Understanding test results

[momof2beauts]

Just received these results online of my 20 year old daughter's thyroid tests that were performed on her yesterday evening. I'm sure we will be getting a call from the doctor tomorrow. I just wanted to see if someone could explain them to me.  Thanks in advance. :)
T4: 138 ng/dl
TSH 7.440 UI
TPO 178 IU/ML
Thyroglobulin Antibody 38.0/IU/ML

[Barb135]

What are the units for the reference range on the FT4?  The numbers don't match the result or should the result be 1.38 instead of 138? There's a big difference.

Thyroid disease (and autoimmune conditions in general) tends to run in families, though not every member of the same family will get the same thyroid condition, or even the same autoimmune condition... Also, once a person has one autoimmune, the chances are greater that they will get another or more...

[momof2beauts]

1.38 ng/dL I'm sorry. We have yet to hear from her doctor as he is out of town until next week. She feels awful though.  

[Barb135]

The elevated TPOab confirms Hashimoto's...

Okay, so your daughter has been hypo for years... How long has she been on the 150 mcg of Synthroid?  Her symptoms are certainly those of being hypo...

Do you not have access to the reference range for the T4 test, then, if you can't access it online?  Can you call the doctor's office and ask?  Or even the lab that performed the test?  Reference ranges vary lab to lab, so we need to know the range used by her lab in order to know where her result falls within that range.  

[momof2beauts]

Thank you Barb135 for all the info you have provided to me. I was able to get her T4 FREE (NORMAL RANGE: 0.61 - 1.12). She's been on the 150mcg for 2 months now. We have a history of thyroid disease in our family. I have it, my Mother, sister, and my paternal grandfather have it.  

[momof2beauts]

Well it looks like I gave you the range but not the actual results for her T4 Free. It was 138 ng/dl (NORMAL RANGE: 0.61 - 1.12).  

[gimel]

Your daughter's test results show a high TSH that then triggered a test for the antibodies of the most common cause for diagnosed hypothyroidism, which is Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously identifies the thyroid gland as foreign to the body and produces antibodies to attack and eventually destroy the gland.  As this proceeds the output of the gland is diminished and results in lower amounts of T4 and T3 which causes the TSH to rise in an effort to stimulate more output from the gland.  Instead of the Total T4 test that was done, she should be tested for the biologically active thyroid hormones, Free T4 and Free T3.  Typically when TSH is the range, then Free T4 and free t3 will be in the lower part of their ranges.  Sometimes doctors will interpret this as being adequate; however, the most important consideration is whether she is having hypothyroid symptoms.  If she is then she needs to be started on thyroid med and then re-tested and dosage adjusted as needed to relieve symptoms.  Symptom relief should be all important, not just test results.  You can get some good insight from this link written by a good thyroid doctor.  
http://www.hormonerestoration.com/Thyroid.html

The most important thing for your doctor is to find a good thyroid doctor.  By that I mean one that will treat clinically by testing and adjusting Free T4 And Free T3 levels as needed to  relieve symptoms.

[momof2beauts]

She's been taking 150 mg of synthroid. She's had thyroidism since she was 12 it's just that she's recently been feeling fatigue, memory issues, significant hair loss, and a few other symptoms.

[Barb135]

What are the reference ranges for the T4 and TPO and TgAb?  Is the T4 Free T4 or is it Total T4?  If the report doesn't specify Free T4, it's Total, which is considered obsolete and not terribly useful, but we'll make do with it...

Also the TPO... is that really just TPO or is it TPOab, which is another antibody test?  

Sorry to answer your question with more questions...  

[momof2beauts]

Thyroid Peroxidase (TPO) Ab (NORMAL RANGE: 0-34)Thyroglobulin Antibody (NORMAL RANGE: 0.0-0.9) For some reason the other results I posted are not available online.  

[Barb135]

Her symptoms are all those of being hypo... Can you get one of her doctors to order another set of tests to include, both Free T4 and Free T3?  

It looks like she might not converting Free T4 to the active Free T3, but it's impossible to tell, without a Free T3 test and they really need to be run together...

Why is your daughter seeing a rheumatologist?

[momof2beauts]

She has hypermobility joint syndrome, and fibromyalgia.

[momof2beauts]

She has hypermobility joint syndrome, and fibromyalgia.Barb you mentioned that it could be that's she overmedicated. How could that be when her TSH is low?  

[Barb135]

Your daughter's FT4 is over the reference range, indicating that she may be over medicated, even though her TSH is higher than normal.  

In what way does she "feel awful", i.e. what symptoms is she having?

[momof2beauts]

Well, shes losing her hair which she's freaking out about. She says her skin is sore, she has muscle pain, slurred speech,memory issues, fatigue, tingling, her tongue is swelled, and she stays cold. This has been going on for several weeks, and we have taken her to our family doctor who normally treats her for her thyroid, her rheumatologist who also helps monitor her thyroid, and her gynocologist who keeps an eye on it as well. The family doctor says he wants her to go to endocrinologist, but their schedule is backed up and the first available appointment is in February. I'm terrified that something is going to happen to her because of the way shes feeling.