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Old 10-27-2008, 10:56 PM   #1
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Recent thyroid labs - thyroid problem, or no?

Hello all,

A while ago I posted several thyroid labs I obtained after seeing an ENT (and later an Endo). My TSH was in the 3.4ish range, and my TPO antibody was around 48, and my TgAB was in the 220s. An ultrasound showed a slightly enlarged thyroid, but no nodules. So... the doctor diagnosed me with Hashimoto's.

I finally was able to just now get my free thyroid levels tested, through my neurologist of all places (odd how some docs are willing to write almost any blood test, while it's a pain to get thyroid tests through endos). But anyway,
the results came back normal. And I mean normal normal... at least they look normal to me.

TSH 1.60 (.27-4.2)
T3: 103 (80-200)
Free T3 2.84 (1.80-4.60)
T4: 9.0 (4.6-12.0)
Free T4: 1.6 (.9-1.8)

So my TSH is certainly a lot better, and is pretty close to optimal. Free T4 looks great to me, definitely not hypo there. Free T3 may be slightly unbalanced in relation to T4? Not sure about that one...

Now, my question for those more knowledgeable about thyroid things than me: can I have a thyroid problem even though this test came back with the above results? Could the raised thyroid antibodies I tested positive for in the past been temporary?

I do have a lot of weird symptoms, and several match Hashimoto's, but it's certainly possible my symptoms have nothing to do with my thyroid at all.

I should also note for the above test I hadn't been sleeping properly for several nights previously, so am not sure if lack of sleep can artificially lower TSH (or does it raise it)? Somewhat odd was also the fact that my total hormone levels pretty much matched my previous tests, where my TSH was around 3.4.

My symptoms preceding this recent test was also a bit unusual, as they seemed more hyper than hypo. I had periods of a fast pulse, shortness of breath, and fatigue several days before this test. My normal symptoms mostly consist of fatigue + lightheadness + throat bothering me + feeling unwell.

Possibilities: My thyroid is fine, and it's something completely different. Adrenal issues perhaps? Maybe Graves and Hashi's at the same time, even though it's rare, (although I think if I had both, the free thyroid levels would be off)? Sleep disturbance/apnea due to thyroiditis?

And any other thyroid related tests worth getting? I am considering asking my family doctor for a Reverse T3, ferritin, magnesium RBC, and DHEA-sulfate. I can't ask her for a full adrenal or hormone range of tests, as she'll never do that, so I have to sorta pick just a handful and hope she'll agree to do them. I do have an appointment in January with an Armour Endo, so hopefully he'll test adrenals and hormones and all of that stuff properly.

Last edited by namelessme; 10-27-2008 at 11:00 PM.

 
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Old 10-28-2008, 06:12 AM   #2
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Re: Recent thyroid labs - thyroid problem, or no?

namelessme;

A while ago I posted several thyroid labs I obtained after seeing an ENT (and later an Endo). My TSH was in the 3.4ish range, and my TPO antibody was around 48, and my TgAB was in the 220s. An ultrasound showed a slightly enlarged thyroid, but no nodules. So... the doctor diagnosed me with Hashimoto's.
The antibodies alone are proof positive of Hashimoto's. The TSH implied you need T4 supplementation at that time as well.

I finally was able to just now get my free thyroid levels tested, through my neurologist of all places (odd how some docs are willing to write almost any blood test, while it's a pain to get thyroid tests through endos).
I do not see this as odd. Hypothyroidism and Hyperthyroidism can cause many neurological side effects. Testing your levels was just a wise precaution. My Neuro loves to run tests on me too.

TSH 1.60 (.27-4.2) This is still above optimal in range. I felt like crud when my TSH was 1.2.. but that is me.

T3: 103 (80-200) This shows you to be 19% of normal range. This is really suboptimal, but there is that 20% error you have to deal with. Let's see what your Ft3 shows.

Free T3 2.84 (1.80-4.60) This shows you are 37% of normal range. Still suboptimal but not as low as the T3 was trying to make you believe.

T4: 9.0 (4.6-12.0) This shows you are 59% of normal range. This is riding the optimal line. But we have to take it with a grain of salt given the 20% error of the test.

Free T4: 1.6 (.9-1.8) This shows 77% of normal. This is a good level. You are right. You are optimal in T4 at the time this test was taken.

There is an imbalance that needs to be addressed. You may be fine just taking a T3 supplement to boost your T3 levels, but first you need to find why your T3 levels are 40% lower than your T4 levels. The two main issues I can think of are hyperadrenal cortisol output OR poor T4 to T3 conversion. Some people make an inactive RT3 form of T3 that the active form our body needs. In these people T3 supplementation is essential. I would recommend an RT3, ACTH, and Cortisol testing scheme next.

Now, my question for those more knowledgeable about thyroid things than me: can I have a thyroid problem even though this test came back with the above results? Could the raised thyroid antibodies I tested positive for in the past been temporary?
Hashimoto's is a permanent condition. Your body is going to kill off your thyroid. The question is how quickly and what can you do about. Proactive treatment of Hashimoto's in the early stages has been known to reduce antibody levels and prolong the function of the thyroid. Hashimoto's is also very tricky to track via blood work until most of your thyroid is dead. Every time you have an antibody attack on your thyroid T4 is dumped from the destroyed thyroid cells and you will get temporary rises in your T4/T3 levels and your TSH will depress. The only way to truly know what your antibodies are doing is to test them again. I was checking mine every 3 months the first year. The higher the antibody levels the more active the Hashimoto's destruction phase.

What vitamin regimes are you taking? Have you had your B12, ferritin, vit D levels checked? Low B12 can effect T4 to T3 conversion. Are you on any steriodal treatments? This can suppress T4 to T3 conversion. Does your multivitamin have Selenium in it? Selenium has been shown to help reduce antibody levels as well.

I should also note for the above test I hadn't been sleeping properly for several nights previously, so am not sure if lack of sleep can artificially lower TSH (or does it raise it)? Somewhat odd was also the fact that my total hormone levels pretty much matched my previous tests, where my TSH was around 3.4.
Improper sleep can effect thyroid levels. Add stress to the picture and things can get worse. There is also the point that you may have been experiencing a mild Hashimoto's flare and your T4 levels were temporarily inflated.

My symptoms preceding this recent test was also a bit unusual, as they seemed more hyper than hypo. I had periods of a fast pulse, shortness of breath, and fatigue several days before this test. My normal symptoms mostly consist of fatigue + lightheadness + throat bothering me + feeling unwell.
This is a classic case of Hashimoto's thyroiditis hormonal flare due to aggressive thyroid attack. Man did I have some rippers. My Adrenals cortisol conversion process went the way of the dodo so I went hyperT in T3 very easily during these periods. You are not converting your T4 to T3 as well as I was... which is a good thing is some regards.

And any other thyroid related tests worth getting? I am considering asking my family doctor for a Reverse T3, ferritin, magnesium RBC, and DHEA-sulfate. Add vit D and B12 to this list, it is a good list. How long ago were your antibody levels checked? It might be worth a recheck to see if your Hashimoto's is kicking it up a notch.

I do have an appointment in January with an Armour Endo, so hopefully he'll test adrenals and hormones and all of that stuff properly.
Make sure this fellow tests your adrenal function. If the RT3 comes back high.. then an adrenal check isn't as warranted. The fatigue would most likely be due to suboptimal T3 levels.

Good luck! It looks like you are still one of us and are slowly working toward your goals.

MG
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Old 10-28-2008, 10:03 AM   #3
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Re: Recent thyroid labs - thyroid problem, or no?

Thanks for the detailed responses. I really appreciate all the info here.

Quote:
Originally Posted by mkgbrook

I finally was able to just now get my free thyroid levels tested, through my neurologist of all places (odd how some docs are willing to write almost any blood test, while it's a pain to get thyroid tests through endos).
I do not see this as odd. Hypothyroidism and Hyperthyroidism can cause many neurological side effects. Testing your levels was just a wise precaution. My Neuro loves to run tests on me too.
By this I meant it is odd how endos make it difficult to get the proper thyroid tests. I guess it was a subtle knock on endos.

Quote:
Originally Posted by mkgbrook
There is an imbalance that needs to be addressed. You may be fine just taking a T3 supplement to boost your T3 levels, but first you need to find why your T3 levels are 40% lower than your T4 levels. The two main issues I can think of are hyperadrenal cortisol output OR poor T4 to T3 conversion. Some people make an inactive RT3 form of T3 that the active form our body needs. In these people T3 supplementation is essential. I would recommend an RT3, ACTH, and Cortisol testing scheme next.
I can pretty much guarantee that she won't give me the ACTH & Cortisol tests, as I asked her to test my adrenals/hormones in the past, and she suggested that an endo should do them. I don't think it's the fact she thinks the tests wouldn't be warranted, but she simply wouldn't know how to read them properly (or know exactly which ones to order). I get that sometimes with docs, when they are ignorant about a certain test... they won't prescribe it, and won't really tell you why, but you can sorta tell they don't even understand the test.

I think I'm going to try going in with a semi-clean slate, not mentioning this recent test to her. Convincing most docs that a person with a TSH in the 1.6 range has a thyroid problem is probably a losing battle. I think my chances are better if I just go in with the 3.4 TSH test, antibodies, and ultrasound report, and see where she goes from there. I probably can get a repeat TSH test, antibodies, and I'll try to throw in the RT3 at the same time, along with maybe some mineral testing (ferritin/mag/selenium) and DHEA-S. I can try for the ACTH + Cortisol, but I'm very doubtful she'll go for it.

Quote:
Originally Posted by mkgbrook
Hashimoto's is a permanent condition. Your body is going to kill off your thyroid. The question is how quickly and what can you do about. Proactive treatment of Hashimoto's in the early stages has been known to reduce antibody levels and prolong the function of the thyroid. Hashimoto's is also very tricky to track via blood work until most of your thyroid is dead.
I've mentioned the studies regarding low dose thyroid hormone treatment in euthyroid hashimoto people to two docs already, and all I get are blank stares in return. The data indicates it's helpful, but unless a doc agrees, I can't do much about that (besides try new doctors). My TPO antibody was retested this time too, and it was lower : 17, using a range of <35. My previous TPO was 48, using a range of <60. And I noticed they used a different lab this time, so perhaps that's why the numbers are different. He didn't retest my TGab, which was the high one. I do sometimes wonder if I even do have Hashimoto's, due to the relatively low TPO. My TGab tested somewhat high, but usually TPO is the high one in Hashi people.

Is it worth getting TSI + TRab tested too, even though those are Grave's antibodies? I ask this, as besides some hyper episodes, as a kid I was diagnosed as borderline Hyper. I know the numbers don't indicate hyper, but what happens if a person has both Graves + Hashi at the same time? Do the numbers sort of level out, yet the person may still have symptoms?

Quote:
Originally Posted by mkgbrook
What vitamin regimes are you taking? Have you had your B12, ferritin, vit D levels checked? Low B12 can effect T4 to T3 conversion. Are you on any steriodal treatments? This can suppress T4 to T3 conversion. Does your multivitamin have Selenium in it? Selenium has been shown to help reduce antibody levels as well.
I'm currently taking fish oil, vitamin D, grape seed extract, plus a multi with selenium. I've had my B12 levels tested in the past, and they came back fine (near optimal). My D levels were a tad low, which is why I am supplementing (I expect they are fine now). My neurologist was actually extremely thorough regarding testing. He tested for a ton of stuff, including Lyme, Sjrogrens (which can raise TGab too), ANA, liver enzymes, hepatitis, etc. The only weird thing that came back from his tests were that my liver enzymes and ANA were slightly elevated. But repeat testing has them normal again.

I also had my selenium serum level tested in the past, and it came back fine. Although I am now wondering if it needs to be a RBC test, like magnesium does. Minerals can be tricky to test via serum... only catch them low if they are super low.

To complicate matters, I do have other health problems too. I use Flovent for asthma, although a medium-dose, so I don't think it's enough to alter thyroid function. I also have cardiomyopathy (idiopathic), which my cardiologist thinks was probably autoimmune in nature. My heart tested pretty much normal though during my last echo, so I don't think it's causing any symptoms. I have to take Coreg (alpha/beta blocker) and Altace (ace inhibitor) for that.

So... I'm basically tired all the time, have weird neurological symptoms, and get odd hyper-like flares on occasion, yet haven't found an exact cause (at least to the satisfaction of any doctors). The symptoms match a thyroid problem pretty well, but I just wish my thyroid tests would cooperate a bit better with that diagnosis. I'm also considering sleep apnea as a potential cause (at least for fatique), although interestingly enough, thyroid problems can cause sleep apnea too.

 
Old 10-28-2008, 11:06 AM   #4
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Re: Recent thyroid labs - thyroid problem, or no?

namelessme;

Thanks for the detailed responses. I really appreciate all the info here.
Your welcome. i am known for lecturing and WTMI. I teach so it is a habit.

By this I meant it is odd how endos make it difficult to get the proper thyroid tests. I guess it was a subtle knock on endos.
I got the knock. I have been through THREE EnDUMs. I haven't found a keeper yet, My thyroid andd endocrine system is treated best by an integrative medicine IM. She is the only one that listened to what my body and EXTENSIVE blood work were telling her. I have a good Neuro, Cardiologist, Immunologist, Dermatologist, Neuro-Opthamologist, MFM, OB, Humm.. I may be missing one. I do not have a good Endo and I have looked in my area and with in 150 miles of my home. It is amazing how good they are at treating diabetes, but given a failing thyroid you might as well be a lepper.

Make sure that you tell your MD you want hormonal and adrenal testing. Don't let them quibble. One would think it would be fine. They get paaid and you get peace of mind. Some of my MDs responded best to the please test X for my peace of mind. Or i will keep coming back until you do.

I think I'm going to try going in with a semi-clean slate, not mentioning this recent test to her. Convincing most docs that a person with a TSH in the 1.6 range has a thyroid problem is probably a losing battle. I think my chances are better if I just go in with the 3.4 TSH test, antibodies, and ultrasound report, and see where she goes from there. I probably can get a repeat TSH test, antibodies, and I'll try to throw in the RT3 at the same time, along with maybe some mineral testing (ferritin/mag/selenium) and DHEA-S. I can try for the ACTH + Cortisol, but I'm very doubtful she'll go for it. Sounds like a good tactic. Go with the highest value and by A A C E standards as far back as 2002.. a 3.4 TSH warrants hyperthyroid and respective supplementation.

I've mentioned the studies regarding low dose thyroid hormone treatment in euthyroid hashimoto people to two docs already, and all I get are blank stares in return. The data indicates it's helpful, but unless a doc agrees, I can't do much about that (besides try new doctors).
Been there done that. I found my Integrative medicine IM and gave her my paper work showing me clear Graves/Hashimoto's. She handed me a script for synthroid and told me to come back in 4 weeks. It has been a ride.

My TPO antibody was retested this time too, and it was lower : 17, using a range of <35. My previous TPO was 48, using a range of <60. And I noticed they used a different lab this time, so perhaps that's why the numbers are different. He didn't retest my TGab, which was the high one. I do sometimes wonder if I even do have Hashimoto's, due to the relatively low TPO. My TGab tested somewhat high, but usually TPO is the high one in Hashi people. Hashimoto's is the presence of TPOAb or TGAb. More patients have both. But some only have one or the other of note. did you start taking your Selenium before or after the first antibody draw? My TPOAbs dropped on Selenium from 1675 to 600. My TGAbs climbed from 286 to 500. It seemed to prime the TGAb based destruction. It is an odd anomolie.

Is it worth getting TSI + TRab tested too, even though those are Grave's antibodies?

I have both Graves and Hashimoto's. So does my mom and one of her four sisters. I have another aunt that is pure Graves and another that is pure Hashimoto's. I will spare you the geneology lecture.. needless to say we are AITD central. Also knowing both is possible it is worth running the TSI and TRAb at least once. Just to be sure and have a baseline value for additional research.

I ask this, as besides some hyper episodes, as a kid I was diagnosed as borderline Hyper. I know the numbers don't indicate hyper, but what happens if a person has both Graves + Hashi at the same time? Do the numbers sort of level out, yet the person may still have symptoms?
are you speaking of antibodies or general thyroid levels. everythign is going to strive for equilibrium. However the nature of AiTDs is to fluctuate. You levels can change from one week to the next. My families levels leveled when part or all of the offending glad was removed not before. I still flux. But I am up to 100 mcgs of T4 so my thyroid is almost dead.

I'm currently taking fish oil, vitamin D, grape seed extract, plus a multi with selenium. I've had my B12 levels tested in the past, and they came back fine (near optimal). My D levels were a tad low, which is why I am supplementing (I expect they are fine now). My neurologist was actually extremely thorough regarding testing. He tested for a ton of stuff, including Lyme, Sjrogrens (which can raise TGab too), ANA, liver enzymes, hepatitis, etc. The only weird thing that came back from his tests were that my liver enzymes and ANA were slightly elevated. But repeat testing has them normal again.

i do not see any supplement that would effect cortisol output or testing. You should be good to go for adrenal testing when you meet your Endo.

I also had my selenium serum level tested in the past, and it came back fine. Although I am now wondering if it needs to be a RBC test, like magnesium does. Minerals can be tricky to test via serum... only catch them low if they are super low.
You are probably good then and can hold off on additional testing here.

To complicate matters, I do have other health problems too. I use Flovent for asthma, although a medium-dose, so I don't think it's enough to alter thyroid function. I also have cardiomyopathy (idiopathic), which my cardiologist thinks was probably autoimmune in nature. My heart tested pretty much normal though during my last echo, so I don't think it's causing any symptoms. I have to take Coreg (alpha/beta blocker) and Altace (ace inhibitor) for that.
These should be alright to take in conjunction with your thyroid and not interfer with testing.

So... I'm basically tired all the time, have weird neurological symptoms, and get odd hyper-like flares on occasion, yet haven't found an exact cause (at least to the satisfaction of any doctors). The symptoms match a thyroid problem pretty well, but I just wish my thyroid tests would cooperate a bit better with that diagnosis. I'm also considering sleep apnea as a potential cause (at least for fatique), although interestingly enough, thyroid problems can cause sleep apnea too. Consulting a sleep specialist is a good idea. Look up symptoms od sleep deprivation and see if they match a set of your symptoms. Most sleep MDs have a decent thyroid base to draw experience from. My sleep specialist is a pulmonologist/IM/Neurologist. I cross check my MD findings with all my MDs. It is nice when they call each other up and bounce ideas off each other. Makes me feel special.

The other things to check on is blood suger/hypoglycemia/insulin resistance and adrenal function. Any of those issues along with low ferritin can cause fatigue and a few other issues.

Keep us posted.
MG
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Old 10-28-2008, 11:41 AM   #5
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Re: Recent thyroid labs - thyroid problem, or no?

Quote:
Originally Posted by mkgbrook

Make sure that you tell your MD you want hormonal and adrenal testing. Don't let them quibble. One would think it would be fine. They get paaid and you get peace of mind. Some of my MDs responded best to the please test X for my peace of mind. Or i will keep coming back until you do.
I expect her argument will be to wait two months and have the endo do it, as he's the expert. Which actually isn't that bad a thing, assuming he actually runs the tests and is a decent doctor.

But she may allow it if I say I want blood tests before I see him, and I'll have the endo interpret. Takes the pressure off of her to treat/figure out what's going on.

Quote:
Originally Posted by mkgbrook
Sounds like a good tactic. Go with the highest value and by A A C E standards as far back as 2002.. a 3.4 TSH warrants hyperthyroid and respective supplementation.
The AACE standards are probably meaningless to most doctors -at least to the doctors I've seen. I mention it anyway, but I think each doc has their own standard they use regardless of the data out there. Most seem to use a TSH of 5, although I've read that some old fashioned docs still even use 10. A TSH of 3.4 tends to just get them to at least somewhat consider a thyroid issue, although as of yet they won't treat me.


Quote:
Originally Posted by mkgbrook
Hashimoto's is the presence of TPOAb or TGAb. More patients have both. But some only have one or the other of note. did you start taking your Selenium before or after the first antibody draw? My TPOAbs dropped on Selenium from 1675 to 600. My TGAbs climbed from 286 to 500. It seemed to prime the TGAb based destruction. It is an odd anomolie.
I was taking the same multi with selenium before and each test, so I don't think it played a role. A TPO of 17 or 48 (depending on which lab you count) is pretty skimpy anyway, isn't it? I mean, would it cause any real symptoms at that level? Most docs won't even consider that antibody level a cause of Hashi's.

My TGab of 220 is the high one, but even that isn't so high. But it's probably high enough to cause some thyroid destruction, I imagine.

Quote:
Originally Posted by mkgbrook
are you speaking of antibodies or general thyroid levels. everythign is going to strive for equilibrium. However the nature of AiTDs is to fluctuate. You levels can change from one week to the next. My families levels leveled when part or all of the offending glad was removed not before. I still flux. But I am up to 100 mcgs of T4 so my thyroid is almost dead.
I guess I am asking if a person has Graves + Hashi's at the same time, can you tell by thyroid hormone testing alone, or can you only tell by antibody testing/symptoms? Just wondering if graves + hashi's sort of levels out the hormones, since they are opposites... yet thyroid destruction still goes on.


Quote:
Originally Posted by mkgbrook
Consulting a sleep specialist is a good idea. Look up symptoms od sleep deprivation and see if they match a set of your symptoms. Most sleep MDs have a decent thyroid base to draw experience from. My sleep specialist is a pulmonologist/IM/Neurologist. I cross check my MD findings with all my MDs. It is nice when they call each other up and bounce ideas off each other. Makes me feel special.
I did have a sleep study done several years ago, which came back as a mild sleep disorder, but it wasn't necessary to use a CPAP at the time (it was optional). I also had my results checked by a pulminologist, who recommended not doing anything at the time.

My main problem with sleep testing is... it's such a pain for me. I have a real hard time sleeping if anything is connected to me. The little pulse meter on my finger alone bothered me. The first night I slept for maybe an hour. The second I was so exhausted I finally fell asleep for about 5 hrs, which was enough to get the study done, at least. But I can't see how I'd possibly be able to use a CPAP machine, and actually fall asleep. It'd be a lot easier if it simply was my thyroid causing a sleep disorder, and treating my thyroid would improve my sleep.

Quote:
Originally Posted by mkgbrook

The other things to check on is blood suger/hypoglycemia/insulin resistance and adrenal function. Any of those issues along with low ferritin can cause fatigue and a few other issues.
My blood sugar is fine. I also had my A1C tested, and that came back decent (4.5). Although oddly enough I have a bit of a triglyceride problem, even though I eat pretty low carb. It was in the high 200s, until I started fish oil, but I can't seem to get it under the 160 range regardless of diet or exercise.

Regarding adrenal testing, is it important to take it very early in the morning? I ask this, as I also have somewhat odd sleeping patterns, and am not sure if it'd throw the test off. I tend to fall asleep late, around 2-3AM, and wake up around 10AM. So if I had to go in at 8AM or earlier to get tested, that may mean waking up around 7AM, with only like 4 hrs of sleep that night.

 
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