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Old 03-19-2013, 06:36 PM   #1
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Help with test results?

Hi I'm new. I was wondering if somebody could explain about TSH and T4 and T3 to me. A little history first: I haven't been feeling well for about two years and I've seen a couple neurologists before speaking to my endocrinologist. Basically I have severe temperature intolerance where I'll get goosebumps and chills that are actually painful during the slightest temperature decrease. I'm also intolerant of heat. I get what I'd describe as a hot flash although I'm not really sure, my skin gets quite hot and a burning sensation is felt all over. I have night sweats too. I've also been fatigued and find it hard to get out of bed, but with intermittent attacks of anxiety and racing heart too. I don't know if this is thyroid related, or I just have a thyroid problem on top of something else, or perhaps my thyroid is OK. I have routine test results from September which only tested TSH and it was at 1.8. Then in January is was 3. Three weeks ago is when I saw the endo and TSH was at 4.6 with Total T4 at 11.6, Free T4 at 4.2, Total T3 at 146 and T3 Uptake at 36%. I thought these were pretty normal results. My endo did order a re-test in four weeks with Thyroid peroxidase antibody and Thyroid stimulating immunoglobulin also being tested. Since she is testing the antibody's I guess she thinks the results were abnormal. My questions are what diseases are associated with a fluctuating TSH like that? Also, what is associated with a high TSH and a high T4/T3, I thought they usually had an inverse relationship? From reading I see many people have symptoms at levels within the range. Is this true only for somebody who is already on medication and trying to stabilize or can that apply to a "healthy" individual? Thanks for reading.

 
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Old 03-19-2013, 08:52 PM   #2
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Re: Help with test results?

I'm pretty new to all this Thyroid stuff so others might have some better and additional information, but I will share what little bit I do know.

If you can try to post lab ranges :-)

Your correct that they should have an inverse results. High TSH -Low T4; Low TSH - High T4. My daughter is like you and presents with Elevated TT4, FT4, and FT3 along with non surpressed TSH .

Yes have your Dr. check for antibodies, that might be the answer. You also might want to check if they can run your FT4 via direct dialysis. This gives the actually value of FT4, and is supposed to be a more accurate measurement.

Other causes for this pattern are Thyroid Hormone Resistance. Or a secreting pituitary adenoma (both of these conditions are rare).

Sounds like you have a good Dr. who is willing to listen!!

 
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Old 03-20-2013, 01:39 PM   #3
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Re: Help with test results?

Thanks for the response, I'll be sure to post lab ranges from now on. Was your daughter diagnosed?

 
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Old 03-20-2013, 02:09 PM   #4
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Re: Help with test results?

No we have not had any luck getting answers for my daughter. Doctors want to just call her numbers "normal" for her, and say stop blaming her thyroid for her symptoms. Her age complicates everything it's VERY difficult even finding a Dr. that will see her. I just keep researching information hoping to find the needle in the haystack that will help get us some answers.

Best of luck to you!! Keep us posted on what you find out.

:-)

 
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Old 03-21-2013, 09:59 AM   #5
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Re: Help with test results?

The best tests for diagnosis haven't been done. From what I can tell... (posts written without paragraphs are hard for me to wade through)... It was TSH and a free T4 index, which is totally inaccurate and meaningless. Better to have direct free T4 measurement, which is the most accurate.

TSH can swing up to 3 full points in a day's time. [It probably isn't that severe for most people, but it's theoretically possible.] It's generally highest in the morning and falls during the daylight hours until about 9 p.m. So the time of day when the blood is drawn for the test matters. If some draws were taken early in the day and others later, that might cause the flux you've seen. Also, the autoimmune disease (Hashimoto's thyroiditis) that causes most cases of low thyroid can cause big TSH swings. Antibody tests for both TPO and Tg can reveal most, but not all, cases of Hashimoto's.

Hope that answers your question and that you'll get the diagnosis (and correct tests) that you need!
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Last edited by midwest1; 03-21-2013 at 10:02 AM.

 
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Old 03-22-2013, 08:26 PM   #6
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Re: Help with test results?

Is TSH only useful in comparison to FT levels to help a diagnosis? For example if a person had very high TSH but normal FT levels, no symptoms, and nothing else could be found wrong, would it simply be deemed benign? In other words TSH can cause no symptoms in and of itself can it?

 
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Old 03-22-2013, 09:19 PM   #7
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Re: Help with test results?

Someone else could confirm this, but no, TSH alone should be nothing more than a messenger from the pituitary gland to the thyroid gland. Unlike other hormones (like T4 / T3) Having too much TSH or having no TSH at all should not cause any symptoms on its own.

However, if someone had high TSH and normal (not just "in range") FT4 and FT3, I'd say there might be a problem somewhere: Why does the pituitary produce so much TSH, and why doesn't the thyroid responds to that TSH (with high TSH your thyroid should produce more T4).

Someone could also fall outside of the bell curve used for determining the normal range. Simply put, some people might be born to operate on higher than normal TSH and be perfectly fine with that.

Still, high TSH suggests hypoT, unless FT4 and FT3 are pretty high as well.

 
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Old 03-23-2013, 03:57 PM   #8
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Re: Help with test results?

Quote:
Originally Posted by light472 View Post
Still, high TSH suggests hypoT, unless FT4 and FT3 are pretty high as well.
Mostly correct.

It's possible that high TSH, and high FT4/T3 is due to a genetic condition, thyroid resistance. The receptors for thyroid don't function as well, thus the body needs more, often a lot more thyroid hormone. What I read it's rare, but... 10-20,000 people in the US have it.

Also on another message board somewhere I read about human anti-mouse antibody, that can mess with TSH results, making them seem very high, yet with normal T4/T3. Apparently this is very common. Another good reason to test for FT4/FT3.

 
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