grandmother had a very severe case of RA that left her an invalid at 40ish).
I feel very validated, it's like someone finally believes me and I'm not just lazy or depressed. I sure hope we can find out what is wrong. I still suspect thyroid issues, but my mother and maternal cousin both have Lupus so the doctor wants to rule it out.
Thanks for all your input. I'll update you when my blood test results come back and again when I have my followup appointments with both doctors.
Forgot to mention this, the endo ordered 50,000 IU of D2 which I have to take on a weekly basis for 90 days. Started this past Sunday.
Endo put me on 50,000IU of D2 taken once weekly. My question is why D2? She questioned my food intake (dairy, fish) which makes me think I should be on D3, not D2. Thoughts?
25OH D3 = 9 (no reference range estalished)
25OH D2 = <4 (no reference range established)
They were rolled up into a total of 9 and both doctors deemed it deficient.
Thanks for your feedback.
Sounds like antibodies are attacking your thyroid and is damaging it this would account for your thyroid being smaller and nothing at all to do with different machines !!!!!! I've never heard the like!!!!!!
My mother's fluid in her legs have improved somewhat since she cut out sugar - high insulin retains sodium. We've been eating these sugary filled chocolate wafers for two weeks lol but we both feel terrible so that was easy to stop cold turkey again! I can't rule out hypothyroidism causing some of the fluid retention though.
It's nearly impossible to get the vitamin D you need from your diet. Vitamin D2 is normal <4 since you aren't taking vitamin D2 supplements. Vitamin D3 is the more potent form of vitamin D and is more effective at raising and maintaining the vitamin D levels than vitamin D2. That said you'll most likely see your vitamin D levels rise. Taking vitamin D can bring out or worsen an existing magnesium deficiency. And also magnesium is the most important co factor for vitamin D absorption. Just make sure magnesium is in good supply!
"It is projected that raising the minimum year-around serum 25(OH)D level to 40 to 60 ng/mL (100-150 nmol/L) would prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year, and three fourths of deaths from these diseases in the United States and Canada, based on observational studies combined with a randomized trial." - Vitamin D for cancer prevention: global perspective. Ann Epidemiol. 2009 Jul;19(7):468-83.
I thought that was something to be alarmed about too...I dont have my paperwork at the moment to see the size of the shrinkage, will report back later...
Also, forgot to mention that everythign that happenedn on the 6th was with the PA. I just switched my next appointment time so I can see the Endo herself. I hope that we can come up with a plan after all my bloodwork comes back. Both docs are sharing bloodwork results between them.
Second set of tests came back from endo.
T4, Free = 0.9 Range 0.8-1.8 ng/dL
TSH = 2.02 Range 0.4-4.5 mIU/L
T3, Free = 2.6 Range 2.3-4.2 pg/mL
Everything is showing within range. I'm on week two of the vitamin D. No change yet.
The larger group with ferritin and B12 isn't back yet. Will keep you posted.
my thoughts on that is, we all know the long list of hypo thyroid simptoms there are, can you imagine the money being made by the Pharmisudacles (spelling?) on all those syptoms, for example sleeping pills, colesteral (spelling?) meds, pain meds, water retetion med, the list goes on and on, keep a person hypo and then give them a perscription for there syptoms, and tell them there thyroid is just fine.