These labs came in today, and i was really hoping one of you out there can give me your insight into what they mean.
TSH - 0.8 mU/L...... range 0.38----5.5 mU/L
T3 Free -4.7 pmol/L.... range 3.5-----6.5 pmol/L
T4 Free- 11.0 pmol/L.... range 10.5------20.0 pmol/L
I really feel like cr-p all the time. So many aches and pains. Could these labs be the reason why i do not feel good,sleep good,look good.....
Any information you can arm me with before my next Dr. appt would be great.
It may not be related but my Lp(a) was off the chart at 709 g/L ?
Hi, your FT4 is at 40% of range but your FT3 is only at 5% which is way low and explains your symptoms and your bad cholesterol labs. Are you currently on thyroid hormones? You will probably need an T3 and T4 hormone replacement like natural desiccated thyroid or if you are already on some you definitely need an increase in dose.
Also ask your doc to test your ferritin, vitamin D, B12 and your antibody levels (TPO-Ab and TG-Ab) so you can get the whole picture here. I always recommend testing saliva cortisol levels too.
Thanks so much for your opinions of the latest labs!
Here i thought it was the T4 that was low. My Ferritin was also taken it is 27ug/L and as of May 2009 my last Vit D was 56 nmol/L and i supplement daily with 3000 IU D3, so go figure why it is low. The Hemoglobin was 122 g/l .I have never been on any replacement for thyroid as i have never been diagnosed with any problem. Seems if lab results don't fall out of range there is no further consideration. The Dr. i will be seeing next will definitely consider your interpretation.
What does the TPO-Ab and TG-Ab test for? Can you give a guess at why I'm having these kind of lab results?
Really appreciate your time Javlina
vanmom
Whoops! You are right! I transposed the numbers by mistake-- it's your T4 that's low!!
Too early for me to be doing math obviously
Your Ferritin is very low, needs to be up around 70-90 so you should suppliment iron even if hemoglobin is ok. It's very common for us hypos to be low in D and ferritin. Also get that B12 checked as it's often low too.
I'm not sure why your FT4 is so low compared to FT3 but if you have symptoms you really do need to get your thyroid supplimented. The antibody tests will tell you if you have an autoimmune thyroid disease (Hashimoto's).
Also can you tell me why these thyroids results and my high Lp(a) results have a correlation?
Vanmom
There's a very close correlation between low thyroid and high LDL cholesterol. Long term hypothyroidism is a big risk factor for heart disease, among other things. Many of us also have elevated CRP levels (an inflammatory marker) that also indicates an increased risk for coronary artery disease.
Looking back now my B12 was 412 pmol/L last year, and my CRP was ok i think at 0.3 mg/L. But it is my ugly fat as they call it the Lp(a) that is 709 mg/L
way way too high. So is it safe to say the same correlation between low thyroid and LDL cholesterol exists with the Lp(a) cholesterol and low thyroid?
I will take the iron but as i said my hemoglobin was only 122 g/L and the bottom of the range is 122 g/L so not the greatest.
I will take this along with me on Monday for my Dr. appointment.
Even though your B12 is "in range" it should be well up over 550 (that's the bottom of range for the Japenese standards, far more progressive than ours) and preferably up around 800 or so. I take sublingual 2000 mcg B12 for my low levels.
And yes the correlation between hypothyroid and elevated LDL holds true for Lp(a) too. There are several studies out about this.
Good luck with your doctor, hope you get some treatment soon!
Javelina ~
Can you tell me so I'm clear for my Dr. appointment that with my low TSh and Low Free T4 that i am Hypothyroid? Because I am having ALL the symptoms of Hypo but i have read that i should have an elevated TSH to be considered Hypo, and mine is low? Does having had a positive ANA relate to any of this because they have not found a reason for the positive ANA to date?
Thanks for clearing it up for me.
Vanmom~
The fact that you have both low TSH and low thyroid hormones can point to a pituitary or hypothalamic problem. If these glands aren't working correctly this causes what is called secondary hypothyroidism. Hypopituitarism/ hypothalamus dysfunction can also cause adrenal problems, it depends on which part of the pituitary is being affected. Your doctor should order an appropriate workup with hormone testing and an MRI.
Even if this is secondary in origin, the effect on your thyroid will be hypothyroidism and you need to treat that anyway because it's a very unhealthy state to be in, not matter what its cause. If the origin of the dysfunction is a treatable or reversable issue then your thyroid should be able to perform normally again.
A positive ANA generally points to autoimmune disease and Lupus is the most commonly associated. But I've heard of a lot of people with Hashi's who have pos ANAs as well.
Jav~
Feels like there is a light at the end of the tunnel! Do you mind me asking what you take to treat the Hypo condition and what supplements you find helpful?
~Vanmom
I use natural desiccated thyroid hormones because I feel this is a healthier choice in that they actually replace all the hormones that my thyroid would produce if it were working properly (the thyroid produces T1, T2, T3, T4 and calcitonin). Most doctors like to prescribe a synthetic T4 medication called Synthroid or Levothyroxine. There is also synthetic T3 that can be added. Do some research on all these hormone replacement choices so you can make an informed decision. Not all doctors prescribe natural thyroid hormones so if that is your choice you might have to search for a doctor to prescribe.
I take a liquid mega multi-vit (I have a hard time swallowing the big horse pills that multis come in) that has iodine in it (but mine doesn't have iron since my ferritin leves were somewhat high). I also suppliment with 6000 iu of D3 and 2000 mcg of B12. I take magnesium citrate to bowel tolerance. I avoid soy, goitrogenic foods like raw cuciferous veggies, strawberries, spinach and peanuts, and omega 6 oils.
Sorry - but, your lab results tell me a different story.
Your Free T3 (that's the active hormone your body actually is USING) is around 40% (as stated). That means your body has "enough" of T3 (sure more is better but not a problem at this level) to use. So your glands / organs are making / converting T4 -> T3 just fine.
Your free T4 (from which t3 is made) is low - within limits - but, this is caused by the fact that your TSH is low. In other words, your pituitary is sensing the fact that your blood T3 (fT3) level is OK and informing your thyroid (with low TSH) NOT to make too much more T4 (hence, low T4).
Your TSH is explainable since fT3 is within range....
The PRIMARY hypo sign (first) is a HIGH TSH - meaning the pituitary is screaming at your thyroid to make T4 (and T3) and ...
The SECOND hypo sign is (along with the high TSH) a low t4 AND ft3 (especially) level -- in other words, your pituitary is screaming at your thyroid to MAKE t4/t3 and "it" ... can't.
That is a situation where T4 (possibly even t3) should be supplemented.
Your situation is NOT classic primary hypo - on the contrary - your body has PLENTY t3 and your thyroid is not "overworking" to produce it.
It "could" be a case of secondary hypo (but, barely) - meaning the pituitary is NOT telling the thyroid to produce more - there are specific drugs for that but they are not t4/t3 supplements.
If you take t4 or t4/t3 drugs now - your pituitary will sense elevated ft3 levels and your TSH will drop further. You will inhibit your thyroid completely.
Your condition could be caused by MANY other factors - from adrenals to other hormone deficiencies. I think your doctor needs to further investigate.
Nonetheless, a low TSH and mid level fT3 is NOT a classic hypo situation. Wish I had those numbers !!!
I guess I respectfully disagree with some of what Othello has to say here . First of all, not everyone has elevated TSH who is hypo, in fact millions don't and go undiagnosed as a result (I'm an example of this. My TSH was always mid-range even with screaming hypo symptoms ). So to base any diagnosis (and treatment) of hypothyroidism on TSH levels is not useful for many of us, and in fact has caused much harm.
FT4 being "within limits" is not a helpful indicator for whether or not you are hypo either. Your T4 is scraping bottom and your T3 is just barely at midrange. Many, if not most of us, need our FT4 to be a mid range or in the top third of range and the FT3 to be up at the top or even a little above its range. Everyone has a different setpoint as to where they are at optimal metabolic health with their free T3/T4 levels. As one other poster has said here, it's like expecting a woman to be able to wear all sizes of shoes just by telling her that they are all woman's sizes. One size does not fit all!
Your symptoms are the primary indicator of how you are doing and your symptoms say you are hypo at these current levels. The fact that you have these hypo symptoms says that your body is indeed screaming for more thyroid hormones, yet your TSH is only at .8, which is pretty low, hence pointing to some kind of issue with your pituitary or hypothalamus. It's well worth ruling out in any case. It could be that TSH is simply not a useful test for you and you need to go solely by symptoms and FT3/FT4.
But the point I'm trying to make, and with this I tend to agree with the above poster, is that you need thyroid hormones and you need enough of them to eliminate your symptoms and keep you healthy. Whether or not this shuts down the thyroid is not what's important (the only exception here is if your hypo state is caused by low iodine levels, which is good to check with an iodine loading test, correcting low iodine will often reverse hypothyroidism), the goal is that you have enough T3 and T4 to keep your metabolism working optimally and therefore ward off all the detrimental health effects of being hypothyroid.
Also it's worth noting that if you do have an autoimmune thyroid disease (which can also cause some odd things to happen with your TSH levels) the goal will be to shut down the thyroid and completely replace your thyroid hormones to ward off the antibody attacks. That's why the antibody tests are so important to have and should be part of a good thyroid workup.
I have found more Labs that may help my picture:
Last year July 2008
TSH 0.9 mU/L.............................0.38---5.5 mU/L
I complained of ALL the HYPO symptoms at the time so he followed up with:
T3 4.4 pmol/L...........................3.5----6.5 pmol/L
T4 14.7 pmol/L..........................10.5----20.0 pmol/L
anti-TPO <10 ug/L.........................<35 ug/L
CRP 0.3 mg/L....................................5.0 mg/L
With these Labs he did not treat my thyroid.
This Feb.2009 labs;
DHHEA-S 2.2 umol/L....................Prepubertal <2.6 umol/L
AM Cortisol 450 nmol/L....................140--690 nmol/L
PM Cortisol 227 nmol/L.....................50---300 nmol/L
TSH 0.8 mU/L........................0.38--5.5 mU/L
25 OH Vit D 56 nmol/L.......................25---135 nmol/L
Vit D was 100 nmol/L last year this time and i have been supplementing all along!!
Lp(a) 620 mg/L ...........................<300 mg/L (May 2009 )
Latest Labs OCT 2009
Lp(a) 709 mg/L............................<300 mg/L
TSH 0.8 mU/L............................0.38------5.5 mU/L
T3 Free 4.7 pmol/L..........................3.5-------6.5 pmol/L
T4 Free (DOWN) 11.0 pmol/L.........................10.5------20.0 pmol/L
So here are a few more labs to compare with the addition of the anti-TPO.
I want to have as much information tomorrow so i can be sure i am sent for all the right follow up test to pin this thing down.
I will print this whole thread out tomorrow and let my Dr. read it ALL over.
~Vanmom
This is the "old" dilema - the fact that primary care physicians (and often your endo) will use high TSH levels as the "only" indication of hypo. While "J" is certainly right that MANY hypo cases go undiagnosed - high TSH levels are very often the correct indication of primary HYPO.
Normally docs then prescribe T4 (standard therapy) - this lowers TSH levels and raises fT4 and fT3 levels. Here doctors stop (sometimes) too early - they see levels in the "normal range" and, as a result, some people don't get OPTIMAL treatment.
Newer knowledge says (after taking fT4) that if your fT3 levels are low EVEN IF you have normal or high fT4 levels - than your body is not converting enough T4 into T3. In other words, your thyroid isn't making T3 and your body isn't converting enough T4 into T3.
Thus, you then tell your doctor - my "hypo" symptoms are still here - either put me on the natural hormones that have T3 (Armour etc...) OR on some combo T4 / T3 (cytomel).
This is the idea that "symptoms" beat "normal" test results. So far so good.
But, yours is NOT the case.
Sure your fT4 is LOW - but you don't really care about that since your fT4 is only important in determining if your body has enough of it to make T3 (T4 is NOT active - it isn't "in use" - you don't feel it). If your body has a NORMAL range of fT3 than it can ONLY come from converting T4 or directly made by your thyroid.
"J" is right about secondary hypo - when TSH levels are low - caused by the pituitary ( if caused by the hypothalamus it is then called tertiary hypo) - however, IMO, if your fT3 is at 40% then it is not a pituitary problem - it is either genetic programming OR another issue in the endo system.
Your symptoms can be caused by a lot of different issues - some hormonal - and you cannot automatically ASSUME that it is the thyroid to blame (or that T3 / T4 meds will fix it).
With low TSH levels and normal fT3 levels I doubt your doctor will put you on thyroid hormones. (after reading your latest post I see I guessed right)
Check your kidneys, check cortisol levels, could be sex hormones etc... they're all part of the endo system. I wish it could all be fixed with T3/T4 but there's unknown here.
OOPS - just now saw your latest post -- I don't know your age (can sexual hormone changes/issues be eliminated?) - but my "guess" (based on cortisol and DHEA_S levels) is that your doctor should be looking at possible adrenal fatigue (or adrenal problems in general) being the culprit.
I'm afraid that needs to be taken into consideration. Sexual hormones, adrenal hormones and thyroid hormones all work together.
You need a VERY good endo who specializes in this. I hate to be even slightly negative but the full connection between adrenal hormones, thyroid hormones and sexual hormones is NOT understood fully - any changes in any of these can screw up the rest.
Good luck ! I'll stick with my earlier post that says your problem is not your thyroid or pituitary.
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). So to base any diagnosis (and treatment) of hypothyroidism on TSH levels is not useful for many of us, and in fact has caused much harm. 
