Aa
Hypothyroid - Lab Opinions
Hi there, 2nd post but looking for some more insight on labwork from the generous contributors here.
TSH normal. Highly symptomatic. Note low (but normal) Free T4. Conflicting doctor opinions. Hypo? Normal? Any input? Thanks in advance.
TSH 1.09 (lowest in 13 years per available bloodwork, but never higher than 2.5)
Free T4 .9 range .8-1.8 nj/dL
Free T3 2.9 range 2.3-4.2 pg/mL
Total T3 101 range 76-181 ng/dL
T3 uptake 29 range 22-35%
Total T4 5.6 range 4.5-12 mcg/dL
Free T4 Index (t7) 1.6 range 1.4-3.8
IGF I, LC/MS 207 range 53-331 ng/mL
Total Cortisol 6.5 (no range noted on Quest paperwork) [Once had a 3.5 AM cortisol serum when range should have been 8-12 at that early time of day; dismissed by previous private practice endo as a fluke]
LDL Cholesterol in range at 118 (under 130 recommended)
Hemoglobin A1c 5.6
THYROID PEROXIDASE AND THYROGLOBULIN ANTIBODIES
THYROGLOBULIN ANTIBODIES <1 range: < or = 1 IU/mL
THYROID PEROXIDASE ANTIBODIES <1 range: <9 IU/mL
***Internist also ordered a thyroid ultrasound. Found a 4 mm nodule without calcification on right plus enlarged 27 mm lymph node on left side.***
TSH normal. Highly symptomatic. Note low (but normal) Free T4. Conflicting doctor opinions. Hypo? Normal? Any input? Thanks in advance.
TSH 1.09 (lowest in 13 years per available bloodwork, but never higher than 2.5)
Free T4 .9 range .8-1.8 nj/dL
Free T3 2.9 range 2.3-4.2 pg/mL
Total T3 101 range 76-181 ng/dL
T3 uptake 29 range 22-35%
Total T4 5.6 range 4.5-12 mcg/dL
Free T4 Index (t7) 1.6 range 1.4-3.8
IGF I, LC/MS 207 range 53-331 ng/mL
Total Cortisol 6.5 (no range noted on Quest paperwork) [Once had a 3.5 AM cortisol serum when range should have been 8-12 at that early time of day; dismissed by previous private practice endo as a fluke]
LDL Cholesterol in range at 118 (under 130 recommended)
Hemoglobin A1c 5.6
THYROID PEROXIDASE AND THYROGLOBULIN ANTIBODIES
THYROGLOBULIN ANTIBODIES <1 range: < or = 1 IU/mL
THYROID PEROXIDASE ANTIBODIES <1 range: <9 IU/mL
***Internist also ordered a thyroid ultrasound. Found a 4 mm nodule without calcification on right plus enlarged 27 mm lymph node on left side.***
Thank you again, Barb, for your comments. I am going to look more carefully into the pituitary issues as suggested.
Low carb is tough for me, I don't eat much meat at all. My nutritionist never said anything about my A1c at all so this was sort of a shock. If it means anything, my A1c has been steady at 5.5% for two years now? I am going to have to take a careful look at my health all around, it seems.
Thank you both for your comments and insight. I truly appreciate your help.
Low carb is tough for me, I don't eat much meat at all. My nutritionist never said anything about my A1c at all so this was sort of a shock. If it means anything, my A1c has been steady at 5.5% for two years now? I am going to have to take a careful look at my health all around, it seems.
Thank you both for your comments and insight. I truly appreciate your help.
COMMUNITY LEADER
Note that Sally said "if" you're on a 2000 calorie/day plan... most of us can't eat that many calories and lose weight. My total daily calorie limit, for instance, is only 1200 calories, based on my age, height and weight, so portions must be cut accordingly.
Hi,
aside from getting your thyroid properly treated (low thyroid definitely affect blood sugar), would recommend that you look at low carb, moderate protein, and high healthy fats diet. Completely opposite to what we've typically been told is healthy. This type of diet is gaining recognition as first line treatment for insulin resistance. Should also help with your energy levels.
If you are eating 2000 calories a day your diet plan would be something like:-
100 g carbs / day (you could go as low as 50g) - 100 x 4 = 400 calories from carbs (mostly non-starchy veges)
80 g protein/day (est. 1 g/kg body fat) - 80 x 4 = 320 calories from protein
140 g fat/day (fat is unlimited and should be to appetite / to meet calorie requirements) = 140 x 9 = 1260 calories from fat (unprocessed, naturally occurring - avocado, fatty meats, olive oil, nuts, full fat dairy, cream, butter, cheese, coconut oil, etc).
aside from getting your thyroid properly treated (low thyroid definitely affect blood sugar), would recommend that you look at low carb, moderate protein, and high healthy fats diet. Completely opposite to what we've typically been told is healthy. This type of diet is gaining recognition as first line treatment for insulin resistance. Should also help with your energy levels.
If you are eating 2000 calories a day your diet plan would be something like:-
100 g carbs / day (you could go as low as 50g) - 100 x 4 = 400 calories from carbs (mostly non-starchy veges)
80 g protein/day (est. 1 g/kg body fat) - 80 x 4 = 320 calories from protein
140 g fat/day (fat is unlimited and should be to appetite / to meet calorie requirements) = 140 x 9 = 1260 calories from fat (unprocessed, naturally occurring - avocado, fatty meats, olive oil, nuts, full fat dairy, cream, butter, cheese, coconut oil, etc).
COMMUNITY LEADER
It looks like you need to find a different endocrinologist - one who would be willing to look into a pituitary/hypothalamus issue. If the pituitary gland isn't telling the thyroid to produce hormones, it won't... it's that simple and yours doesn't seem to be producing hormones.
A pituitary issue can affect one or all of the endocrine glands and it appears that your thyroid may be the only one affected, unless the higher A1c is an indication that the pancreas is beginning to be affected, as well.
Your doctor telling you that optimal levels are simply an internet fad is bordering on malpractice and probably keeps all of his hypo patients ill by keeping their levels just within the ranges. The "medical evidence" is that the majority of patients feel best with FT4 at/near mid range and with FT3 in the upper half to upper third of its range and there are studies that back this up. I had a doctor who thought it was okay to have FT4 just "in range" and I felt like cr@p.
I'm not sure what to say about your diet... you're bordering on the pre-diabetes level and in order to prevent full blown type II diabetes, sugar is basically a no-no. That includes limiting fruit to no more than one serving/day. Bread, pasta, rice, etc should all be the whole grain varieties, not white. Of course, if you have a dietician, you should already have been told that.
One thing a lot of do to excess (did it myself) is cut out too much fat... our bodies do need some fat and unlike sugar and other simple carbs, fat doesn't spike blood sugar, but it does satisfy hunger. Of course, fat has more calories so it has to be eaten in moderation. I've lost weight, since I added fat back into my diet.
A pituitary issue can affect one or all of the endocrine glands and it appears that your thyroid may be the only one affected, unless the higher A1c is an indication that the pancreas is beginning to be affected, as well.
Your doctor telling you that optimal levels are simply an internet fad is bordering on malpractice and probably keeps all of his hypo patients ill by keeping their levels just within the ranges. The "medical evidence" is that the majority of patients feel best with FT4 at/near mid range and with FT3 in the upper half to upper third of its range and there are studies that back this up. I had a doctor who thought it was okay to have FT4 just "in range" and I felt like cr@p.
I'm not sure what to say about your diet... you're bordering on the pre-diabetes level and in order to prevent full blown type II diabetes, sugar is basically a no-no. That includes limiting fruit to no more than one serving/day. Bread, pasta, rice, etc should all be the whole grain varieties, not white. Of course, if you have a dietician, you should already have been told that.
One thing a lot of do to excess (did it myself) is cut out too much fat... our bodies do need some fat and unlike sugar and other simple carbs, fat doesn't spike blood sugar, but it does satisfy hunger. Of course, fat has more calories so it has to be eaten in moderation. I've lost weight, since I added fat back into my diet.
Hi Barb, symptoms are: extreme fatigue, "treatment resistant" depression/anxiety, unable to lose weight, random weight gain, despite healthful eating; bloated/puffiness; constipation; dry brittle hair, skin, nails; menstrual changes; body temp average 97 degrees; exercise intolerance; consistently COLD, etc...you name it for hypo and I've got it, except fertility issues (I've only had one child 4 years ago so I'm not sure if this is a problem or not, as I'm not trying to conceive)....
In 11.14 my A1c was 5.5. No one has ever said anything to me about A1c until the endo I consulted about the nodule in my thyroid just last month - she spoke to me like my weight was just a symptom of motherhood - and like I wasn't eating healthfully enough for her liking. My nutritionist has been very happy with my selections so I'm not really sure what to make of it. Yes I do consume sugar (I'm not paleo) but I don't drink soda, premade coffee drinks, I use Stevia in my coffee so I'm not adding real sugar to anything that I eat or drink. I rarely have candy. I've cut out pasta, bread, stuff like that, for the most part, particularly over the last year. I walk about 20 minutes daily, about a mile, and I have a preschooler so I'm hopping. I had gastric lapband surgery in December 2013 to try and help with the weight after I was told repeatedly that there was no endocrine issue. I can barely eat now but I've lost practically nothing. My metabolism just isn't right for whatever reason and I thought maybe this was the missing piece for me.
Any doctor I've seen that takes insurance tell me that optimal levels are just an internet fad without medical evidence. I have seen others labs that have similar FT levels and are being treated with success. I can't shake the feeling that there is something here.
Sorry for ranting, just confused and need help.
In 11.14 my A1c was 5.5. No one has ever said anything to me about A1c until the endo I consulted about the nodule in my thyroid just last month - she spoke to me like my weight was just a symptom of motherhood - and like I wasn't eating healthfully enough for her liking. My nutritionist has been very happy with my selections so I'm not really sure what to make of it. Yes I do consume sugar (I'm not paleo) but I don't drink soda, premade coffee drinks, I use Stevia in my coffee so I'm not adding real sugar to anything that I eat or drink. I rarely have candy. I've cut out pasta, bread, stuff like that, for the most part, particularly over the last year. I walk about 20 minutes daily, about a mile, and I have a preschooler so I'm hopping. I had gastric lapband surgery in December 2013 to try and help with the weight after I was told repeatedly that there was no endocrine issue. I can barely eat now but I've lost practically nothing. My metabolism just isn't right for whatever reason and I thought maybe this was the missing piece for me.
Any doctor I've seen that takes insurance tell me that optimal levels are just an internet fad without medical evidence. I have seen others labs that have similar FT levels and are being treated with success. I can't shake the feeling that there is something here.
Sorry for ranting, just confused and need help.
COMMUNITY LEADER
What are your exact symptoms?
Both your FT3 and FT4 are very low in the ranges, at 32% and 9% respectively, which are both far below the recommended levels, though your TSH is well within range. In view of that, I might suggest central/secondary hypothyroidism.
Your A1c is on the upper end of the scale and I'd say you're close to insulin resistance.
Unfortunately, Total T3, Total T4 and T3 Uptake are obsolete and don't tell us a lot, though yours are all relatively low in the ranges. A single cortisol doesn't really tell anything either - you need a 24 hr saliva test to really tell what's going on.
Your symptoms are the most important thing, at this point.
Both your FT3 and FT4 are very low in the ranges, at 32% and 9% respectively, which are both far below the recommended levels, though your TSH is well within range. In view of that, I might suggest central/secondary hypothyroidism.
Your A1c is on the upper end of the scale and I'd say you're close to insulin resistance.
Unfortunately, Total T3, Total T4 and T3 Uptake are obsolete and don't tell us a lot, though yours are all relatively low in the ranges. A single cortisol doesn't really tell anything either - you need a 24 hr saliva test to really tell what's going on.
Your symptoms are the most important thing, at this point.
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
