My daughters test results advice plz

[astunally12]

Hi all,
I have Hashimotos so I advised my 2 daughters to have their thyroids checked as well , these are their results , I would be grateful for any input ,

(1)
FT3  4.71         range 2.8 - 7.1
FT4  14.0         range 13 - 23
TSH 1.66         range  0.27 - 4.2

(2) This daughter also has PCOS
FT3 6.20      range 2.8 - 7.1
FT4 16.0      range 13 - 23
TSH 2.42     range  0.27 - 4.2

they are not on any medication at all .
Thank you
San.


(I did have an account here but couldnt get into it so opened up another one).

[Barb135]

Yes, many doctors only look at TSH, but that's not because it works; it's because, that's what they were taught to do, in medical school.  

[gimel]

Just because so many doctors use it doesn't mean it is the right way.  It is still being used because they were told that in med school and haven't been told differently by the professional thyroid organizations like the AACE and the ATA, although the Guidelines published by those organizations leaves the door wide open by saying that "a guideline is not intended to take the place of physician judgment in diagnosing and treatment of particular patients."  Also they go on to say, "We encourage medical professionals to use this information in conjunction with their best clinical judgment."  

Unfortunately most doctors don't get beyond TSH and a Free T4 test compared to erroneous ranges.  It if were really as easy as that it could be done far more effectively by a computer.  Why would a doctor be needed to look at a TSH and a FT4 test and comparing to reference ranges?  This current approach is quick and easy and gets the patient out of the doctor's office fast, so they can get to the next paying patient.  

I can give you all kinds of links to scientific information that dispels using TSH and FT4 as the only diagnostics for hypothyroid patients.  You really should read through the scientific evidence so we can stop wasting our time on this subject and use it to better respond to members.  

[des900]

If treatment based on TSH value not work for most people why then its used by most doctors? TSH is still the gold standard both for diagnosing and treating. It work for some and for some it not.

[gimel]

No, looking at TSH doesn't work for most people.  The answer to people having doctors who don't understand how to adequately test and treat hypothyroidism is not to give incorrect info to the patient, but to give them the right information so they can relate to the doctor and try to get tested and treated correctly.  If the doctor refuses, then the patient should find a good thyroid doctor that will test and treat correctly.  

No, you are also wrong about Armour Thyroid and Cytomel.  People with heart problems and normal thyroid function obviously tolerate Free T3 in their body.  If instead they happened to be hypothyroid they can also tolerate normal T3 levels, adequate to bring them to euthyroidism.  The only concern with T3 would be excessive dosage.   If hypothyroid patients need T3 then not providing it can lead to other severe issues.  Doctors stick with Levothyroxine because because they have incorrectly been trained to think that T4 always converts to T3 as needed.  That has been proven wrong in many sscientific studies.  You are not helping  hypothyroid patients by saying  "levothyroxine therapy is good and desired tsh in between 1 and 2". That is very misleading, and incorrect.  

[des900]

Here is a thread giving a typical example of above case

http://www.medhelp.org/posts/Thyroid-Disorders/Please-help-me-Doctors-stumped-High-TSH-and-HIGH-T4/show/1670622

Armour thyroid or desiccated ones and T3 only drug like cytomel might the treatment some may say but its risky for people who have heart and other organ problems and thus most doctors stick with levothyroxine only and in such cases how to solve?

[des900]

Yes but most doctors only look at TSH values and that's because it works for most people but exceptions there and such people going to suffer if went to such doctors.

Its true that free T4 should be bought around 50% in reference range and free T3 around 75% for good result but how can that be achieved? Levothyroxine is still the standard medication for under active thyroid gland which only have T4 and the result in most people is high Free T4 and low Free T3 though their TSH come down but symptoms often worsens due to low Free T3 may be because of high reverse T3 due to excess Free T4 in system and most doctors are silent on this issue.

[Barb135]

There is no standard guideline for TSH levels... TSH is a pituitary hormone, not a thyroid hormone.  It's only function is to stimulate the thyroid to produce thyroid hormones.  It neither causes nor alleviates symptoms and can vary by as much as 75% over the course of a single day.  Trying to keep TSH at a certain level is like shooting a moving target.

For best results, try to keep Free T4 about the mid point of its range and Free T3 in the upper half of its range.  Some people will need a little bit different levels of Free T4 and Free T3, but these are good guidelines to target until one finds the right levels for themselves.

[des900]

yes that would be nice if some doctor willing to prescribe. also make sure their vitamin d, b12 in optimal ranges. bringing tsh in between 1 and 2 is the standard guideline.

low vitamin d and b12 can bring lot of symptoms and also most doctors miss it.

[astunally12]

Thank you for the advice,
Hard to find a good doctor here at present , each one I have gone to only ask for TSH or FT4 at best and dont ask about symptoms .
Daughter 1 TSH is not very high but FT4 and 3 are low , wonder if she should start with 25mg and work up .
Will try a new doctor if available.

[gimel]

TSH is a pituitary hormone that does not even correlate well with the biologically active thyroid hormones, Free T4 and Free T3.  It does not correlate well at all with tissue thyroid effects, including symptoms.  Note  this link to a scientific study which concluded that "We found no correlations between the different parameters of target tissues and serum TSH.......Therefore, the biological effects of thyroid hormones at the peripheral tissues- and not TSH concentrations- reflect the clinical severity of hypothyroidism."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC143526/

There are so many variables between TSH and tissue thyroid effects that it is a foregone conclusion that there will be no significant correlation between the two, and the above study, and many others, verify that.  Therefore, suggesting that the TSH level should be brought under 2 to prevent straining a weak thyroid gland is erroneous information.  

[des900]

welcome

[des900]

check for vitamin d, b12 deficiencies. and then correct appropriately. vitamin d optimal range 50 - 70 while b12 above 500.

vitamin d deficiency is suspected if the individual stays in indoors most of the time. defeciencies develop over time and most doctors miss it so testing it on a private lab is best.

also concerning thyroid the average tsh value for normal thyroid function individuals is around 1.5 so levothyroxine therapy is good and desired tsh in between 1 and 2. see a good endocrinologist doctor and start therapy under prescription.

[astunally12]

thank you very much :)

[gimel]

With Hashi's being somewhat hereditary, it would be good info to have, but i would only test for TPO ab.  TG ab becomes necessary only if TPO ab is negative and the TSH is high.

[gimel]

For daughter 1 I could support starting her on T4 med and gradually increasing as needed to get her level to the middle of the range, at minimum, and Free T3 into the upper third of the range.  

Along with that both daughters should be tested for Vitamin D and ferritin.  D should be 55 min, and ferritin should be 70 min.  Adequate ferritin is also important for hair growth.  If at all possible, I would suggest getting those tested along with a morning serum cortisol test.  

For your second daughter, it is not as clear cut because of the PCOS, which may also be a cause for the weight problem; however, I think the relatively low Free T4 suggests that a therapeutic trial would be worthwhile.  If there is no apparent benefit, then there would be no ill effects to weaning off whatever dosage of T4 she gets to as a trial.  

All of this should be discussed with their doctor, of course.    

[astunally12]

Thank you very much for your input , much appreciated .

[astunally12]

Do you also think they should test for Hashimotos ? as I have it as well ?

[gimel]

As you know, tissue thyroid effects, which relate to symptoms, are affected by many things other than just Free T3 and Free T4.  So a more in-depth assessment should start with symptoms, if you will tell us about those, for each daughter.  

Just looking at the lab results only, TSH really indicates nothing for them.  Daughter 1 has low FT4, at only 10% of the range.  Her FT3 is at 44%, which is lower than many people find best for them.  It appears that her body is converting extra T4 in an effort to satisfy the need for FT3.  Most doctors will look mostly at the TSH and the FT4 and FT3 being somewhere within the range and tell her she is fine.  But it should be dependent on whether she has symptoms or not.

Daughter 2 is similar, but her levels are both higher in the range.  FT4 is at 30%, FT3 is at 80% of their ranges.  Does she have any symptoms?

[astunally12]

Hi, thank you for your reply,

They both have put on weight and find it very hard to shift , daughter (2) also has PCOS which makes it hard for her to loss weight. She also hardly ever has a monthly period .

Daughter (1) hair has been thinning as well. Very moody both of them but then that could be put down to where we are living as the life here is very unstable. (Libya)

They have both joined a gym now to try and loss the weight and have been eating healthy and adding a few supplements for hair and POCS condition.

I was wondering if they need to start on T4 meds as theirs are so low ?

best regards
San