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Old 05-21-2013, 05:37 PM   #1
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T3 & T4 normal but high TSH with antibodies present

First post here. I recently had my thyroid tested because I was having symptoms like not sleeping through the night, low sex drive, tiredness, and mood swings. I'm actually on hormone replacement therapy (BHRT) for low T, but starting to think my symptoms could be related to or caused by hypothyroidism.

Here are my labs:

TSH: 3.62 (0.45-4.5 uIU/mL)
Free T3: 3.2 (2.0-4.4 pg/ml)
Free T4: 1.23 (0.82-1.77 ng/dl)
Reverse T3: 22.2 (9.2-24.1 ng/dl)

I got suspicious of the high but "in range" TSH level. I've read that TSH should be close to 1.0. I also see my Reverse T3 is high, which may be blocking the effects of free T3.

So I ordered my own thyroid autoimmune panel to determine if I have Hashimoto's. Here are the results:

TPO: 5 IU/ml (0-34)
TgAB: 27 IU/ml (0-40)

I'm not sure how to interpret these results. From what I understand, these are autoimmune antibodies that attack the thyroid, and are not supposed to be in my bloodstream. The TPO seems pretty low, but still detectable. TgAB is higher in the range, but not over the top. Is this still a problem?

Last edited by moderator2; 05-21-2013 at 05:40 PM. Reason: please do not post a commercial website for any reason

 
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Old 05-22-2013, 10:22 AM   #2
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Re: T3 & T4 normal but high TSH with antibodies present

It's not unusual for perfectly healthy people to have miniscule titers of thyroid antibodies, but a high-"normal" titer such as your TgAB is very likely not entirely normal in the presence of TSH above 2 and symptoms. Your free T4 is slightly below lab median, which is too low and could account for at least some symptoms for most people.

You'll have a hard time convincing a mainstream doctor that your thyroid isn't up to snuff, but a particularly thyroid-savvy one might agree to at least a trial treatment.
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Old 05-23-2013, 06:18 AM   #3
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Re: T3 & T4 normal but high TSH with antibodies present

Thanks for responding, much appreciated!

So, it isn't hashi's, but it's not normal either, yet most doctors out there will just dismiss my concerns. Ok, what should I do about it? Would OTC supplements like iodine and selenium help, or am I in need of actual thyroid hormone?

 
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Old 05-23-2013, 08:49 AM   #4
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Re: T3 & T4 normal but high TSH with antibodies present

No, I didn't say it wasn't Hashi's. It very likely could be. The antibody tests are only so accurate, though. They might be false-negative up to 20% of the time. It also could be that your antibodies were less active on the day of this test; they tend to wax and wane over time.

Doctors are taught to dismiss anyone with TSH that's within range. Many dismiss anyone with TSH less than 10, even though ranges are far narrower than that. And they're taught that TSH is more important than low T4/T3, which is untrue. TSH, as a pituitary hormone, is only an indirect measure of thyroid status. When thyroid hormones can be easily and directly measured, it makes absolutely no sense to consider a hormone from another gland as most important. It's like trying to judge when to fill your gas tank by looking at your mileage gauge!

If it's Hashi's, iodine is unlikely to help and may make things worse. It's been hypothesized that iodine overload may contribute to the autoimmune response that causes Hashi's. And people with the disorder report that they're symptoms worsen when they try supplementing with it.

Selenium can help reduce TPO antibodies by up to 40%, but IMO, that only slows down the progression... Doesn't stop it. Se won't do anything for Tg antibodies.
One thing it can help with is the conversion of T4 to T3. If T3 is low, that could be useful. New evidence is showing that Se is useful for other things, though... perhaps prevention of certain cancers, etc. Since food sources are few, a reasonable daily dose not to exceed 200 mcgs may be useful.

When the thyroid gland can no longer keep up with the body's needs and symptoms start showing up, just about the only way to fix that is with a prescription for hormone. But for the reasons I mentioned, it can be tough to find a thyroid-savvy doctor to help. Ones who practice with a holistic or naturopathic approach are usually better at it than the average PCP or internist.
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Old 05-23-2013, 09:28 AM   #5
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Re: T3 & T4 normal but high TSH with antibodies present

Interesting. I should say that when I had my antibody labs done, I had been supplementing with iodine and selenium for a little over a week. So maybe my TPO was a little higher even, and the Se could have knocked it back down a little bit.

I assume you know about waking basal body temps? My average waking temp is 97.9, and I'm trying to get it up to 98.2 or higher. So I am taking iodine for that reason. So far, my body temps have not budged one iota. Iodine has not made me feel worse, but it has not made me feel better, either. I did feel a little throat / neck soreness, however... not a cold/flu sore throat, but a different kind of mild soreness that comes and goes (hard to explain).

Let me back up a little, and explain how I got here. I have been taking testosterone therapy due to low T, and I discovered that hypothyroidism symptoms are almost identical to symptoms of low testosterone. I also learned that patients who are hypothyroid have difficulties absorbing testosterone cream / gel through the skin. So I wanted to try to fix my thyroid so that it can help me absorb the testosterone cream, and support the demands of increased testosterone in my body.

I seem to be a marginal case. When I read other threads by other people with obvious hypothyroidism or hashi's, their symptoms seem to be worse than mine. Sometimes a lot worse.

Any advice on how to find a good thyroid doctor or a holistic/naturopath? Do holistic naturopaths take insurance?

 
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Old 08-29-2013, 01:50 PM   #6
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Re: T3 & T4 normal but high TSH with antibodies present

Hi all,

Back after 3 months. My doctor tested my TSH again, and it had gone up to 4.6. Last time it was 3.6 in May.

The lab's reference range is 0.4-4.5, and my doctor is saying that he wants to do a full thyroid panel, cholesterol panel, among other hormone tests next month. He also assigned me the task of recording my basal body temperatures upon waking every morning for a month.

He said if the thyroid tests come back with a problem or my body temps are too low, he may start me on thyroid hormone medication.

What do you think? Again, for context, I don't currently take thyroid meds or have extreme symptoms other than feeling a little cold or a little fatigue.

Last edited by trekbiker; 08-29-2013 at 01:54 PM.

 
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Old 08-29-2013, 03:02 PM   #7
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Re: T3 & T4 normal but high TSH with antibodies present

Your TSH is high and you very likely likely have "Hashi's". I find what you said very interesting because my husband tested low testosterone and positive Hashimoto's at about the same time. He tried 2 different testosterone gels and they weren't really changing his levels. He now gets the injections every 2 weeks and he is happy with that. His thyroid levels seem to be pretty good now too. He is a big mountain and road biker and from the name "trekbiker" it looks like you also have that in common. I think you will find that when you get your thyroid levels optimized you will feel so much better and maybe you might like to try the injections. It was such a surprise for him and he is now happier than he has been in years! Good luck!

 
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Old 08-30-2013, 07:55 AM   #8
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Re: T3 & T4 normal but high TSH with antibodies present

jlajet, funny you should say your husband is a road/mountain biker, has low T and is on TRT, and has hypothyroidism. You sure you're not my wife?

Anyway, I'm not totally convinced that I have Hashi's... my anti-thyroid antibodies are low enough to be in range, and I have minimal symptoms. The thing is though, I've found that symptoms of low T and hypothyroidism are virtually identical.

I may move to injections next month if my T levels or my body temps don't move up to where my doc wants them to be. My current morning temps are in the 97.2-97.5 range, and I hear they should be at least 97.8 or higher.

Don't people with Hashi's have unstable temps with all the swings between hypo and hyper?

Last edited by trekbiker; 08-30-2013 at 07:57 AM.

 
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