Well here I was reading the neurology boards and I may end up needing all my thyroid sisters as well! I recently went to my endocrinologist for my annual checkup like I always do since I have a couple of tiny nodules that aren't doing much of anything. One is shrinking and the other has slightly increased but they are both well under 1 cm so no need for a biopsy or anything yet. My doctor always runs my blood work while I'm there and I've come back literally perfect for the past 5 years until now.
I work in a medical profession (although not endocrinology) so I can read tests and do my own research but I'm slightly confused by my blood work and would love some other opinions. So here they are!
TSH 1.1 (0.4-4.5) So pretty normal although maybe slightly low in the normal range of things
T3 Free 2.2 (2.3-4.2) So slightly low
T4 Free 0.7 (0.8-1.8) So slightly low again
My Thyroid Peroxidase came in at less than 10 with less than 35 being the reference range and Thyroglobulin is less than 20 with the reference range also being less than 20.
So I talked to the nurse at my doctors office who said that these numbers are significantly lower than my "normal" numbers over the years and that they had them run again and they came out even lower. Unfortunately I was not able to get those "normal" numbers for myself or the second round of numbers. So I'm going back to have my blood retested in a month to see if this was some sort of fluke or whether I'm heading into hypo territory.
Now my true questions, most often hypothyroidism is associated with Hashimoto's which usually causes a spike in thyroid peroxidase and thyroglobulin which obviously I don't have. If anything I'm at the low end of thyroid peroxidase. So now I'm looking at secondary and tertiary causes of hypothyroidism and nothing is really sticking there either. I'm curious as to how common just plain old hypothyroidism is and whether in your opinions I'm heading that way or if maybe this is some weird dip. I have to admit I've been much more tired the past 4 months which is a symptom but I've also started grad school too, although I'm not exactly stressed by it. It's a lot of work but I'm doing well and I haven't been depressed by any means. And my TSH number is normal albeit the lower end of normal.
Your TSH is actually "perfect." Average TSH for healthy people is 1.2 (or between 1 and 1.5), so you are not low at all.
Your Free T's on the other hand are extremely low, especially for how normal looking your TSH is. Based on the fact that you have thyroid nodules, I would think that central hypothyroidism is less likely than primary/ autoimmune hypothyroidism. In central hypothyroidism, I believe the thyroid is usually healthy and the problem lies with the feedback from the pituitary/ hypothalamus.
Did they check you for any other antibodies? I would think checking for TR ab (thyroid receptor antibodies) or TSI antibodies might be a good idea, even though you are not hyperthyroid. My understanding is that poor adrenal function can also contribute to a low/normal TSH with low thyroid hormones.
Last edited by bee01; 05-31-2012 at 11:29 AM.
The Following User Says Thank You to bee01 For This Useful Post: TremoringFun (05-31-2012)
Yes your levels are a little bit below the range, BUT considering the fact that healthy people will have their levels at least midrange, than your levels show pretty hypo and consequently causing symptoms.
the levels tested the years before might be an indication of what your optimal levels are (at least if those still really were good and your normal healhty thyroid production)
Hashimoto can occur without antibodies being present. (with is much more common of course)
The Following User Says Thank You to lisa789 For This Useful Post: TremoringFun (05-31-2012)
I have all my blood work and I wasn't tested for any of the other antibodies. I assume because my blood work had been normal for so long. My doctor is mailing me my prescription to get my next run of blood work done so I'll see what I'm being test for at that point.
If I'm hypo I can't wait to go through the ups and downs of getting my meds correct!
Please know that "plain old hypothyroidism" is most often caused by Hashi's. It wasn't until antibody tests were invented that anyone knew this. And, even though most cases of thyroid disease are autoimmune in nature, not everyone will test positive for the antibodies.
Thyroid status is always confirmed by looking at the actual thyroid hormone levels - FreeT4 and FreeT3 and not pituitary hormone TSH.
Both of your FreeT4/T3 levels are below-range so, without a doubt, you are hypothyroid.
Just because your TSH is "normal" doesn't mean you don't have *some* type of antibody skewing it.
At the end of the day, antibodies or not, "normal" TSH or not, there isn't a single healthy person that would have FreeT4/T3 levels such as yours.
The fact that your levels have moved lower over the years is common with hypothyroid people. In fact, it's because many doctors erroneously look at TSH that they fail to diagnose people who have been suffering with hypothyroidism for years. There are countless stories about this within current threads and in the personal stories section here.
I would surely hope that *some* doctor recognizes your below-range thyroid hormone levels and starts you on treatment now.....you really do not need additional bloodwork until after you've been taking a starter dose of thyroid hormone replacement for 6 wks.
Thanks for your reply! My numbers actually haven't been going down, they've been roughly the same for years so that's why my drop this year was rather unexpected. If it was just a continual decline I wouldn't be surprised at all. I even had blood drawn in November to check my Vitamin D and it was normal then too. (My doctor always checks TSH and Free Ts when I have blood drawn regardless, apparently she is in the minority!) Anyway, I'm curious to see how it all shakes out. Other than being more tired than usual, which can certainly be expected with my schedule, I really haven't had any other problems that are typical in hypothyroid patients.
Have you done any sleuthing in your family to determine if your parents, siblings or close relations have hypothyroidism? Also you would want to see if there is the presence of autoimmune illnesses as I have read that while some family members may have hashimoto's hypo, others may have other AI issues.
This information may help you determine what you are dealing with.
If this is the first/only time you have had your tpo antibodies tested, maybe you could request that this be done a second time. Who knows, maybe there was an error?
I'm definitely going to get copies of my old labs. I used to have them but since they always came back normal I didn't keep them. Honestly though I really haven't had any of the symptoms that you've listed which makes me wonder if this was just a bad blood draw. Actually, I'm always cold but I've been that way for as long as I can remember!
As for any family members with hypothyroidism, if I am officially diagnosed, I'll be the only one! Fortunately, my family is actually really healthy other than our goofy hereditary tremor. Everyone (on both sides of my family literally!) lives to about 89 or 90, then has a big heart attack or stroke and that's it. Not even high cholesterol runs in my family!
I got my lab prescription and my doc is retesting TSH, Free T3 and T4 as well as Total T3 and T4. She's also re-running my CBC Panel which came back normal last time.
I also received my 2nd set of numbers when they re-ran my original labwork. TSH was unchanged at 1.1. Free T3 came in at 2.1 (2.2 originally) and Free T4 came in at 0.7 again. My T3 Free Tracer Dialysis (which I believe is just Total T3, please correct me if I'm wrong!) came in at 148 (Range 210-440 pg/dL).
The dialysis method removes any possible inteferences so, it makes sense that results would be lower.
Both sets of results were very hypo.
If you have similar with this next set of labs, you would surely benefit from treatment.
Even though you don't have many of the symptoms of hypothyroidism, this doesn't mean that things aren't going on "behind the scenes" such as absorption issues, possible increases in cholesterol/glucose levels, cardiac damage, fertility issues, etc.